One million sexually transmitted infections happening every day, WHO reports

The World Health Organization (WHO) has released its first progress report on the global health sector strategies designed to end AIDS, sexually transmitted infections (STIs) and hepatitis B and C by 2030 – and it makes for concerning reading.

What is the report about?

In 2022, the WHO released global health sector strategies on HIV, viral hepatitis and STIs which run from 2022 to 2030. This is the first report to assess the progress that has been made and the challenges that remain.

Why is this important?

The Sustainable Development Goals, which countries across the world have agreed to, commit to ending AIDS, STIs and viral hepatitis B and C as public health threats by 2030. The WHO’s health sector strategies outline how to reach these goals. Although a lot of progress has been made, these goals are off track. Understanding why will help countries focus attention on where it is needed most.

What does the report say?

For all three health issues, new infections and deaths are not declining fast enough.

Every day, four curable STIs cause over 1 million new infections. These STIs are syphilis, gonorrhoea, chlamydia and trichomoniasis. In many regions, STIs are rapidly increasing, particularly syphilis. Gonorrhoea that is resistant to antibiotics is also increasing.

Each year, there are around 3.5 million HIV, hepatitis B and hepatitis C infections.

HIV infections fell from 1.5 million in 2020 to 1.3 million in 2022. But this decline is slower than it should be. Gay and bisexual men and other men who have sex with men, sex workers, people who use drugs, transgender people and people in prisons continue to face increased risk of infection compared to other people. And although more people with HIV are getting diagnosed, testing volumes are still low. Testing rates remain lower among men than women.

HIV, viral hepatitis and STIs cause around 2.5 million deaths and 1.2 million cases of cancer each year.

More people died from hepatitis-related causes in 2022 than in 2019 (1.3 million deaths in 2022 compared to 1.1 million in 2019). This is despite the availability of effective tools for prevention, diagnosis and treatment.

The report contains encouraging findings which show that treatment access has increased for all three conditions.

For example, globally more than 75% of people with HIV are receiving antiretroviral treatment, and 93% of those on treatment have suppressed viral loads.

Expanding access to hepatitis C treatment means deaths have fallen from 290,000 in 2019 to 240,000 in 2022. In 2023, Egypt became the first country to achieve gold tier status on the path to elimination for hepatitis C. This shows that such achievements are possible in low- and middle-income countries.

Nineteen countries have eliminated parent-to-child transmission of HIV and/or syphilis. And more pregnant women and at risk populations are getting access to rapid dual HIV/syphilis tests.

But despite this progress, many areas remain off-track.

Despite the widespread availability of ART, 630,000 people died due to AIDS in 2022. Many of these deaths were because people did not access HIV care until it was too late.

The number of girls fully vaccinated against human papillomavirus (HPV) by the age 15 increased from 14% in 2020 to 17% in 2022. But it is still far below the 2025 target of 50%.

Most new hepatitis B infections happen in Africa. But only 18% of infants receive hepatitis B vaccinations at birth, compared to 45% globally. Between 2015 and 2022, only 36% of people living with hepatitis C had been diagnosed, and only 20% had received treatment.

What does this mean for HIV services?

For all three health issues, stronger efforts are needed to reach the people with the highest risk of infection and the poorest access to prevention and treatment. This means prioritising adolescent girls and young women, gay and bisexual men and other men who have sex with men, sex workers, people who use drugs, transgender people, and people in prisons.

While responses to HIV, viral hepatitis and STIs face different financing and resource challenges, there are clear links between each health issue. The WHO’s strategies show how integrating services will improve testing and treatment for each condition.

While many countries are doing this, more can be done to secure political will and commitment to strengthen the links between the three conditions.

The report outlines the following actions as being “essential” for an effective and sustainable co-ordinated response:

• strengthened planning
• implementation and financing dialogues for HIV, viral hepatitis and STIs as part of universal health coverage
• better use of available data for decision-making
• intensified efforts to address ongoing stigma and discrimination in healthcare settings.

If you are working on HIV and/or STIs, these are all things to advocate for and to contribute towards.

Groups most affected by the three health issues should be meaningfully involved in all coordination efforts.