Date Published:
17 April 2007 |
Access to HIV therapy increased in 2006; universal access yet to come (UNICEF)
More than two million people in low- and middle-income countries now receive
HIV therapy; Efforts must increase significantly to increase access to HIV
treatment and prevention
Access to antiretroviral therapy for advanced
HIV infection in low- and middle-income countries continued to grow throughout
2006, with more than two million people living with HIV/AIDS receiving treatment
in December 2006, a 54% increase over the 1.3 million people on treatment one
year earlier in these countries. These encouraging findings were released today
in a new report, “Towards universal access: scaling up priority HIV/AIDS
interventions in the health sector,” published by the World Health Organization
(WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and UNICEF.
At the same time, however, the report details a number of key areas in which
efforts to scale up services are insufficient if the global goal of moving
towards “universal access to comprehensive prevention programmes, treatment,
care and support” for HIV by 2010 is to be achieved. For example, just
11% of HIV-positive pregnant women in need of antiretrovirals to prevent mother-to-child
transmission of HIV (PMTCT) in low- and middle-income countries are receiving
them. Global coverage of HIV testing and counselling remains unsatisfactorily
low, as does coverage of prevention and treatment interventions for injecting
drug users. And while countries committed themselves to setting targets for
universal access by the end of 2006, only 90 had provided data on these by
that date.
“ The combined efforts of donors, affected nations, UN agencies
and public health authorities are providing substantial, ongoing progress
in access
to
HIV services,” said Dr Margaret Chan, Director-General, WHO.
“ Yet,
in many ways we are still at the beginning of this commitment. We need ambitious
national programmes, much greater global mobilization, and increased accountability
if we are going to succeed."
Access to HIV treatment
The report shows that countries in every region of the world are making substantial
progress in increasing access to HIV treatment. More than 1.3 million people
in sub-Saharan Africa were receiving treatment in December 2006, representing
coverage of approximately 28% of those in need compared to just 2% in 2003.
Coverage in other regions varied, from 6% in North Africa and the Middle East,
to 15% in Eastern Europe and Central Asia and 72% in Latin America and the
Caribbean. Overall, while encouraging trends continue, just 28% of the estimated
7.1 million people in need of treatment in all low- and middle-income countries
were receiving it in December 2006.
Funding provided by the United States President’s Emergency Plan for
AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria was
supporting 1 265 000 individuals receiving treatment by the end of 2006. The
prices of most first-line ARVs decreased by between 37% and 53% in low- and
middle-income countries from 2003 to 2006, and by between 10% and 20% from
2005 to 2006.
“ The significant progress outlined in this report in scaling up
access to treatment is a positive step forward for many countries in achieving
their
ambitious goals of universal access to HIV prevention, treatment, care and
support,” said Dr Peter Piot, Executive Director of UNAIDS.
“ However
new data in the report also shows that there is still a long way to go, particularly
in the widespread provision of treatment to prevent mother to child transmission
of HIV, which remains one of the simplest and cheapest proven prevention
methods available,” he added.
The number of children receiving treatment increased by 50% in the past year,
but from a very low base. In December 2006, only about 115 500 (15%) children
of the 780 000 estimated to be in need of HIV treatment had access to it. According
to WHO HIV/AIDS Director, Dr Kevin De Cock "urgent priorities are improving
access to HIV treatment for children, especially in sub-Saharan Africa, as
well as for injecting drug users everywhere".
“ Access to HIV testing
and counselling, a critical entry point for both prevention and treatment services,
also needs to be broadened significantly if we are to come near to reaching
the targets for universal access by 2010," he added.
“ Children continue to be the missing face of the AIDS pandemic,” said
UNICEF Executive Director Ann M. Veneman,
“ with too many children
still missing out on life-saving treatment and access to other essential
services.”
In
2005, UNICEF, UNAIDS and other partners launched the Unite for Children,
Unite against AIDS campaign. Unite for Children, Unite against AIDS targets
four
key areas: prevention of mother to child transmission; treatment of paediatric
AIDS; education programmes for prevention; and support for orphans and
vulnerable children.
