A new report highlights the significant rise in sexually transmitted infections, amid ongoing challenges in HIV and hepatitis.

The global epidemics of HIV, viral hepatitis, and sexually transmitted infections (STIs) continue to present significant public health challenges, resulting in 2.5 million deaths annually, according to a new WHO report titled "Implementing the Global Health Sector Strategies on HIV, Viral Hepatitis and Sexually Transmitted Infections, 2022–2030."

New data reveals that STIs are on the rise in numerous regions. In 2022, WHO Member States set an ambitious goal to reduce the annual number of adult syphilis infections tenfold by 2030, from 7.1 million to 0.71 million. However, new syphilis cases among adults aged 15-49 increased by over 1 million in 2022, reaching 8 million. The most significant increases were observed in the Americas and the African Region.

Coupled with the insufficient decline in new HIV and viral hepatitis infections, the report highlights threats to achieving the related Sustainable Development Goals (SDGs) by 2030.

“The rising incidence of syphilis is deeply concerning,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “Fortunately, we have made significant progress in other areas, such as increasing access to critical health commodities, including diagnostics and treatment. We have the tools necessary to end these epidemics as public health threats by 2030, but countries must intensify their efforts to meet the ambitious targets they have set in an increasingly complex world.”

* Emerging Trends in Sexually Transmitted Infections

The global landscape of sexually transmitted infections (STIs) is witnessing a concerning surge, marked by an escalating incidence of four curable STIs: syphilis (Treponema pallidum), gonorrhea (Neisseria gonorrhoeae), chlamydia (Chlamydia trachomatis), and trichomoniasis (Trichomonas vaginalis), collectively responsible for over 1 million infections daily.

Of particular alarm is the pronounced uptick in adult and maternal syphilis, with a staggering 1.1 million cases reported alongside a concerning rise in congenital syphilis, reaching 523 cases per 100,000 live births annually during the COVID-19 pandemic. Tragically, the toll of syphilis-related fatalities in 2022 amounted to 230,000 deaths, underscoring the gravity of the situation.

Moreover, recent data signals a worrisome escalation in multi-resistant gonorrhea, with alarming findings from 87 countries indicating elevated resistance levels, ranging from 5% to a staggering 40% to ceftriaxone, the last resort treatment for gonorrhea. In response, the World Health Organization (WHO) has intensified surveillance efforts and updated treatment protocols to mitigate the proliferation of this formidable strain.

The persistent threat of viral hepatitis remains unabated, as evidenced by the recording of approximately 1.2 million new hepatitis B cases and nearly 1 million new hepatitis C cases in 2022. Despite the availability of effective preventive measures, diagnostics, and treatment modalities, the mortality toll from viral hepatitis has surged from 1.1 million in 2019 to 1.3 million in 2022, accentuating the urgent need for intensified intervention strategies.

While strides have been made in curbing new HIV infections, the decline from 1.5 million in 2020 to 1.3 million in 2022 underscores lingering challenges. Certain key population groups, including men who have sex with men, people who inject drugs, sex workers, transgender individuals, and those incarcerated, continue to grapple with disproportionately high HIV prevalence rates. Alarmingly, an estimated 55% of new HIV infections occur within these demographics and their associates, perpetuating the epidemic's trajectory.

Tragically, HIV-related mortality remains distressingly high, with 630,000 deaths reported in 2022, including a staggering 13% among children under the age of 15 years, underscoring the imperative for intensified efforts to combat this enduring public health crisis.

*Advancements in Access to Healthcare Services

Remarkable strides have been made by countries and collaborative partners in broadening access to services for sexually transmitted infections (STIs), HIV, and hepatitis, yielding formidable gains. The World Health Organization (WHO) has endorsed the efforts of 19 countries for successfully eliminating mother-to-child transmission of HIV and/or syphilis, reflecting substantial investments in testing and treatment coverage for these conditions among expectant mothers. Notably, Botswana and Namibia are forging ahead in the journey towards HIV elimination, with Namibia pioneering the submission of a comprehensive dossier for evaluation, aiming for the triple elimination of mother-to-child transmission of HIV, hepatitis B, and syphilis.

On a global scale, HIV treatment coverage has surged to 76%, with an impressive 93% of individuals receiving treatment achieving suppressed viral loads. Ongoing endeavors include intensifying HPV vaccination initiatives and enhancing screening protocols for women living with HIV. Furthermore, there have been incremental improvements in the diagnosis and treatment coverage for hepatitis B and C globally, underscoring progress in combating these viral infections.

Sustainable Planning Across Disease Areas

The report underscores the imperative for sustainability planning across the three disease areas, outlining key recommendations for countries to strengthen collaborative approaches towards achieving set targets:

Conduct policy and financing dialogues to develop comprehensive investment cases and national sustainability plans.
Enhance the consolidation and alignment of disease-specific guidance, plans, and implementation support within a primary healthcare framework.
Accelerate efforts to address persistent issues of criminalization, stigma, and discrimination within healthcare settings, particularly targeting populations most affected by HIV, viral hepatitis, and STIs.
Expand multi-disease elimination strategies, leveraging insights from successful initiatives such as the triple elimination of mother-to-child transmission.
Strengthen the emphasis on primary prevention, diagnosis, and treatment across the diseases to enhance awareness, particularly focusing on hepatitis and STIs.

While member states have set ambitious targets for 2025 and 2030, progress remains uneven across disease areas, with many indicators still off-track to achieve global targets. Urgent action is required, necessitating heightened political will and commitment to accelerate efforts towards achieving the outlined goals.

Editorial Note

This report, detailing progress in implementing the global health sector strategies on HIV, viral hepatitis, and sexually transmitted infections (STIs) for 2022-2030, will be deliberated at the Seventy-seventh World Health Assembly.

In 2022, the Seventy-fifth World Health Assembly acknowledged with appreciation the global health sector strategies on HIV, viral hepatitis, and sexually transmitted infections (STIs) for the period 2022-2030 These strategies are designed to steer the health sector towards implementing targeted and strategic responses, with the overarching goal of effectively ending the epidemics of AIDS, viral hepatitis B and C, and sexually transmitted infections by the year 2030. aligning with efforts towards realizing the 2030 Agenda for Sustainable Development. The strategies advocate for synergies across disease areas within a universal health coverage framework and advocate for implementation under a primary healthcare approach.