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HIV

Strategy Overview

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A doctor tests blood samples at a hospital laboratory in Lusaka, Zambia.

OUR GOAL:

to accelerate the decline in HIV infection worldwide and save lives by ensuring expanded and simplified HIV treatment and improved and effective use of interventions to prevent new infections.

The Challenge
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At A Glance

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Nearly 37 million people around the world are living with HIV, 25 million of them in Sub-Saharan Africa.

Nearly half of all people living with HIV are unaware of their status.

A major challenge in controlling HIV is the large increase in the number of young people in Sub-Saharan Africa who are reaching the age of highest risk for sexually transmitted HIV.

We work to expand access to and improve prevention, diagnosis, and treatment approaches; develop new prevention tools; and advocate for needed resources and policy changes.

Our HIV strategy is led by Emilio Emini, director, and is part of the foundation’s Global Health Division.

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Nearly 37 million people around the globe are living with human immunodeficiency virus (HIV), and nearly as many people have died from HIV-related complications since the earliest cases were detected in the 1980s. Sub-Saharan Africa is the hardest-hit region, with more than 70 percent of the world’s people living with HIV.

While substantial progress has been made in increasing access to HIV treatment and new cases of HIV have declined substantially in some regions, controlling the epidemic will require improved efforts to increase the number of people living with HIV who know their status, as well as the effective use of better treatment and prevention measures.

Sub-Saharan Africa has an estimated 1.2 million new infections per year at a time when young people account for a significant and rapidly growing percentage of the population. As these young people reach the age of highest risk for HIV, a rebound in the epidemic may be inevitable unless efforts to combat the infection are greatly enhanced.

The Opportunity
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In the past decade, the world has made significant progress in the fight against HIV due to large-scale treatment programs and efforts to prevent infection among infants born to mothers with HIV. The global incidence of HIV has declined by nearly 40 percent since 2001, and 17 million people worldwide are receiving antiretroviral treatment.

Countries and global partners can continue to accelerate progress by sustaining their investments to improve the efficiency and effectiveness of HIV prevention and treatment programs and support research into new and better prevention methods.

Our Strategy
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The goal of our program is to accelerate the decline in HIV infection worldwide and save lives by ensuring expanded and simplified HIV treatment and improved and effective use of interventions to prevent new infections.

A medical field worker explaining a clinical trial for microbicides to residents outside Durban, South Africa.

We focus our efforts in some of the hardest-hit countries of Sub-Saharan Africa and among key populations that are at greatest risk of infection. To date, we have committed more than US$3 billion in HIV grants to organizations around the world and more than US$1.6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Because our resources represent only a small portion of worldwide funding to combat HIV, we concentrate on areas where existing funds are insufficient, our support can have potentially catalytic impact, and we can assume risks that others may not be able to.

Areas of Focus
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In each of our areas of focus, we work with an array of partners, including government agencies in high-burden and donor countries, multilateral organizations, nongovernmental organizations, academic institutions, community organizations, and private industry. We also work to ensure that adequate funding and appropriate global and national-level policies are in place to support HIV prevention and treatment efforts, research and development, and efforts to understand the motivations and needs of high-risk populations.

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Improving Diagnosis and Expanding Treatment Coverage

About half of all people living with HIV, particularly men, do not know they have the virus. We support the development and appropriate use of novel tools that can greatly increase the number of people who know their status and who seek treatment.

Improving Treatment Retention

HIV treatment programs are often expensive and inflexible, leading many individuals living with HIV to discontinue the treatment they need. We support partners who are working to simplify the delivery of HIV treatment and introduce models of care that are more tailored to the needs of particular populations and their circumstances. Better patient data systems are also crucial to keeping people living with HIV on effective treatment.

HIV-related information is displayed in a waiting area outside a rural clinic in Kivumu, Rwanda.

Viral load testing—the measuring of HIV particles in the blood—can be crucial to helping people living with HIV understand their health status and be motivated to continue treatment. We support the improved use of viral load testing, as well as the development of novel virus load-testing systems, as a means of sustaining effective treatment.

Expanding the Use of Existing Preventive Measures

Several existing measures have proven effective in preventing HIV infection. They include voluntary medical male circumcision, condoms, and drugs that reduce the risk of acquiring the virus after exposure. These measures can be effective only if they are affordable and reach high-risk populations—and only if those populations are aware of their risk of contracting HIV.

Widespread voluntary medical male circumcision could play a major role in limiting the spread of HIV, and efforts by global partners have greatly improved access to and demand for circumcision. We support circumcision-related efforts in several high-burden countries in Sub-Saharan Africa.

We also support efforts to improve consistent condom use and the use of drugs that reduce the risk of contracting HIV. In addition, understanding and addressing the obstacles to accessing and using these measures among high-risk populations is central to our overall prevention strategy.

Developing Long-Acting Prevention Measures

New, more effective prevention methods are essential to reducing HIV transmission. We support efforts to develop, evaluate, and introduce innovative approaches to protecting those at risk. These include potential long-acting prevention interventions that can provide continuous protection over a period of time.

Developing an HIV Vaccine

We continue to invest in efforts to develop an HIV vaccine. Although developing a highly effective vaccine remains a substantial scientific challenge, even a vaccine with partial efficacy and limited duration could help dramatically reduce the global incidence of HIV.

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