The One Point Three by Five final report is out. Just as plans are being formulated for Ten by Ten. Myanmar will have to work harder to do her part. Data in the report include: estimated number of people 0–49 years old needing antiretroviral therapy: 50 000, reported number of people receiving antiretroviral therapy, January–December 2005: 3,500 (range 2,500 to 4,500), and overall coverage 7%.
GLOBAL ACCESS TO HIV THERAPY TRIPLED IN PAST TWO YEARS, BUT SIGNIFICANT CHALLENGES
REMAIN - 1.3 Million People Now Receiving Treatment in Low- and Middle-Income
Countries; Sub-Saharan Africa Leads in Treatment Scale-up - Lessons Learned in "3
by 5" Should Guide Efforts to Move Towards Universal Access to Treatment by 2010
UNAIDS Press Release - March 28, 2006 http://www.aegis.org/news/unaids/2006/UN060303.html
Geneva - A new report by the World Health Organization (WHO) and the Joint United
Nations Programme on HIV/AIDS (UNAIDS) shows that the number of people on HIV
antiretroviral treatment (ART) in low- and middle-income countries more than
tripled to 1.3 million in December 2005 from 400 000 in December 2003. Charting
the final progress of the "3 by 5" strategy to expand access to HIV therapy in
the developing world, the report also says that the lessons learned in the last
two years provide a foundation for global efforts now underway to provide universal
access to HIV treatment by 2010.
Progress in treatment scale-up, while substantial, was less than initially hoped.
The report notes, however, that treatment access expanded in every region of the
world during the "3 by 5" initiative, with approximately 50 000 additional people
beginning ART every month in the past year. Sub-Saharan Africa, the region most
severely impacted, led the scale-up effort, with the number of people receiving
HIV treatment there increasing more than eight-fold to 810 000 from 100 000 in
the two-year period. By the end of 2005, more than half of all people receiving
HIV treatment in low- and middle-income countries resided in sub-Saharan Africa,
up from one-quarter two years earlier.
"Two years ago, political support and resources for the rapid scale-up of HIV
treatment were very limited," said WHO Director-General, Dr LEE Jong-wook. "Today
"3 by 5" has helped to mobilize political and financial commitment to achieving
much broader access to treatment. This fundamental change in expectations is
transforming our hopes of tackling not just HIV/AIDS, but other diseases as well."
In July 2005, the G8 nations endorsed a goal of working with WHO and UNAIDS to
develop an essential package of HIV prevention, treatment and care with the aim
of moving as close as possible to universal access to treatment by 2010, a target
subsequently endorsed by the United Nations General Assembly in September 2005.
The new WHO/UNAIDS report outlines a number of steps that must be taken to continue
and expand treatment scale up toward achieving this goal.
Substantial Increases in HIV Treatment Access
Countries in every region of the world made substantial gains during the "3 by 5"
period in closing the gap between those in need of treatment and those receiving
it. The number of public sector treatment sites in low- and middle-income countries
increased from fewer than 500 providing ART to more than 5100 operational treatment
sites by the end of 2005. A recent survey showed for example that the number of
treatment sites in Malawi increased from three in early 2003 to 60, and in Zambia
increased from three to more than 110 facilities in just over two years.
Globally, 18 developing countries met the "3 by 5" target of providing treatment
to at least half of those in need by the end of 2005, and are now concentrating
their efforts on moving towards universal access to treatment. While other countries
fell short of this target, lessons learned in expanding treatment access and
overcoming critical weaknesses in health systems are informing new initiatives to
further scale-up HIV prevention, treatment and care services. Increased availability
of ART averted an estimated 250 000 to 350 000 premature deaths in the developing
world in 2005 alone.
