Nairobi/Geneva/Washington DC, 28 September 2010: Developing countries can provide universal access to HIV/AIDS services, the latest report confirms
Sustained commitments necessary to secure future progress
NAIROBI/GENEVA/WASHINGTON DC, 28 September 2010 – Leaders of major global health agencies released a new report today stating that several low- and middle-income countries, including some with the most heavy burden of HIV/AIDS, have achieved or getting "on track" to achieve HIV/AIDS universal access target set for 2010.
The new report Towards Universal Access by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) highlights that fifteen countries such as Botswana, Guyana and South Africa were able to attain universal access to prevention of mother-to-child transmission (PMTCT) services, defined broadly as 80 percent or higher coverage, by the end of 2009.
Fourteen countries, including Brazil, Namibia and Ukraine have achieved universal access to paediatric treatment of HIV. And eight countries, including Cambodia, Cuba, and Rwanda, have achieved universal access to antiretroviral treatment (ART) for adults. The report assessed HIV/AIDS progress in 2009, in 144 low- and middle-income countries.
“Individual countries in all parts of the world demonstrate that HIV/AIDS universal access is achievable," said Dr Hiroki Nakatani, WHO's Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases. "However, universal access by 2010 is still an unfulfilled commitment globally. We know it can be achieved, and we must join forces to make it a worldwide reality."
Remarkable progress in the region, most severely affected by HIV, offers more hope. In Eastern and Southern Africa ART coverage has increased from 32 percent to 41 percent in one year. Half of pregnant women were able to access HIV testing and counseling in 2009 in this region.
“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, Programme, UNAIDS. “But we’re US$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.”
Treatment, testing, and prevention
In 2009, 5.25 million people had access to HIV treatment in low- and middle-income countries, accounting for 36 percent 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 percent of those in need. Latin America and the Caribbean region reached 50 percent coverage for ART, East, South and South-East Asia - 31 percent, Europe and Central Asia - 19 percent, and North Africa and the Middle East - 11 percent.
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 HIV drug stock-outs 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 programmes 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 percent and 85 percent 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 percent.
Results from population surveys in ten countries showed more than 60 percent of HIV positive people did not know their HIV status. As a result, many patients start treatment too late. Around 18 percent 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 to further increase access to key HIV/AIDS interventions but also strive 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. Women were increasingly taking more efficacious antiretroviral drugs (ARVs) for preventing transmission to their children, in accordance with updated WHO guidelines. A record 53 percent 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.
"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."
Care for infants and children require highest attention. Children born with HIV can lead a normal life, if diagnosed for HIV and started treatment early. Global treatment coverage for HIV positive children has increased from 22 percent to 28 percent in one year, a notable progress, but the rate is lower than the ART coverage for adults (36 percent). And only 15 percent of children born to HIV-positive mothers were able to be receive appropriate infant diagnostics in 2009.
Steps towards universal access beyond 2010
The report called for a clear set of actions to be taken by the international community in order to deliver HIV/AIDS universal access. The actions include:
This call to action is complimentary with 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.
Editor's note: All coverage rates in the new report are calculated using the 2010 guidelines. In July 2010, WHO issued new guidelines on antiretroviral treatment for adults and adolescents. The new guidelines changed CD4 count threshold to initiate antiretroviral treatment from 200 cells /mm3 to 350mm3. This change has increased the number of people who needed HIV treatment at the end of 2009 from 10.1 million to 14.7 million. Based on the new criterion for treatment initiation, global ART coverage has increased from 28 percent in December 2008 to 36 percent in December of 2009. Under the previous criterion for treatment initiation, global coverage would have increased from 42 percent to 52 percent during the same period. You can download the full report and related materials at www.who.int/hiv.
For more information, please contact:
Claire Hoffman (in Nairobi/London), Tel: +44 7977 440 353, e-mail: claire.hoffman@bartley
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Michael Klaus (in Nairobi), Tel: + 254 716 431880, e-mail: email@example.com
Roshan Khadivi (in Washington D.C), Tel: + 1 917 478 2574, e-mail: firstname.lastname@example.org
“Towards Universal Access" on HIV/AIDS (2010)