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."