Launched by WHO and UNAIDS on World AIDS Day, 1 December 2003, "3 by 5" aimed to
provide treatment to 3 million people in low- and middle-income countries by the
end of 2005. This ambitious target was based on a 2001 analysis of what could be
accomplished with an optimal combination of funding, technical capacity building,
health systems strengthening and political will and cooperation. The initiative
confirmed that HIV treatment can be delivered effectively in a wide variety of
health systems, including those in poor countries and rural settings, and that
large-scale ART access is both achievable and increasingly affordable.
Between 2003 and 2005, global expenditure on AIDS increased from US$ 4.7 billion
to an estimated US$ 8.3 billion. Significant proportions of this funding were
provided by the US President's Emergency Plan for AIDS Relief, the Global Fund to
Fight AIDS, TB and Malaria and the World Bank. During the same period, the price
of first-line treatment decreased by between 37% and 53%, depending on the regimen
used.
Progress: Treatment Access by Region
Between end-2003 and 2005, HIV treatment access expanded in every region of the
world. Sub-Saharan Africa and East, South and Southeast Asia, the regions most
heavily affected by the epidemic, achieved the most rapid and sustained progress.
• More than 810 000 people in sub-Saharan Africa, or 17% of those in need of ART,
had accessed treatment by the end of 2005. Well over half the people on ART in
the developing world live in this region. This substantial increase in ART
availability in sub-Saharan Africa occurred despite considerable regional challenges:
the region is home to over 20 of the world's 25 poorest countries, and suffers a
shortage of some 1 million professional health workers, with an additional 20 000
trained staff lost each year to emigration.
• East, South and Southeast Asia recorded significant gains in ART access from
end-2003 (70 000 people) to 2005 (180 000 people), with coverage in the region
expanding more than 75% in 2005. Thailand was a major driver of this increase,
particularly during 2004 and the first half of 2005.
• Latin America and the Caribbean, with more than 315 000 people on ART (up from
210 000 at the end of 2003), is providing treatment to approximately 68% of its
population in need - the highest coverage of any region in the developing world.
Thirteen countries in this region provide treatment to more than half of the
population in need.
• Despite gains in overall numbers on treatment, ART access in low- and middle-income
countries in Eastern Europe, Central Asia, the Middle East and North Africa was
lower than in other regions, with just 21 000 people in Eastern Europe and Central
Asia and 4000 in the Middle East and North Africa receiving treatment as compared
to 15 000 and 1000 respectively at the end of 2003. Virtually all countries in
these regions are experiencing low-level epidemics that involve difficult-to-reach
populations such as injecting drug users (IDUs) and sex workers.
Reaching Women, Children and Vulnerable Populations
While the new report found no systematic bias against women in ART access, rates
of coverage for women varied. In some countries, more women receive treatment; in
others, more men. One notable area of concern is access to therapy to prevent
mother-to-child HIV transmission, which remains unacceptably low. Between 2003
and 2005, fewer than 10% of HIV-positive pregnant women received antiretroviral
prophylaxis before or during childbirth. As a result, 1800 infants were born with
HIV every day. Each year, over 570 000 children under the age of 15 die of AIDS,
most having acquired HIV from their mothers. In 2005, 660 000 children under the
age of 15 were in need of immediate ART, representing more than 10% of unmet global
need. Nine out of ten children needing treatment live in sub-Saharan Africa. While
an estimated 36 000 injecting drug users (IDUs) were receiving ART by the end of
2005, more than 80% (30 000) of these are in Brazil. The remaining 6000 patients
were distributed among 45 other countries. These figures suggest a large unmet
need, particularly in Eastern Europe and Central Asia, where IDUs represent 70%
of HIV cases but just 24% of patients currently on treatment.
"Misinformation about the disease and stigma against people living with HIV still
hamper prevention, care and treatment efforts everywhere," said Dr Peter Piot,
UNAIDS Executive Director. "If we are to get ahead of the AIDS epidemic, we must
tackle stigma, ensure that the available funds are spent effectively to scale-up
HIV prevention, care and treatment programmes, and mobilize more resources."
