AIDS first emerged in the early 1980s, claiming thousands of lives each year as it spread. But it wasn't until the disease reached pandemic status more than a decade later that the global community really galvanized in an effort to stop it.
In 1996, as HIV prevalence was peaking around the world, the United Nations established UNAIDS, the first global health body focused on a single disease. In 2000, the UN Security Council convened an unprecedented meeting to address the out-of-control AIDS crisis. This led to a massive concentration of resources into HIV/AIDS research, and triggered global and coordinated efforts to stem the disease.
In 2000, global funding for HIV/AIDS barely reached $5 billion. By last year, it had risen to $20 billion. In that time, researchers around the world made breakthrough discoveries about the HIV virus. They figured out how to get people tested and diagnosed quickly, and uncovered effective treatments that allowed those with HIV to live long, relatively healthy lives. Public health officials also waged awareness campaigns about prevention, reminding people to practice safe sex with condoms and get tested, and that early HIV treatment can save lives. Recently, researchers even discovered a pill to prevent HIV.
The results have been astonishing. "We broke the trajectory of the AIDS epidemic," explains Michel Sidibé, executive director of UNAIDS. "Fewer people are dying, there are fewer new infections, and we can even say soon that we will not have babies born to HIV." But Sidibé also cautioned that there remains a lot of work to be done. We've made significant progress against HIV/AIDS — but we're still very far from winning.
1) We've made major progress in stemming HIV/AIDS
Over the past 15 years, the global response to HIV/AIDS has vastly slowed the spread of the disease, averting more than 30 million new HIV infections and nearly 8 million deaths since 2000, according to UNAIDS. New HIV infections are down 35 percent in the past 15 years, and AIDS-related deaths have fallen by more than 40 percent in about the same period.
2) Thanks to new treatments, people can now live with HIV for years — with only a small risk of passing it on
The discovery of antiretroviral treatments in the 1990s turned an HIV diagnosis from a death sentence into a chronic illness:
These medicines have gotten better with time. They used to require patients take cocktails of pills, at multiple times every day. Now they require one pill in the morning, and they come with fewer side effects. An estimated 1.2 million are living with HIV in the US.
Importantly, however, these drugs don't cure patients; they only suppress the HIV virus to the point that it's undetectable in the blood. That means there's still a very small chance that people taking these treatments can pass on the virus to others. And if people stop taking their medicines, their "viral load" rises again. This puts them at risk of developing AIDS or increases the risk of transmitting the virus to others.
3) People on HIV treatment have an almost-normal life expectancy
Because of new treatments, the life expectancy for someone who is diagnosed early and begins treatment with antiretrovirals has risen to 71 years:
These medicines are also being used preventively to stop people who are at risk of HIV from ever getting the virus.
4) Still, only 40 percent of people who need treatment get it
Even though new HIV drugs can be lifesaving and halt the transmission of the virus, there remain big gaps in access to treatment.
This has improved over time: In 2000, fewer than 1 percent of people with HIV in low- and middle-income countries had access to treatment, according to UNAIDS. By last year, about 40 percent of people who needed treatment were receiving antiretroviral therapy.
But there are still major inequalities, as you can see in the chart above. Globally, more than 14 million people are estimated to be in need of antiretrovirals, but fewer than half are on treatment. In the US, there are major racial and socioeconomic disparities in access, with African Americans less likely to get treatment even though they're more likely to be infected with the virus compared to other racial groups.
5) Many HIV cases continue to go undiagnosed
Between 10 and 60 percent of people with early HIV infection have no symptoms, so their disease often remains undiagnosed.
In one recent study by the Centers for Disease Control and Prevention, about 20 percent of the people living with HIV had an undetected infection at the end of 2008. An estimated 30 percent of people with new infections got it from others who didn't know they had HIV.
6) Globally, sub-Saharan Africa is most affected by the disease
A lot of progress has been made in the fight against HIV/AIDS, but there are still nearly 40 million people living with the infection. Seventy percent of new cases are in sub-Saharan Africa, where many people don't have access to the diagnostics and treatments available in high-income countries — helping the disease spread further.
Sidibé said one huge challenge is that in some sub-Saharan African countries, the disease is on the rise among young girls. Seventy-four percent of adolescents in Africa who get HIV are girls.
Worldwide, women represent about half of all adult HIV infections, and HIV is the leading cause of death among women of reproductive age, according to the Kaiser Family Foundation.
7) Stigma remains a big barrier to stopping HIV/AIDS
As you can see in the chart above, there are still many misconceptions about HIV and AIDS, and stigma can be a barrier to getting people diagnosed and treated. Even though we are two decades into the epidemic, the stigma around the virus remains firmly in place.
"HIV is a disease linked to sex," said Sidibé. "It is highly stigmatized and linked to discrimination and exclusion." The more people who have come out to break "the conspiracy of silence," he added, "the more it moves HIV from a tiny virus to a human life, a human face."
8) In the US, the disease has made a comeback among men who have sex with men
Since the discovery of AIDS, gay and bisexual men (referred to as "MSM" in the chart below) have been disproportionately affected by the disease. In the US, the Kaiser Family Foundation points out, "While gay men make up just 2 percent of the U.S. population, they account for two thirds (66 percent) of new HIV infections, a majority (56 percent) of people living with HIV, and more than half (55 percent) of all AIDS deaths since the epidemic's beginning."
This is a problem that's only getting worse in the gay and bisexual community both in the US and globally. "There's a complacency," Sidibé said. "People are comfortable with treatment today. They feel that with treatment, they will not have AIDS, and they are not protecting themselves anymore."
Indeed, young gay and bisexual men today weren't around for the height of the AIDS epidemic and haven't lived through the dangers of the disease. So, as Vox's German Lopez explains here, they are more likely to engage in sexual practices that put them at risk.
9) HIV remains stubbornly persistent among African Americans
African Americans are more likely to be infected with the virus compared with other racial groups. According to the CDC, though HIV incidence is on the decline among heterosexuals, black men and women bear most of the burden of the disease.