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Why Can't We Bring Down The Number Of New HIV Cases?

While the HIV/AIDS epidemic no longer looks as menacing as it did in the 1980s and '90s, efforts to stop the spread of the disease have hit a brick wall.

The number of people getting infected with HIV each year peaked in 1997 at about 3.5 million. Prevention efforts — including HIV education campaigns, testing programs and the distribution of billions of condoms-- have slashed that figure dramatically. But progress stalled around 2010. Since then the world has tallied about 2 million new cases a year with no end in sight.

"Two million new infections a year for a disease that is preventable and primarily infecting people at young ages is a lot," says Jennifer Kates, director of HIV policy at the Kaiser Family Foundation.

She says the HIV/AIDS epidemic remains one of the biggest health crises in the world: "It's still quite challenging and still alarming."

Yet a new report from her foundation and UNAIDS shows that global funding to combat HIV declined in 2015 to $7.5 billion from $8.6 billion in 2014.

"I think we are at an odd point," Kates adds. "HIV is still a part of the global dialogue but not at the same intensity that it used to be. And that's a challenge because this epidemic isn't over."

Last year roughly 36 million people around the world were living with HIV, according to UNAIDS. About half of them are on drugs they'll have to take for the rest of their lives.

HIV remains the leading killer of women of reproductive age, according to the World Health Organization, claiming more lives than cancer, childbirth, violence as well as any other infectious disease.

And the future looks grim. On Thursday UNICEF has came out with a report projecting that HIV infections among adolescents — currently 250,000 a year — could rise dramatically over the next 15 years if more isn't done to address sexual transmission among teens. UNICEF executive director Anthony Lake in a statement addressed the current stagnation around HIV/AIDS, saying, "We need to recapture the urgency this issue deserves."

But that may be difficult.

The U.S. government is the largest funder of HIV/AIDS programs around the world both through PEPFAR (the President's Emergency Plan For AIDS Relief) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. That funding fell last year and could be cut further under a new presidential administration. The HIV epidemic is now also competing with lots of other global crises — wars, refugee flows, new emerging diseases such as Zika and Ebola — for the world's attention.

Africa — where the vast majority of people with HIV live, roughly 25 million — has limited health resources to begin with.

And it could be argued that HIV/AIDS prevention measures have gotten through to many of the people who are most receptive to those messages.

"The epidemic is increasingly concentrated among folks who are extremely hard to reach," says Julie Pulerwitz, who directs social and operational research for HIV and AIDS at the Population Council in Washington, D.C. The Population Council helps develop and test HIV programs.

Since the beginning of this epidemic there's been incredible progress in getting people on treatment and keeping others from getting infected, she says. But the fact that 2 million more people acquired HIV last year shows that prevention efforts have "really not been successful among the most vulnerable" — the poor and the marginalized of the world.

She says particular emphasis needs to be placed on stopping HIV among young women in southern and east Africa: "This part of Africa has the largest epidemic [globally] in terms of numbers and as many as 7,000 new infections among young women a week."

Despite how stubborn this epidemic has proven to be, the U.N. has set a goal of ending AIDS by 2030. Short of a cure (which is nowhere in sight), the goal is to drive HIV and AIDS down to such a low level that they're no longer a major health problem.

Jennifer Kates at Kaiser calls that an "ambitious" goal. Reaching it, she says, "is going to be a stretch."

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Jason Beaubien is NPR's Global Health and Development Correspondent on the Science Desk.