Sustained commitments necessary to secure future progress
World Health
Organization
Significant progress has been made in several low- and
middle-income countries in increasing access to HIV/AIDS services, according
to a new report released recently. The report Towards Universal Access by
the World Health Organization (WHO), the United Nations Children’s Fund
(UNICEF) and the Joint United Nations Program on HIV/AIDS (UNAIDS) is the
fourth annual report for tracking progress made in achieving the 2010 target
of providing universal access to HIV prevention, treatment and care.
The report assessed HIV/AIDS progress in 144 low- and
middle-income countries in 2009 and found:
* 15 countries, including Botswana, Guyana and South
Africa, were able to provide more than 80% of HIV-positive pregnant women in
need, the services and medicines to prevent mother-to-child HIV
transmission;
* 14 countries, including Brazil, Namibia and Ukraine,
provided HIV treatment to more than 80% of the HIV-positive children in
need;
* Eight countries, including Cambodia, Cuba and Rwanda,
have achieved universal access to antiretroviral treatment (ART) for adults.
“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.”
Remarkable progress in Eastern and Southern Africa, the
region most severely affected by HIV, offers hope. In this region, HIV
treatment coverage has increased from 32% to 41% in one year. And half of
the pregnant women were able to access HIV testing and counseling in 2009.
“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,
Program, UNAIDS. “But we’re US$10 billion short. At the Global Fund
replenishment conference in New York countries have a chance to put this
right - to make a smart investment and secure the future of the AIDS
response.”
In 2009, 5.25 million people had access to HIV treatment
in low- and middle-income countries, accounting for 36% 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 ART, the number increasing from 2.95 million at the end of 2008
to 3.91 million at the end of 2009, covering 37% of those in need. Latin
America and the Caribbean region reached 50% coverage for ART, East, South
and South-East Asia - 31%, Europe and Central Asia - 19%, and North Africa
and the Middle East - 11%.
Challenges in delivering
universal access
Obstacles to scaling up HIV treatment persist in most
countries, including funding shortages, limited human resources, and weak
procurement and supply management systems for HIV drugs and diagnostics and
other health systems bottlenecks. One third of countries reported at least
one or more cases when supply of HIV medicines had been interrupted in 2009.
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.
Availability and safety of blood and blood products
continue to be a concern for HIV prevention, especially in low-income
countries. While 99% and 85% of blood donations in high- and middle-income
countries, respectively, were screened in a quality-assured manner in 2009,
in low-income countries the comparable figure was 48%.
Results from population surveys in ten countries showed
more than 60% of HIV-positive people did not know their HIV status. As a
result, many patients start treatment too late. Around 18% 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.
Women and children
Steady progress was seen in access to prevention of
mother-to-child transmission (PMTCT) services. A record 53% 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 the highest attention.
Global treatment coverage for HIV positive children was 28% in 2009, a
notable progress, but the rate is lower than the ART coverage for adults
(36%). And only 15% 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.”
Steps towards 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/AIDS prevention, treatment and care;
* Improving integration and linkages between HIV/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.
