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16 July 2019Lights and shadows on the phenomenon of AIDS in the world. While the UN notes that the number of HIV-related deaths has fallen by 33% compared to 2010, with "only" 770mila deaths in 2018, the same UNAIDS report underlines and denounces that research funding is lacking and that in the world only 3 out of 5 patients have access to antiretroviral therapies.

Strong decline since 2010
HIV-related deaths have dropped to around 770,000 in 2018, 33% less since 2010, but they are still too high a number to reach disease eradication targets. This is revealed by the United Nations Program for AIDS / HIV in its annual report in which the alarm is raised above all due to the lack of research funding. The victims are down compared to 2017 (800 thousand deaths) and are much less than the massacre registered at the peak of the epidemic in 2004 (1.7 million). At the moment, it is estimated that 37.9 million people worldwide live with HIV, with a record 23.3 million people who have access to antiretroviral therapies (equivalent to 3 out of 5). According to the UNAIDS report, according to whose new infections were 1.7 million. The dead are 30 thousand less than in 2017, with the aim of reaching 500 thousand in total by 2020, which remains far away. Even the new cases fall very slowly.

Unaids alarm
"We urgently need to increase political leadership to put an end to the epidemic - points out Gunilla Carlsson, executive director of UNAIDS -. We need to invest adequately and intelligently, looking also to the countries that are achieving the greatest successes in this field. AIDS is possible if we focus on people, not on disease, creating road maps for patients and areas left behind and adopting a human rights-based approach to reach those most affected ".

Focus on forgotten areas
The timely use of effective diagnostic tools and drugs for the treatment of HIV / AIDS could prevent most deaths, but since 2014 the annual number of deaths has only minimally decreased. The alarm comes from Doctors Without Borders, after data from the Global Aids Update 2019 were released, presented in South Africa by UNAIDS, the United Nations Program for HIV / AIDS. Although 2 million more people have started antiretroviral therapy, Msf writes in a note, all the parties involved must do more to deal with the deadly infections that cause AIDS-related deaths, starting from tuberculosis and cryptococcal meningitis .

Rapid diagnosis
"In MSF-supported hospitals in the Democratic Republic of the Congo, Guinea, Malawi and other countries, many deaths occur in the first 48 hours after admission," said Gilles Van Cutsem, medical coordinator of the MSF for HIV / AIDS. "Patients arrive very sick, often with serious opportunistic infections such as tuberculosis, cryptococcal meningitis or Kaposi's sarcoma. When they arrive, sometimes it's too late to save them. This happens because they were not diagnosed in time or because they failed to access a life-saving therapy, "he stressed. The causes of deaths are mainly due to the delay in diagnosis, treatment interruption, virological and immunological failures in patients in therapy. The WHO estimates that more than 30% of people starting treatment for HIV worldwide have an advanced pathology with severe immune impairment, a condition that makes them particularly vulnerable to opportunistic infections and more exposed to the risk of death. One third of deaths linked to AIDS in the world is caused by tuberculosis, while cryptococcal meningitis affects hundreds of thousands of people living with HIV every year and causes 15% to 20% of the total number of deaths related to the virus. Despite being treatable, other serious opportunistic infections also contribute to AIDS-related deaths, such as Pneumocystis pneumonia, bacterial pneumonia, sepsis, and others.

The fight must continue
Nevertheless, the attention paid to the identification and management of people with advanced HIV, as well as access to diagnostic tests and therapy for many opportunistic infections, remains very limited. Often, in countries where MSF works, diagnostic tools such as tests to measure the level of CD4, a type of white blood cells that fight infections and whose count is used to assess the state of the immune system and the therapeutic response between people with HIV are completely missing. The same goes for the TB-Lam and CrAg LFA, all tests that provide quick diagnosis of tuberculosis and cryptococcal meningitis that are often not available in primary care facilities where most people go for treatment. "Many patients go to primary health centers when they feel ill. If these facilities are not equipped and prepared to detect the presence of HIV in an advanced state, patients at risk remain in the dark and do not start treatment. "As a result, they continue to get worse and become terminally ill. Someone is then transferred to hospitals that often lack the basic tools to manage them," said Gilles Van Cutsem.

Reduce deaths by 50% by 2020
In 2016, UN member states agreed on the goal of reducing AIDS deaths by 50% by 2020, bringing them to less than 500,000 a year. Six months after the deadline, we are very far from the set target, recalls Msf: the number of deaths from AIDS in 2018 (770 thousand) was reduced slightly compared to previous years (800 thousand in 2017 and 840 thousand in 2016). The rate of mortality reduction is stagnant, the organization denounces. UN member states have also agreed 90-90-90 treatment goals, meaning that 90% of people with HIV are aware of their state, that 90% of diagnosed people receive antiretroviral treatment and that in 90% of those under treatment the suppression of the viral load is obtained. "Governments, ministries of health, international organizations and donors must increase efforts and focus on reducing mortality among people with HIV, with a special focus on prevention, virus detection and therapy for diseases. advances related to HIV and AIDS, "says MSF.

Access to basic care is required
"We cannot celebrate or talk about success while hundreds of thousands of people continue to die from AIDS every year because they do not have access to basic care or because they live in countries that are little considered, in forgotten communities, where policies ignore their conditions: Preventing, detecting and treating HIV and AIDS requires more attention and more funding, especially in contexts that are generally overlooked such as West and Central Africa and among forgotten populations, "said Silvia Mancini, an MSF epidemiologist.

Sicily, information campaigns
Information is always fundamental, underlined by those responsible for the Palermo Asp camper who have been campaigning in the Palermo nightlife since February 2018. Around 2000 children were intercepted by the camper. Of these, 70% do not use any protection in the case of sexual intercourse, 55% of whom also have promiscuous relationships. Reports that are at risk not only of HIV, but also of other sexually transmitted diseases such as hepatitis a, bo syphilis. Furthermore, on a sample particularly at risk of 90 subjects, thirty were positive on the first examination of syphilis and directed towards the appropriate structures. Still, in Sicily every year about 300 people contract HIV and 50 develop AIDS (3,000 cases in total since the birth of the observatory). With a specific treatment, HIV loses its transmissibility. "For this reason - the heads of the department added - it is essential to know soon your own health condition and in case of risky relationships do all the necessary tests".