Towards universal access: scaling up HIV/AIDS interventions in the health sector
Dr Margaret Chan
Director-General of the World Health Organization
Ladies and gentlemen,
The report being launched today documents the multiple, complex factors that shaped the evolution of the HIV/AIDS epidemic in 2007. Jointly issued by WHO, UNAIDS, and UNICEF, the report gives us the best possible portrait of the impact of specific interventions and strategies, of hot spots in the epidemic and some weak points in the response.
It tells us how individual countries and the international community are doing in their efforts to combat the epidemic. And it documents some significant progress.
At the end of last year, access to antiretroviral therapy had been extended to nearly 3 million people in low- and middle-income countries. The rate at which people were placed on therapy accelerated considerably compared with previous years. In 2007, treatment was extended to nearly one million more people.
Almost three quarters of people receiving these drugs are in Africa, where the epidemic is disproportionately severe and the challenges are especially daunting. The access of women to treatment is at least as good as that for men. Globally, deaths from this disease are now declining, and we can say with confidence that recent progress towards the goal of universal access is the principal reason why.
This is a remarkable achievement for public health. This proves that, with commitment and determination, major obstacles can be overcome. People living in resource-constrained settings can indeed be brought back to economically and socially productive lives by these drugs.
When my predecessor, Dr JW Lee, launched the 3 by 5 initiative in December 2003, the goal of bringing antiretroviral therapy to 3 million people in low- and middle-income countries appeared unrealistic, if not unwise, to many. In fact, the sceptics were almost as vocal as the proponents.
Governments – and activists – rallied. Treatment schedules were streamlined and standardized. Drug prices dropped. Nongovernmental organizations stepped in to provide front-line support. Creative new sources of funding were devised. Partnerships were formed, and presidents and prime ministers launched emergency plans. World leaders, including the G8, expressed their commitment.
All can share pride in last year’s achievements, but much remains to be done. We are still running behind this devastating, unforgiving epidemic.
Nearly a million additional people joined the ranks of those on treatment last year. But last year also saw 2.5 million new infections. If we want to catch up and get ahead, we must do more for prevention.
With early diagnosis and good adherence, treatment outcomes and survival rates in low-income settings rival those seen in the most advanced countries. But far too many cases are going undetected for far too long. Late diagnosis and late initiation of therapy reduce the power of these drugs to prolong survival.
The prevention of mother-to-child transmission has improved, but far too many women learn their infection status only when pregnant or during delivery. Hard-hit countries are still experiencing frequent stock-outs of antiretroviral drugs and other essential supplies. And weak health systems still prevent large numbers of people from accessing services, whether for testing and counselling or for treatment.
Above all, commitment, funding, and determination must rise even higher if we want to meet internationally-agreed goals and targets.
Ladies and gentlemen,
The report being launched today opens the window on what can be achieved. We are reaching 31% of the people in need of treatment for HIV/AIDS. That represents significant progress. But it also represents an unmet need affecting some 6.7 million people.
That is a staggering number of people in need. Once again, to get ahead, we must do better with prevention.