Moving Toward Universal Access
While important advances in HIV treatment access have been achieved in the past
two years, the report also acknowledges that, despite the efforts of many partners
and significant funding from a number of donors, the "3 by 5" strategy fell short
of its ambitions. Obstacles to scaling up HIV treatment and prevention highlighted
in the report include poorly harmonized partnerships; constraints on the procurement
and supply of drugs, diagnostics and other commodities; strained human resources
capacity and other critical weaknesses in health systems; difficulties in ensuring
equitable access; and lack of standardized systems for the management of programmes
and monitoring progress.
"The past two years have provided a wealth of experience and information on which
we must now continue to build," said Kevin De Cock, Director, HIV/AIDS Department
at the World Health Organization. "We intend to utilize this knowledge to focus
future efforts on overcoming persistent challenges and obstacles. It is particularly
important that scaling-up HIV prevention, treatment and care services contributes
to strengthening of health systems overall." A number of lessons learned in
treatment scale-up efforts and outlined in the new report provide a valuable roadmap
for efforts to achieve universal access to treatment. Among these are:
• The positive impact of targets in creating and sustaining momentum for action
and in increasing accountability among stakeholders. A key element of the "3 by
5" strategy was developing bold country-level targets that encouraged national
governments to expand capacity beyond what was previously considered possible.
Moving forward, targets for treatment must be complemented by achievable targets
for other elements of a comprehensive response to AIDS, including prevention and
mitigating impact.
• The need to strengthen health systems. Building universal access to HIV treatment
will require significant ongoing efforts to re-build, reinforce and expand
under-staffed and under-funded health care systems that are already severely challenged
in many countries.
• Promoting a 'public health approach' to health care delivery that emphasizes
service decentralization, community mobilisation and education, team-based approaches
and the delegation of routine tasks to trained nurses and health workers. The
approach also promotes use of mechanisms to ensure the consistency and quality of
supplies of drugs and diagnostics as well as the routine offer of voluntary testing
and counselling to increase knowledge of HIV status in settings where there is
high HIV prevalence.
• The ongoing need to intensify prevention efforts and to integrate prevention
and treatment scale-up, using all effective approaches and paying particular
attention to the needs of vulnerable groups. Epidemiological modelling consistently
shows that more deaths can be averted with a comprehensive response including
both prevention and treatment, than by focusing on treatment or prevention alone.
• The need for substantial increases in resources and sustainable financing. UNAIDS
estimates that the gap between available resources and those needed is US$18
billion for the period 2005-2007, and that at least US$22 billion per year will be
needed by 2008 to fund comprehensive national HIV prevention, treatment and care
programmes.
• Long-term donor commitments are essential to ensuring sustainable treatment
scale-up, as placing large numbers of people on ART is impractical for many
countries without firm funding. The report encourages the use of innovative financing
mechanisms to fund increased resources for AIDS. These include a proposal by France
to introduce an airline solidarity contribution and the UK's International Finance
Facility, which aims to "front-load" additional funds leveraged from international
capital markets to make them immediately available for sustainable investments
that support the achievement of the Millennium Development Goals.
The new report emphasizes that WHO and UNAIDS will continue to build upon these
lessons learned, as well as on the priorities, strategies and partnerships of "3
by 5" in accelerating the AIDS response. UNAIDS is currently facilitating the
development of nationally agreed plans and targets to move towards universal access
to HIV prevention, treatment, care and support. WHO's contribution to realizing
the goal of universal access will be based on a set of priority interventions in
the following five strategic directions, known to be able to significantly influence
the epidemic in different epidemiological contexts:
- enabling people to know their HIV status through HIV testing and counselling;
- accelerating the scale-up of treatment and care;
- maximizing the health sector's contribution to HIV prevention;
- investing in strategic information to guide a more effective response; and
- strengthening and expanding health systems.
Copyright © 2006 - Joint United Nations Programme on HIV/AIDS (UNAIDS).
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