Fewer people worldwide are getting infected with HIV than 10 years ago, and those who have already contracted the virus are living longer, according to a new report from the Joint United Nations Programme on HIV/AIDS (UNAIDS). The report attributes this encouraging news to prevention efforts that are producing “clear and impressive results” and to greatly expanded access to HIV treatment. However, UNAIDS also cautions that not all countries saw declines in HIV infections, and that new infections still outpace new patients receiving treatment by a two-to-one margin.

For advocates and policymakers, these welcome successes also create greater urgency to tackle a range of related issues, including better meeting the sexual and reproductive health needs of people living with HIV, achieving more integration between HIV and sexual and reproductive health services, and addressing the unique needs of young people living in countries most affected by HIV.

As the number of people with access to treatment has expanded from 700,000 in 2004 to 5.2 million globally in 2009, HIV infection for many of them can now be managed as a chronic disease. The evidence shows that HIV infection need not prevent men and women from safely having sex, bearing children, using most modern contraceptives or having an abortion where services are legally available. Given the rapid growth in the number of people receiving HIV treatment and living longer lives, meeting their sexual and reproductive health needs is essential both to vindicating their human rights and to sustaining global HIV prevention efforts.

Another ongoing challenge is the lack of linkages between programs that provide HIV services and those providing sexual and reproductive health services. U.S.-funded family planning programs in developing countries generally provide HIV counseling and testing services, and refer women who test positive for HIV treatment. But provision of family planning services—including contraceptive counseling, referrals and direct provision of contraceptives in the absence of a referral site—is not widespread in U.S.-funded HIV treatment facilities. This, notwithstanding a high degree of consensus at the global level that better linkages between HIV and reproductive health services are key both in meeting the needs of HIV-positive individuals and in preventing HIV transmission.

Likewise, doing more of what we already know works is crucial in helping young people avoid HIV infection. According to UNAIDS, HIV prevalence has fallen by more than 25% among young people in 15 of the most severely affected countries. The report identifies behavior change as the key factor behind these declines, noting that they are due to “significant positive trends (for either or both sexes) in important behavior indicators, including increased condom use, delayed sexual debut, and reductions in multiple partnerships.” But as previously noted by Guttmacher, policymakers—including those in the United States—need to move more quickly and effectively to meet the urgent needs of young people globally.

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Meeting the sexual and reproductive health needs of people living with HIV

The crucial importance of better integrating HIV and sexual and reproductive health services

The importance of policymakers keeping pace with the needs of young people