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A new report by UNAIDS shows that countries are getting on the Fast-Track, with an additional one million people accessing treatment in just six months (January to June 2016). By June 2016, around 18.2 million people had access to the life-saving medicines, including 910 000 children, double the number five years earlier. If these efforts are sustained and increased, the world will be on track to achieve the target of 30 million people on treatment by 2020.

“”Get on the Fast-Track: the life-cycle approach to HIVâÂÂâ says the report contains detailed data on the complexities of HIV and reveals that girlsâ transition to womanhood is a very dangerous time, particularly in sub-Saharan Africa. âÂÂYoung women are facing a triple threat,â said Mr Michel Sidibé, Executive Director of UNAIDS. âÂÂThey are at high risk of HIV infection, have low rates of HIV testing, and have poor adherence to treatment. The world is failing young women and we urgently need to do more.âÂÂ

HIV prevention is key to ending the AIDS epidemic among young women and the cycle of HIV infection needs to be broken. Recent data from South-Africa shows that young women are acquiring HIV from adult men, while men acquire HIV much later in life after they transition into adulthood and continue the cycle of new infections, the report says.

The report also shows that the life-extending impact of treatment is working. In 2015, there were more people over the age of 50 living with HIV than ever beforeâÂÂ5.8 million. The report highlights that if treatment targets are reached, that number is expected to soar to 8.5 million by 2020. Older people living with HIV, however, have up to five times the risk of chronic disease and a comprehensive strategy is needed to respond to increasing long-term health-care costs.    

The report also warns of the risk of drug resistance and the need to reduce the costs of second- and third-line treatments. It also highlights the need for more synergies with tuberculosis (TB), human papillomavirus (HPV) and cervical cancer, and hepatitis C programmes in order to reduce the major causes of illness and death among people living with HIV. In 2015, 400 000 of the 1.1 million people who died from an AIDS-related illness died from TB, including 40 000 children.

The report outlines that large numbers of people at higher-risk of HIV infection and people living in high-burden areas are being left without access to HIV services at critical points in their lives, opening the door to new HIV infections and increasing the risk of dying from AIDS-related illnesses. The report examines the gaps and approaches needed in HIV programming across the life cycle and offers tailored HIV prevention and treatment solutions for every stage of life.

Globally, access to HIV medicines to prevent mother-to-child transmission of HIV has increased to 77% in 2015 (up from 50% in 2010). As a result, new HIV infections among children have declined by 51% since 2010.

The report stresses that more efforts are needed to expand HIV testing for pregnant women, expand treatment for children and improve and expand early infant diagnosis by using new diagnostic tools and innovative methods, such as SMS reminders, to retain mothers living with HIV and their babies in care.

The report shows that the ages between 15 and 24 years are an incredibly dangerous time for young women. In 2015, around 7500 young women became newly infected with HIV every week. Data from studies in six locations within eastern and southern Africa reveal that in southern Africa girls aged between 15 and 19 years accounted for 90% of all new HIV infections among 10âÂÂ19-year-olds, and more than 74% in eastern Africa. 

Globally, between 2010 and 2015, the number of new HIV infections among young women aged between 15 and 24 years was reduced by just 6%, from 420 000 to 390 000. To reach the target of less than 100 000 new HIV infections among adolescent girls and young women by 2020 will require a 74% reduction in the four years between 2016 and 2020.

Many children who were born with HIV and survived are now entering adulthood. Studies from 25 countries in 2015 show that 40% of young people aged between 15 and 19 years became infected through mother-to-child transmission of HIV. This transition is also magnifying another major challengeâÂÂhigh numbers of AIDS-related deaths among adolescents. Adolescents living with HIV have the highest rates of poor medication adherence and treatment failure.

A range of solutions are needed to respond to the specific needs of adolescents, including increased HIV prevention efforts, keeping girls and boys in school, increasing HIV testing and voluntary medical male circumcision, pre-exposure prophylaxis and immediate access to antiretroviral therapy.   

The report shows that antiretroviral therapy is allowing people living with HIV to live longer. In 2015, people more than 50 years old accounted for around 17% of the adult population (15 years and older) living with HIV. In high-income countries, 31% of people living with HIV were over the age of 50 years.

As people living with HIV grow older, they are also at risk of developing long-term side-effects from HIV treatment, developing drug resistance and requiring treatment of co-morbidities, such as TB and hepatitis C, which can also interact with antiretroviral therapy. Continued research and investment is needed to discover simpler, more tolerable treatments for HIV and co-morbidities and to discover an HIV vaccine and cure, the report says.”