A new United Nations report showing significant progress in improving access to HIV/AIDS services in 37 developing countries offers realistic hope for the achievement of universal access, a UN official responsible for battling the pandemic said today.
Towards Universal Access, produced by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and the Joint United Nations Programme on HIV/AIDS (UNAIDS) and released today, assesses progress in 144 low- and middle-income countries.
It finds that 15 countries were able to provide more than 80 per cent of HIV-positive pregnant women with the services and medicines needed to prevent mother-to-child transmission, while 14 countries provided HIV treatment to more than 80 per cent of their HIV-positive children. An additional eight countries have achieved universal access to antiretroviral treatment for adults.
“Countries in all parts of the world are demonstrating that universal access is achievable,” said Hiroki Nakatani, Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases of WHO. “But globally, it remains an unfulfilled commitment, and we must join forces to make it a worldwide reality in the coming years,”
“We’re on the right track,” said Paul De Lay, Deputy Executive Director with UNAIDS. “We’ve shown what works and now we need to do more of it. But we’re $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.”
“Every day, more than 1,000 infants acquire HIV during pregnancy, delivery and breastfeeding,” said Jimmy Kolker, UNICEF’s Chief of HIV and AIDS. “We know how to prevent this.”
“While many countries are now showing significant progress, intensified efforts are urgently needed to reach all mothers and children with the most effective treatment” to prevent mother-to-child transmission – “for their own health, and for the sake of their communities,” he said.
The report’s findings include: 5.25 million people had access to HIV treatment in low- and middle-income countries last year, accounting for 36 per cent of those in need – an increase of more than 1.2 million people over 2008.
There was remarkable progress in Eastern and Southern Africa – the region most severely affected by HIV – where treatment coverage increased from 32 per cent to 41 per cent in one year, and half of all pregnant women were able to access HIV testing and counselling.
In sub-Saharan Africa, close to one million more people began antiretroviral treatment, resulting in 37 per cent coverage of those in need. The rate in other regions included: Latin America and the Caribbean – 50 per cent; 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.
Globally, a record 53 per cent of pregnant women needing services to prevent mother-to-child transmission received them. Global treatment coverage for HIV-positive children was 28 per cent – a significant increase, though still lower than the rate of antiretroviral coverage for adults (36 per cent). Unfortunately, many pregnant women and their infants still lacked access to these timely interventions, and only 15 per cent of children born to HIV-positive mothers were receiving appropriate diagnostics.
The report also calls attention to significant challenges in delivering universal access in most countries, such as funding shortages, limited human resources, and weak procurement and supply management systems for HIV drugs and diagnostics, as well as other health systems bottlenecks.
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 were reached with HIV prevention programmes in 2009.
Availability and safety of blood and blood products continue to be a concern, especially in low-income countries. Quality assured screening of blood covered only 48 per cent of donations in low-income countries, compared with 99 per cent in high-income and 85 per cent in middle-income countries.
And in 10 countries, more than 60 per cent of HIV-positive people did not know their HIV status. As a result, many began treatments too late. Nearly one in five who initiated treatments did not show up for follow-up care – many having died as a result of getting a late start.
“The report findings indicate challenges, but also clear opportunities for optimizing investments and increasing efficiency,” said Gottfried Hirnschall, WHO's Director for HIV/AIDS. “By starting treatment earlier and improving adherence within the first year, we can save many more lives.”
“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 added.
The report is the fourth in an annual series tracking progress made in achieving the 2010 target of providing universal access to HIV prevention, treatment and care.
The report also calls for a set of actions to be taken by the international community, consistent with the key strategies proposed in the new Global Health Sector Strategy for HIV/AIDS, 2011-2015. WHO is developing the strategy – which is intended to guide the next phase of the health sector response to HIV/AIDS once it is discussed and ratified by WHO’s World Health Assembly next year.