While the HIV/AIDS epidemic no longer looks as menacing as it did in the 1980s and '90s, efforts to stop the spread of the disease have hit a brick wall.
The number of people getting infected with HIV each year peaked in 1997 at about 3.5 million. Prevention efforts — including HIV education campaigns, testing programs and the distribution of billions of condoms -- have slashed that figure dramatically. But progress stalled around 2010. Since then the world has tallied about 2 million new cases a year with no end in sight.
"Two million new infections a year for a disease that is preventable and primarily infecting people at young ages is a lot," says Jennifer Kates, director of HIV policy at the Kaiser Family Foundation.
She says the HIV/AIDS epidemic remains one of the biggest health crises in the world: "It's still quite challenging and still alarming."
Yet a new report from her foundation and UNAIDS shows that global funding to combat HIV declined in 2015 to $7.5 billion from $8.6 billion in 2014.
"I think we are at an odd point," Kates adds. "HIV is still a part of the global dialogue but not at the same intensity that it used to be. And that's a challenge because this epidemic isn't over."
Last year roughly 36 million people around the world were living with HIV, according to UNAIDS. About half of them are on drugs they'll have to take for the rest of their lives.
HIV remains the leading killer of women of reproductive age, according to the World Health Organization, claiming more lives than cancer, childbirth, violence as well as any other infectious disease.
And the future looks grim. On Thursday UNICEF has came out with a report projecting that HIV infections among adolescents — currently 250,000 a year — could rise dramatically over the next 15 years if more isn't done to address sexual transmission among teens. UNICEF executive director Anthony Lake in a statement addressed the current stagnation around HIV/AIDS, saying, "We need to recapture the urgency this issue deserves."
But that may be difficult.
The U.S. government is the largest funder of HIV/AIDS programs around the world both through PEPFAR (the President's Emergency Plan For AIDS Relief) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. That funding fell last year and could be cut further under a new presidential administration. The HIV epidemic is now also competing with lots of other global crises — wars, refugee flows, new emerging diseases such as Zika and Ebola — for the world's attention.
Africa — where the vast majority of people with HIV live, roughly 25 million — has limited health resources to begin with.
And it could be argued that HIV/AIDS prevention measures have gotten through to many of the people who are most receptive to those messages.
"The epidemic is increasingly concentrated among folks who are extremely hard to reach," says Julie Pulerwitz, who directs social and operational research for HIV and AIDS at the Population Council in Washington, D.C. The Population Council helps develop and test HIV programs.
Since the beginning of this epidemic there's been incredible progress in getting people on treatment and keeping others from getting infected, she says. But the fact that 2 million more people acquired HIV last year shows that prevention efforts have "really not been successful among the most vulnerable" — the poor and the marginalized of the world.
She says particular emphasis needs to be placed on stopping HIV among young women in southern and east Africa: "This part of Africa has the largest epidemic [globally] in terms of numbers and as many as 7,000 new infections among young women a week."
Despite how stubborn this epidemic has proven to be, the U.N. has set a goal of ending AIDS by 2030. Short of a cure (which is nowhere in sight), the goal is to drive HIV and AIDS down to such a low level that they're no longer a major health problem.
Jennifer Kates at Kaiser calls that an "ambitious" goal. Reaching it, she says, "is going to be a stretch."
AUDIE CORNISH, HOST:
Today is December 1, World AIDS Day. The event was first held 28 years ago to raise awareness for HIV and AIDS at a time when a diagnosis was considered a death sentence. A lot has changed since 1988. Now HIV/AIDS is considered manageable, but it remains a major health problem around the world. NPR's global health correspondent Jason Beaubien joins me to talk more about it. Hi there, Jason.
JASON BEAUBIEN, BYLINE: Hello.
CORNISH: So if we look at HIV now compared to that first World AIDS Day, there's been incredible progress. Describe the state of things.
BEAUBIEN: It really is this interesting moment. On the one hand, you do have this incredible progress. Many people are able to survive now. You've pretty much wiped out transmission from mothers to child of the virus inside the womb. And that's not just in Europe but also in, you know, many parts of Africa.
The problem is, you continue to have about 2 million new infections every year. It sort of peaked in about 1997. You had about three and a half million new infections. It's gotten down to 2 million. But then it's just sort of hit this floor, and it just hasn't gotten below that. And most of those infections are happening in impoverished parts of Africa, so it continues to be a big problem.
CORNISH: So given that, is it possible to meet the U.N. goal, right? The United Nations has said it wants to see the end of AIDS by 2030.
BEAUBIEN: I mean you're not going to get this genie back in the bottle, basically. It is something that people believe they can get the numbers of cases significantly lower, but people worry now that there's a lack of urgency to actually do that. You've got other diseases that are competing for attention. You've got other global health problems. You've got wars and refugees.
And there's a lot of concern that without some renewed urgency, that this threat is just going to continue. You're going to have this health problem that's just going to kind of go on for decades and decades to come.
CORNISH: All right, so there's the lack of urgency. What are the other I guess big barriers out there to wiping out HIV?
BEAUBIEN: So the big barrier is just stopping transmission. You know, this 2 million infections every year is a huge problem. And most of that is sexual spread. Also, injection drug use continues to be the other big source of transmission. There's work on vaccines. There is no cure really on the horizon.
But ultimately, this does come down to changing people's behavior - giving them condoms, the tools, the social skills they need to keep from getting infected. And that has turned out to be a huge cultural and logistical challenge.
CORNISH: You know, to bring this home a bit, the U.S. has played a big role in combating HIV/AIDS around the world. What do we know about this next administration? Under Donald Trump, what happens to those efforts?
BEAUBIEN: We really don't know, and that is the big question that's hanging out there right now amongst people who are in the HIV/AIDS world. The U.S. has been the largest funder to global efforts to fight AIDS and HIV around the world - billions of dollars to the Global Fund to Fight AIDS, TB and Malaria and then PEPFAR, the President's Emergency Plan for AIDS Relief that George W. Bush put together in 2003. Those two together have really been credited with turning this epidemic around, particularly in Africa. I talked yesterday with the head of PEPFAR, Deborah Birx.
DEBORAH BIRX: Frankly, now this administration, the new administration, will be the administration that if we're able to continue on and focus and do what we need to do, this will be the president that will have the ability to say, we controlled the epidemic in these 10 or 15 countries that were the highest burden.
BEAUBIEN: And those are countries in Africa that have had incredibly high rates of HIV - you know, above 20 percent of the population infected. And she says she believes that this is going to be the type of program that the Trump administration will want to continue to fund.
CORNISH: That's NPR's Jason Beaubien. Jason, thank you.
BEAUBIEN: You're welcome. Transcript provided by NPR, Copyright NPR.