Although four million people are now receiving antiretroviral treatment in low and middle-income countries, another five million adults and children lack access to treatment, according to figures released today by United Nations agencies.
The report Towards universal access: scaling up priority HIV/AIDS interventions in the health sector is published by the World Health Organization, UNAIDS and UNICEF, and is the third annual review of international progress towards the goal of universal access to treatment and prevention by 2010.
Although more than a million people are estimated to have been enrolled into treatment programmes during 2008 alone, the biggest annual increase since treatment scale-up began, only 42% of those in need of treatment in low and middle-income countries are currently being reached.
The report also reveals major gaps in two priority areas, the prevention of mother to child transmission and treatment of children.
The report estimates that 21% of pregnant women received an HIV test in 2008, and 45% received drugs to prevent mother to child transmission, of whom around one-third received only single-dose nevirapine, the least effective form of preventive treatment. Only one-third of those who tested positive were assessed for eligibility for antiretroviral treatment for their own health.
Although 38% of children with HIV in low- and middle-income countries in need of treatment received it, infant diagnosis continues to lag behind. In 41 reporting low- and middle-income countries only 15% of children born to HIV-infected mothers were tested for HIV within the first two months of life.
Background to universal access
In 2001 the convening of The United Nations Special Session on HIV/AIDS marked an historic beginning. For the first time a global set of targets was agreed in response to the crisis. In 2006 at the second United Nations General Assembly High Level Meeting on HIV/AIDS, countries agreed to work towards the goal of “universal access to comprehensive prevention programmes, treatment, care and support” by 2010. The G8 Final declaration in L’Aquila, Italy in July 2009 claimed “We will implement further efforts towards universal access to HIV/AIDS prevention, treatment, care and support by 2010”
WHO, UNICEF and UNAIDS in collaboration with other international monitoring and reporting mechanisms have been monitoring progress, nationally, regionally and globally, of the health sector’s response to HIV. The report presented today is the third in a series of annual progress reports towards universal access that includes HIV services for women and children.
WHO together with UNICEF developed a joint reporting tool to request information from national programmes to collect data on the scale-up of health sector interventions in response to HIV. The goal of this process is to facilitate the collection of a standardised set of information.
Indicators in the reporting tool are based on the WHO Framework for Monitoring and Reporting on the Health Sector Response to HIV/AIDS towards Universal Access, and The Report Card on the Prevention of Mother-To-Child Transmission (PMTCT) and Paediatric HIV Care and Treatment coordinated by UNICEF and WHO on behalf of the Expanded Interagency Task Team (IATT) on the Prevention of HIV Infection in Pregnant Women, Mothers and their Children.
Data collected include the number of people on antiretroviral treatment at the end of 2008, disaggregated by age and sex. Validation of data included national authorities, key implementing partners as well as UN and donor agencies at the national, regional and global levels. Following receipt of information from countries on March 31, 2009, validation of data ready for analysis was finalised by April 15, 2009.
139 (out of 149) low- and middle-income countries and 19 high-income countries reported data (among a total of 192 United Nations member states).
By the end of 2008 between 3.7 and 4.3 million people were on antiretroviral treatment including an estimated 275,700 children (38% of those in need) under the age of 15 years.
Progress varies by country and region. In sub-Saharan Africa, for example, where two-thirds of all global infections occur, an estimated 2.9 million people were on treatment by the end of 2008, with an approximate increase of 800,000 people during 2008.
In Latin America, and East, South and South-East Asia antiretroviral coverage is estimated to be 54% and 37%, respectively, whereas in North Africa and the Middle East, and among low- and middle-income countries in Europe and Central Asia, coverage is estimated to be 14 % and 23% respectively.
In 2008 just one percent of pregnant women living with HIV in North Africa and the Middle East received antiretroviral therapy for prevention of mother-to-child transmission.
While there is evidence of increased political commitment for HIV testing and counselling policies, with 90% of reporting countries having national policies in place, knowledge of status remains low; a median of less than 40% of people living with HIV are aware of their status.
The report highlights new data as well as acknowledgment of the dynamics of the epidemic among men who have sex with men, in particular in sub-Saharan Africa where same-sex relations are often considered taboo.
The authors note that population groups at high risk, for example, injecting drug users, sex workers and men who have sex with men, continue to face technical, legal and socio-cultural barriers in accessing health care.
Factors that have hampered progress include weak health care systems, a shortage of health care personnel, stigma and discrimination, and limited access to HIV testing and counselling which is poorly integrated into a continuum of care.
The current global economic crisis not only highlights the obstacles to attaining universal access but also threatens to reverse progress made. Programme budgets will be cut or eliminated and this would mean increasing morbidity and mortality, increasing transmission risks, increased antiretroviral resistance leading to increased burden on health systems and a reversal of economic and social gains.
According to the authors opportunities do exist within this climate. For example, they point to the high levels of commitment pledged to attaining universal access; the increase in access to testing and counselling as well as the emerging evidence on the effects of antiretroviral treatment for prevention of HIV, and they stress that “The hard-won gains of recent years are fragile and call for renewed commitment by all stakeholders.”
WHO, UNICEF, UNAIDS. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. September 2009.