Universal access to HIV and AIDS services is possible
22 September 2010: Ambassador Eric Goosby, US Global AIDS Coordinator, speaks about a comprehensive, high-impact approach to reducing child and maternal mortality rates and mother-to-child transmission of HIV.
GENEVA/NAIROBI/WASHINGTON D.C., 28 September 2010 - Significant progress has been made in several low- and middle-income countries in increasing access to HIV and AIDS services, according to a new report released today by the World Health Organization (WHO), UNICEF, and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
'Towards Universal Access' is the fourth annual report for tracking progress made in achieving the 2010 target of providing universal access to HIV prevention, treatment and care.
"Countries in all parts of the world are demonstrating that universal access is achievable," said Dr Hiroki Nakatani, WHO's Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases. "But globally, it remains an unfulfilled commitment. And we must join forces to make it a worldwide reality in the coming years."
In 2009, 5.25 million people had access to HIV treatment in low- and middle-income countries, accounting for 36 per cent of those in need. This represents an increase of over 1.2 million people from December 2008, the largest increase in any single year.
In sub-Saharan Africa, close to one million more people started on antiretroviral therapy (ART), the number increasing from 2.95 million at the end of 2008 to 3.91 million at the end of 2009, covering 37 per cent of those in need. Latin America and the Caribbean region reached 50 per cent coverage for ART, East, South and South-East Asia–31 per cent, Europe and Central Asia–19 per cent, and North Africa and the Middle East–11 per cent.
“We’re on the right track, we’ve shown what works and now we need to do more of it,” said Dr Paul De Lay, Deputy Executive Director, Programme, UNAIDS. “But we’re US$ 10 billion short. At the Global Fund replenishment conference in New York next week countries have a chance to put this right––to make a smart investment and secure the future of the AIDS response.”
Challenges to universal access
Obstacles to scaling up HIV treatment persist in most countries. Prevention efforts to reach most-at-risk populations such as sex workers, drug users, and men who have sex with men are limited. For example, only about one third of injecting drug users in reporting countries were reached with HIV prevention programs in 2009.
Results from population surveys in ten countries showed more than 60 per cent of HIV-positive people did not know their HIV status. As a result, many patients start treatment too late. Around 18 per cent of patients initiating treatment were lost to follow-up during the first year, a large proportion of them dying due to late initiation of treatment.
"The report findings indicate challenges but also clear opportunities for optimizing investments and increasing efficiency. By starting treatment earlier and improving adherence within the first year, we can save many more lives," said Dr Gottfried Hirnschall, WHO's Director for HIV/AIDS. "We also need to not only further increase access to key HIV/AIDS interventions but also to pay attention to ensure higher quality of these life-saving services," he said.
Reaching women and children
Steady progress was seen in access to prevention of mother-to-child transmission (PMTCT) services. A record 53 per cent of pregnant women who needed PMTCT services received them globally in 2009. But still many pregnant women and their infants lacked access to these timely interventions.
Care for infants and children require highest attention. Global treatment coverage for HIV positive children was 28 per cent in 2009, a notable progress, but the rate is lower than the ART coverage for adults (36 per cent). And only 15 per cent of children born to HIV-positive mothers were receiving appropriate infant diagnostics.
"Every day, more than 1,000 infants acquire HIV during pregnancy, delivery and breastfeeding. We know how to prevent this," says Jimmy Kolker, Chief of HIV and AIDS of UNICEF. "While many countries are now showing significant progress, intensified efforts are urgently needed to reach all mothers and children with the most effective treatment and PMTCT interventions for their own health and for the sake of their communities."
Universal access beyond 2010
The report called for a clear set of actions to be taken by the international community including:
§ renewing political and funding commitments to achieve universal access to HIV and AIDS prevention, treatment and care;
§ improving integration and linkages between HIV and AIDS and related services such as tuberculosis, maternal and child health, sexual health and harm reduction for drug users;
§ strengthening health systems to achieve broader public health outcomes; and
§ taking bold measures to address legal and structural barriers that increase HIV vulnerability, particularly for most-at-risk populations.
This call to action is consistent with the key strategies proposed by a broad range of stakeholders for the new Global Health Sector Strategy for HIV/AIDS, 2011-2015. WHO is developing the strategy which is meant to guide the next phase of the health sector response to HIV/AIDS, once discussed and ratified by the World Health Assembly next year.
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