JOHANNESBURG, 30 September 2009 (PlusNews) - More than four million people globally are now on antiretroviral (ARV) treatment - a 10-fold jump in five years - but this is still less than half the people living with HIV who need it.

A new report, Towards Universal Access, was released on 30 September by the World Health Organization (WHO), UNAIDS and the UN Children's Agency (UNICEF), and is the third annual review of international progress towards the Millennium Development Goal of universal access to treatment and prevention by 2010.

At the end of 2007 about three million people were receiving life-prolonging ARV medication; in 2008 there was a 36 percent increase in people accessing treatment.

Dr Stella Anyangwe, the WHO country representative in South Africa, told journalists at a press conference that the biggest gains in providing treatment had been made in sub-Saharan Africa, the worst-affected region, and about 2.9 million people were now on ARVs, compared to about 2.1 million in 2007.

South Africa and Zimbabwe are among the countries that made the most progress in putting people on treatment in 2008, with both countries registering an increase of more than 50 percent from 2007 to 2008.

"Reaching the 700,000 mark [of people accessing ARVs] is something we hadn't really envisaged when we started providing treatment," admitted Dr Nono Simelela, CEO of the South African National AIDS Council. However, with an estimated five million people living with the virus - the highest caseload in the world - the country would have to "push really hard" to achieve universal access to treatment.

Anyangwe attributed the huge jump in global treatment access to a rise in the number of people being tested for HIV as well as lower drug prices, especially first-line treatment regimens, which had dropped by as much as 40 percent. The report noted that 94 of the 101 countries surveyed in 2008 were providing free HIV testing at public sector health facilities.

Despite these achievements there were still some major obstacles: people were still often tested at a late stage of the disease, and only accessed treatment when they were very ill and their immune systems could not recover. Also, "supply chain management is still an issue ... some countries are experiencing stock-outs [of drugs]," Anyangwe said.

One of her biggest concerns was the widening treatment gap - about 9.5 million people are in need of ARVs, but only 4 million are getting them. "At the rate we are going, with new [HIV] infections rising it will be almost impossible ... to keep providing free treatment to those who need it," she warned.

Countries should start looking at financing their own treatment programmes, rather than relying heavily on external funding. "If we keep people alive for longer ... then they may be able to buy their own treatment," she suggested.

Prevention still the weakest link

Despite the remarkable progress made towards achieving universal access to treatment, countries were still lagging behind when it came to prevention.

In 2008, 45 percent of pregnant women in low- and middle-income countries received treatment to prevent mother-to-child transmission, up from 35 percent in 2007, and far beyond the 10 percent reached in 2004.

However, the number of new infections was still extremely high. "Not enough is being done to balance two new infections for every person getting on treatment," said Mark Stirling, regional director of UNAIDS Eastern and Southern Africa, during the launch of the report.

More than 2.7 million people became newly infected in 2007 alone. Stirling called for more resources to be pumped into the prevention response, and for more "frank talk" from leaders about why so many new infections were occurring.

Nevertheless, most countries in East and Southern Africa had made a "quantum shift" towards universal access to prevention, and several countries in Southern Africa were pushing for male circumcision as a prevention measure to be rapidly scaled up.

Stirling noted that the prevention response was becoming "much more sophisticated than the ABC [Abstinence, Be faithful, Condomize] campaign of previous years", and national prevention strategies were now more focused on action.

Yet all too often vulnerable populations were still faced technical, legal and socio-cultural barriers when trying to access HIV/AIDS services. Only 30 countries provided needle- and syringe-exchange programmes for injecting drug users, and the number of syringes distributed annually by these programmes was still well below the internationally recommended target of 200 syringes per injecting drug user per year.

The report concluded that "Without significant acceleration in the rate at which services are expanded and people are reached, millions of new infections will occur, more lives will be lost, and the human and economic burden on future generations will continue to increase."