THE TIPPING POINT

Understanding a crucial milestone in the AIDS response

One way to measure progress in fighting AIDS is to compare the number of new HIV infections with the increase in HIV positive people on antiretroviral therapy (ART) over a given time period. An AIDS epidemic reaches its tipping point when the number of annual new HIV infections falls below the annual increase in patients starting ART. Coverage matters. A first milestone is treating approximately two thirds of the people in need in a given country. Once that level is reached, countries and advocates can track progress to the tipping point. However, a country can reach the tipping point and then cross backreturning to a situation where incidence outstrips rate

of ART initiation. Thats why it is essential to achieve optimal coverage rates of high-impact prevention including voluntary medical male circumcision, male and female condoms and harm reduction. Newer strategies such as PrEP and, eventually, a microbicide or vaccine should also be used for maximum impact. The pace at which treatment and prevention are scaled up is key. To reach the tipping point the rate at which people are started on treatment should accelerate immediately. To stay on course countries and donors need to increase financial and human resource commitments to strategic combination prevention.

Botswana
Increase in people on ART New HIV infections

New Infections in Botswana in 2012

12,000 95%
Estimated ART Coverage in 2012
1

Tipping Point Ratio

25,614
Increase in Patients on Treatment in Botswana in 2012 New Infections in Kenya in 2012

0.47

Rate of ART treatment scale-up outpaces HIV incidence.

4

TIPPING POINT

When rate of scale-up = incidence, tipping point ratio = 1. Countries that have reached tipping point have values < 1; Countries that have not have values > 1.

Kenya

Global and regional figures Countries that have not reached the tipping point
2

98,000 81%
Estimated ART Coverage in 2012
Rwanda
1

Tipping Point Ratio

1.5
1

Countries that have reached the tipping point

65,044
Increase in Patients on Treatment in Kenya in 2012

1.5

0.47
0

Mozambique

Cameroon

India

Cote d'Ivoire

Global

Zimbabwe

Ethiopia

South Africa

Swaziland

Tanzania

Burundi

Nigeria

Uganda

Lesotho

Zambia

sub-Saharan Africa

Namibia

Malawi

Ghana

DRC

Haiti

Botswana

Kenya

Global progress in reducing new HIV infections and scaling up antiretroviral treatment by 2012

1 Based on WHO 2010 Guidelines; WHO issued updated guidelines in June 2013, Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a public health approach. www.who.int/hiv/pub/guidelines/arv2013/download/en/index.html 2 UPEPFAR. PEPFAR Blueprint: Creating an AIDS-free generation. November 2012. www.pepfar.gov/documents/organization/201386.pdf 3 UNAIDS. UNAIDS report on the global AIDS epidemic 2013. www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf 4 UNAIDS. UNAIDS report on the global AIDS epidemic 2012. www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/ gr2012/20121120_UNAIDS_Global_Report_2012_with_annexes_en.pdf