Faced with an acute crunch of resources for investment in HIV/AIDS prevention, a latest U.N. report has said this was a matter of worry as “if the world did not invest now, we will have to pay several times more in the future.”

According to a new report, AIDS at 30: Nations at the crossroads, released by the Joint United Nations Programme on HIV/AIDS (UNAIDS) investments in the HIV response in low- and middle-income countries rose nearly 10-fold between 2001 and 2009, from US$ 1.6 billion to US$ 15.9 billion. However, in 2010, international resources for HIV declined. Many low-income countries remain heavily dependent on external financing. In 56 countries, international donors account for at least 70 per cent of HIV resources.

A 2011 investment framework proposed by UNAIDS and partners found that an investment of at least US$ 22 billion is needed by the year 2015, US$ 6 billion more than is available today. When these investments are directed towards a set of priority programmes that are based on a country’s epidemic type, the impact is greatest. It is estimated that the return on such an investment would be 12 million new HIV infections averted and 7.4 million AIDS related deaths averted by the year 2020. The number of new infections would decline from about 2.5 million in 2009 to about 1 million in 2015.

On the positive side, about 6.6 million people are receiving antiretroviral therapy in low- and middle-income countries at the end of 2010, a nearly 22-fold increase since 2001. A record 1.4 million people started lifesaving treatment in 2010—more than any year before. According to the report, at least 420 000 children were receiving antiretroviral therapy at the end of 2010, a more than 50 per cent increase since 2008, when 275 000 children were on treatment.

In recent years, there has been significant progress in preventing new HIV infections among children as increasing numbers of pregnant women living with HIV have gained access to antiretroviral prophylaxis during pregnancy, delivery and breastfeeding. The number of children newly infected with HIV in 2009 was 26 per cent lower than in 2001, the report said.

Despite expanded access to antiretroviral therapy, a major treatment gap remains. At the end of 2010, 9 million people who were eligible for treatment did not have access. Treatment access for children is lower than for adults—only 28 per cent of eligible children were receiving antiretroviral therapy in 2009, compared to 36 per cent coverage for people of all ages.

While the rate of new HIV infections has declined globally, the total number of HIV infections remains high, at about 7000 per day. The global reduction in the rate of new HIV infections hides regional variations.

The global rate of new HIV infections declined by nearly 25 per cent between 2001 and 2009. In India, the rate of new HIV infections fell by more than 50 per cent and in South Africa by more than 35 per cent; both countries have the largest number of people living with HIV on their continents.