【桑葛石原研翻译系列】全球艾滋病毒（HIV）流行病学研究
检测是获得治疗的必要的第一步，全球近80%的艾滋病毒感染者都接受过检测，并了解自己的艾滋病毒状况。据估计，2019年全球有170万人感染了艾滋病毒，自2010年以来，新感染艾滋病毒的人数下降了23%。新感染艾滋病病毒的人数，即“艾滋病发病率”，是指在某一特定时期（如一年）新感染艾滋病病毒的估计人数，这与一年中确诊感染艾滋病病毒的人数不同，有些人可能感染了艾滋病毒，但并不知道它。在这些新感染中：150万是成年人，15万人感染儿童（<15岁）。
然而，预防艾滋病毒传播的进展仍然缓慢，2019年新感染者的估计总数比UNAIDS 2020年的目标高出三倍多。全球约81%的艾滋病毒感染者知道他们在2019年的病毒状况，剩余19%（约710万人）仍需要获得艾滋病毒检测服务。艾滋病毒检测是获得艾滋病毒预防、治疗、护理和支持服务的重要途径。
截至2019年底，全球有2540万艾滋病毒感染者（67%）获得抗逆转录病毒治疗（ART），还有1260万人没有得到治疗。获得艾滋病毒治疗是努力消除艾滋病威胁的关键，患者每天按规定服用ART药物，可以获得病毒载量检测下限的结果，就可以健康的生活。
HIV治疗连续体是指HIV感染者从诊断到接受治疗的一系列步骤，直到其病毒载量被抑制到无法检测的水平。这个连续体的每一步都要对到达这一阶段的人数进行评估。这些阶段是：被诊断为艾滋病毒携带者；与医疗保健系统挂钩；获得ART治疗；坚持治疗方案；最后，HIV在血液中被抑制到无法检测的水平。UNAIDS的90-90-90目标确定的目标是，到2020年，90%的艾滋病毒感染者了解自己的艾滋病毒状况，90%的艾滋病毒感染者将接受ART治疗，90%的接受ART治疗的人病毒受到抑制。UNAIDS跟踪这些目标的进展情况的报告指出，2019年在全球所有艾滋病毒感染者中：81%的人知道自己的HIV状况，67%的人接受了ART治疗，59%的人病毒得到抑制。
母婴传播
2019年，85%感染艾滋病毒的孕妇接受了ART治疗，以防止在怀孕和分娩期间将艾滋病毒传播给其婴儿，并保护她们自己的健康。
与艾滋病相关的死亡
与艾滋病相关的死亡人数自2004年达到峰值以来已经减少了60%。2019年，全球约有69万人死于与艾滋病相关的疾病，而2010年这一数字为110万人。
区域影响
艾滋病毒感染者绝大多数生活在低收入和中等收入国家。2019年，东非和南部非洲有2070万艾滋病毒感染者(54%)，西非和中非有490万(13%)，亚洲和太平洋有580万(15%)，西欧和中欧和北美有220万(6%)。
挑战和进展
尽管人们对艾滋病毒及其预防和治疗的取得了进展，全球卫生界、政府和民间社会组织也作出了多年的重大努力，但仍有很多艾滋病毒感染者或处于艾滋病毒感染风险的人得不到预防、护理和治疗，仍然没有有效的治疗。此外，艾滋病毒的流行不仅影响个人的健康，也影响家庭、社区以及国家的发展和经济增长。许多受艾滋病毒影响最严重的国家还有其他传染病、粮食安全等其他严重问题。
尽管面临这些挑战，但仍有一些成功和令人鼓舞的迹象。特别是在过去十年里，，新感染艾滋病毒的人数有所下降，在资源贫乏国家接受治疗的艾滋病毒感染者人数急剧增加，在防止艾滋病毒母婴传播和使母亲存活方面取得了巨大进展。
不过UNAIDS警告，在减少新的艾滋病毒感染、增加获得治疗的机会和结束与艾滋病有关的死亡方面，取得的进展并不平等。有太多的弱势群体被抛在后面。
事实证明，羞耻感和歧视以及其他社会不平等和排斥是主要障碍。
HIV与COVID-19大流行
联合国UNAIDS指出：为遏制COVID-19而实施的封锁和边境关闭正在影响ART药物的生产和分发，可能导致成本增加和供应问题。最近的模型估计，如果艾滋病治疗中断6个月，可能会导致超过50万人死于艾滋病相关疾病。如果预防艾滋病毒母婴传播的服务同样停止6个月，估计马拉维儿童新感染艾滋病毒的人数将增加162%，乌干达139%，津巴布韦106%，莫桑比克83%。
应对艾滋病毒的全球经验有助于为有效、高效、以人为本和可持续地应对COVID-19提供信息和指导。
美国总统艾滋病紧急救援计划（PEPFAR）是美国政府对全球艾滋病疫情的应对措施，加强了全球预防、检测和应对新风险和现有风险的能力。在2019财年，PEPFAR为7960万人提供了艾滋病毒检测服务，截至2019年9月30日，PEPFAR还为近1570万男性、女性和儿童提供了ART支持。
此外，国家卫生研究院（NIH）是世界上对艾滋病毒/艾滋病研究的最大公共投资。NIH在全球范围内从事研究，以了解、诊断、治疗和预防HIV感染及其许多相关疾病，并寻找治愈方法。
【原文】
The Global HIV/AIDS Epidemic
HIV, the virus that causes AIDS, is one of the world’s most serious public health challenges. But there is a global commitment to stopping new HIV infections and ensuring that everyone with HIV has access to HIV treatment.