Challenges and recommendations
Among the report’s recommendations for improving the global AIDS response
are the following:
Increase efforts to accelerate the prevention, diagnosis and treatment of
HIV disease in children. In addition to the need to increase treatment access,
progress remains unsatisfactory in the prevention and diagnosis of HIV disease
in children. The technical challenges of expanding services for children have
been considerable. New approaches to overcoming these, such as the development
of appropriate diagnostics and fixed-dose paediatric drug formulations, need
to be more widely explored and accelerated.
Introduce a range of strategies to increase knowledge of HIV status. Surveys
in twelve high-burden countries in sub-Saharan Africa showed that a median
of just 12% of men and 10% of women in the general population had been tested
for HIV and received the results. While client-initiated voluntary counselling
and testing (VCT) is helping people know their status, provider-initiated HIV
testing and counselling (PITC) in health care settings is emerging as a key
additional strategy to expand access to HIV prevention, treatment and care
services. The conditions under which testing and counselling are provided must
also be improved in order to diminish obstacles to uptake, such as fear of
stigma and negative reactions to disclosure.
Accelerate scale-up of services to prevent mother-to-child transmission of
HIV (PMTCT). More than 100 low- and middle-income countries have established
PMTCT programmes, yet only seven were reaching 40% or more of HIV-infected
pregnant women in 2005. In sub-Saharan Africa, where 85% of HIV-infected pregnant
women live, coverage in countries ranges from less than 1% to 54%. Current
efforts to prevent mother-to-child transmission of HIV are far below what is
required to meet the UN target of reducing the proportion of children infected
with HIV by 50% in 2010.
Improve access to services for most-at-risk populations, including injecting
drug users and men who have sex with men (MSM). Injecting drug use is a major
mode of HIV transmission in several regions and is emerging as a concern in
Africa. Adequate prevention, treatment, and care services need to be provided
to this population if a significant impact is to be made on HIV transmission.
Resurgent transmission of HIV and other sexually transmitted infections in
MSM in industrialized countries needs to be countered, and prevention needs
of MSM in low- and middle-income countries addressed.
Invest in prevention for people living with HIV/AIDS. Persons living with
HIV can be the strongest advocates for HIV prevention. Better follow-up is
required of individuals diagnosed with HIV in voluntary counselling and testing
centres. The health sector should provide a wider range of services and interventions
to help people with HIV/AIDS to maximize their health, prevent and treat opportunistic
and sexually transmitted infections, reduce the harms associated with injecting
drug use, and avoid passing HIV on to others.
Improve access for people living with HIV/AIDS to quality TB prevention, diagnostic
and treatment services. Most cases of TB are preventable or curable. Nevertheless,
almost one million people living with HIV will develop TB disease each year,
leading to nearly a quarter of a million avoidable TB deaths. Chronic underinvestment
and inadequate political commitment to TB control in many countries of high
HIV prevalence have resulted in high TB incidence among people with HIV/AIDS
and have contributed to the development of TB drug resistance. The emergence
of extensively drug-resistant tuberculosis (XDR-TB) must now be urgently addressed
through increased coordination and availability of prevention, diagnostic,
and treatment services, and through comprehensive infection control strategies.
Recognize male circumcision as an important additional HIV prevention intervention.
Recent clinical trial data demonstrate a significant reduction in the risk
of heterosexually acquired HIV infection among circumcised men. Male circumcision
could have a major public health impact in countries where HIV prevalence is
high, transmission is predominantly through heterosexual contact, and rates
of male circumcision are low. Such countries should urgently consider scaling
up access to safe male circumcision services. Key issues in implementation
include the quality and safety of services, cultural considerations, and adherence
to human rights principles in the provision of male circumcision, including
informed consent, confidentiality, and absence of coercion.
Address concerns about longer-term financial sustainability. Financial concerns,
especially with reference to what will be available from major multilateral
and bilateral sources in the long term, continue to limit the scope and rate
of scale-up in many countries and threaten long-term sustainability. While
encouraging reductions have occurred in the price of first-line regimens in
most low- and some middle-income countries, the demand for expensive second-line
regimens will continue to increase. Unless prices for second-line regimens
fall significantly, budgetary constraints may put treatment programmes at risk.
About UNICEF
UNICEF is on the ground in 156 countries and territories to help children
survive and thrive, from early childhood through adolescence. The world’s
largest provider of vaccines for developing countries, UNICEF supports child
health and nutrition, good water and sanitation, quality basic education for
all boys and girls, and the protection of children from violence, exploitation,
and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals,
businesses, foundations and governments.
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