HIV treatment access reaches over 1 million in sub-Saharan Africa, WHO reports
WHO HIV/AIDS Director Dr Kevin De Cock Outlines Progress and Obstacles to Achieving Universal Access to AIDS Treatment
16 August 2006 | Toronto - Addressing a plenary session of the XVI International AIDS Conference here today, WHO HIV/AIDS Director Dr Kevin De Cock reported that the number of people receiving HIV antiretroviral therapy in sub-Saharan Africa has surpassed 1 million for the first time, a ten-fold increase in treatment access in the region since December 2003.
In low- and middle-income countries, just over 1.6 million persons were receiving antiretroviral therapy at the end of June 2006, a 24 percent increase over the 1.3 million who had access to the drugs in December 2005, and four times the 400,000 people receiving treatment in these countries in December 2003. Ninety-five percent of people living with HIV/AIDS today live in the developing world.
While WHO and UNAIDS reported significant increases in treatment access in several regions of the world, Dr De Cock emphasized that there is considerable work ahead to reach the G-8 and UN-endorsed goal of providing as close as possible to universal access to HIV prevention programmes, treatment, care and support by 2010. In his remarks today, Dr De Cock also laid out WHO’s vision for continuing to expand HIV treatment access, calling for new action to overcome barriers that, if unaddressed, will slow the rate of expansion in access to HIV treatment in the future.
“The combined efforts of donors, affected nations, UN agencies and public health authorities are providing substantial, ongoing increases in access to lifesaving HIV treatment,” commented Dr De Cock. “Yet, in many ways we are still at the beginning of this effort. We have reached just one-quarter of the people in need in low and middle-income countries, and the number of those who need treatment will continue to grow. Our efforts to overcome the obstacles to treatment access must grow even faster.”
Of the 38.6 million persons living with HIV globally, approximately 6.8 million people living in low- and middle-income countries require antiretroviral therapy now. This means that about 24 percent of people in need worldwide were receiving antiretroviral therapy by end-June 2006. Coverage by region varied, from five percent in North Africa and the Middle East and 13 percent in Eastern Europe and Central Asia to 75 per cent in Latin America and the Caribbean.
Sixty-three percent of persons on antiretroviral therapy in low- and middle-income countries today are African, compared with 25 percent in late 2003. Although sub-Saharan Africa has the greatest number of people on treatment, and the second-highest rate of treatment coverage among those who need it, the region still accounts for 70 percent of the global unmet treatment need.
In addition to expenditures by countries themselves, treatment scale-up has been funded through the U.S. President's Emergency Plan for AIDS Relief; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the World Bank; other bilateral donors, and pharmaceutical companies through contributions such as the Accelerating Access Initiative. In general, progress has been greatest in countries receiving specific assistance from these initiatives.
Increasing Equitable Access
Speaking on efforts to ensure equitable access to treatment among all people who need it, Dr De Cock reported that current data do not indicate any systematic bias against women in treatment access, with the proportion of female ART recipients corresponding closely to, and in some cases exceeding, the proportion of people infected.
However, other inequities are clear. While an estimated 800,000 children below the age of 15 require antiretroviral therapy, only about 60,000 to 100,000 are estimated to be receiving it. One in 7 people dying of HIV-related illness worldwide is a child under 15 years of age, a fact that is largely due to the failure to scale up programmes for the prevention of mother-to-child transmission of HIV and to prevent HIV infection in young women, noted Dr De Cock.
Despite the successes of such countries as Brazil, Thailand, and Botswana, only about six percent of HIV-positive pregnant women globally are currently benefiting from antiretroviral prophylaxis to help prevent HIV transmission in childbirth. In contrast, pediatric HIV disease has been virtually eliminated in the industrialized world.
People who contracted HIV through injecting drug use are also not receiving equitable access to treatment. In Eastern Europe and Central Asia, injecting drug users, a majority of them men, account for over 70 per cent of HIV-infected persons, but only about a quarter of treatment recipients.
Dr De Cock encouraged delegates at the meeting to evaluate treatment efforts not only based on the number of patients receiving care, but on the quality of treatment outcomes as well. Noting that most patients in developing country treatment programmes present with late-stage disease, he emphasized that improving treatment outcomes will require both diagnosing HIV and starting treatment earlier.
“A three-and-a half times higher death rate after one year of therapy in HIV-infected citizens of resource-poor countries compared with Europeans and North Americans should not be viewed as acceptable, and we must commit to change it,” said Dr De Cock. “These priorities are not radical new insights but they do require altered commitment to saving human life.”
Moving Towards Universal Access
Looking forward, Dr De Cock outlined five strategic directions, each of which represents a critical area where the health sector must lead if countries are to make progress towards achieving universal access, and on which WHO will focus its technical assistance. These include:
- expanding HIV testing and counselling;
- maximizing prevention opportunities in health care settings;
- increasing access to treatment and care;
- strengthening health systems; and
- investing in strategic information.
While stressing that prevention, treatment and care are inextricably linked, De Cock called for an increased emphasis on prevention efforts where HIV transmission is most intense. He also emphasized the need to be guided by science when determining the effectiveness of prevention interventions.
Reviewing lessons learned from the ”3 by 5” effort to rapidly scale up access to HIV treatment, De Cock cited the frailty of health systems - including human resources, physical infrastructure, laboratory capacity, procurement and supply systems, and fiscal management - as the key obstacle to widescale provision of HIV services, and called for the elevation of health systems strengthening among global political priorities. De Cock also cited the reliability and availability of strategic information, including epidemiology and surveillance, monitoring and evaluation, and operational research as essential in monitoring progress towards universal access.
Noting that only about 10 percent of people living with HIV in sub-Saharan Africa know their HIV status, De Cock added that WHO is working with UNAIDS to evaluate how countries are implementing HIV testing and counseling. A consultative process is under way to develop operational guidelines to help countries expand access to provider-initiated testing and counseling in health care settings, with a view to increasing uptake of treatment and prevention particularly in high prevalence countries. The guidelines will be issued later this year.
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