According to UNAIDS :
Number of People with HIV—There were approximately 38 million people across the globe with HIV/AIDS in 2019. Of these, 36.2 million were adults and 1.8 million were children (<15 years old).
Almost 80% of people with HIV worldwide have been tested and know their HIV status. Testing is the essential first step to accessing treatment.
New HIV Infections—An estimated 1.7 million individuals worldwide acquired HIV in 2019, marking a 23% decline in new HIV infections since 2010. (New HIV infections, or “HIV incidence,” refers to the estimated number of people who newly acquired the HIV virus during given period such as a year, which is different from the number of people diagnosed with HIV during a year. (Some people may have HIV but not know it.) Of these new infections:
1.5 million were among adults
150,000 infections were among children (<15 years old)
However, progress on the prevention of HIV transmission remains far too slow, with the estimated total number of new infections in 2019 more than three times higher than UNAIDS’s 2020 target.
HIV Testing—Approximately 81% of people with HIV globally knew their HIV status in 2019. The remaining 19% (about 7.1 million people) still need access to HIV testing services. HIV testing is an essential gateway to HIV prevention, treatment, care and support services.
HIV Treatment Access—As of the end of 2019, 25.4 million people with HIV (67%) were accessing antiretroviral therapy (ART) globally. That means 12.6 million people are still waiting. HIV treatment access is key to the global effort to end AIDS as a public health threat. People with HIV who are aware of their status, take ART daily as prescribed, and get and keep an undetectable viral load can live long, healthy lives and have effectively no risk of sexually transmitting HIV to their HIV-negative partners.
HIV Care Continuum—The term HIV care continuum refers to the sequence of steps a person with HIV takes from diagnosis through receiving treatment until his or her viral load is suppressed to undetectable levels. Each step in the continuum is marked by an assessment of the number of people who have reached that stage. The stages are: being diagnosed with HIV; being linked to medical care; starting ART; adhering to the treatment regimen; and, finally, having HIV suppressed to undetectable levels in the blood. UNAIDS’s 90-90-90 goals set as targets that by 2020, 90% of all people with HIV will know their HIV status, 90% of all people who know their status will be on ART, and 90% of all people receiving ART will have viral suppression. Tracking progress toward those goals, UNAIDS reports that in 2019, of all people with HIV worldwide:
81% knew their HIV status
67% were accessing ART
59% were virally suppressed
Mother-to-Child Transmission—In 2019, 85% of pregnant women with HIV received ART to prevent transmitting HIV to their babies during pregnancy and childbirth and to protect their own health.
AIDS-related Deaths—AIDS-related deaths have been reduced by 60% since the peak in 2004. In 2019, around 690,000 people died from AIDS-related illnesses worldwide, compared to 1.1 million in 2010.
Regional Impact—The vast majority of people with HIV are in low- and middle-income countries. In 2019, there were 20.7 million people with HIV (54%) in eastern and southern Africa, 4.9 million (13%) in western and central Africa, 5.8 million (15%) in Asia and the Pacific, and 2.2 million (6%) in Western and Central Europe and North America.
Challenges and Progress
Despite advances in our scientific understanding of HIV and its prevention and treatment as well as years of significant effort by the global health community and leading government and civil society organizations, too many people with HIV or at risk for HIV still do not have access to prevention, care, and treatment, and there is still no cure. Further, the HIV epidemic not only affects the health of individuals, it also impacts households, communities, and the development and economic growth of nations. Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity, and other serious problems.
Despite these challenges, there have been successes and promising signs. New global efforts have been mounted to address the epidemic, particularly in the last decade. The number of people with new HIV infections has declined over the years. In addition, the number of people with HIV receiving treatment in resource-poor countries has dramatically increased in the past decade and dramatic progress has been made in preventing mother-to-child transmission of HIV and keeping mothers alive.
However, despite the availability of a widening array of effective HIV prevention tools and methods and a massive scale-up of HIV treatment in recent years, UNAIDS cautions there has been unequal progress in reducing new HIV infections, increasing access to treatment, and ending AIDS-related deaths, with too many vulnerable people and populations left behind. Stigma and discrimination, together with other social inequalities and exclusion, are proving to be key barriers.
HIV and the COVID-19 Pandemic
According to UNAIDS:
The lockdowns and border closures imposed to stop COVID-19 are impacting both the production of antiretroviral medicines and their distribution, potentially leading to increases in their cost and to supply issues.
Recent modelling has estimated that a six-month complete disruption in HIV treatment could lead to more than 500,000 additional deaths from AIDS-related illnesses.
If services to prevent mother-to-child transmission of HIV were similarly halted for six months, the estimated increases in new child HIV infections would be 162% in Malawi, 139% in Uganda, 106% in Zimbabwe and 83% in Mozambique.
The global experience of tackling HIV can help inform and guide effective, efficient, people-centered and sustainable COVID-19 responses.
The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is the U.S. Government’s response to the global HIV/AIDS epidemic and represents the largest commitment by any nation to address a single disease in history. Through PEPFAR, the U.S. has supported a world safer and more secure from infectious disease threats. It has demonstrably strengthened the global capacity to prevent, detect, and respond to new and existing risks—which ultimately enhances global health security and protects America’s borders. Among other global results, PEPFAR provided HIV testing services for 79.6 million people in Fiscal Year 2019 and, as of September 30, 2019, supported lifesaving ART for nearly 15.7 million men, women, and children.
In addition, the National Institutes of Health (NIH) represents the largest public investment in HIV/AIDS research in the world. NIH is engaged in research around the globe to understand, diagnose, treat, and prevent HIV infection and its many associated conditions, and to find a cure.