Two million people are now receiving antiretroviral treatment in developing countries, a 54% increase in one year, according to figures released today by the World Health Organization (WHO) and UNAIDS. But only 28% of those who need treatment are getting it, the report says, and only 11% of women with HIV in Africa are accessing drugs to prevent mother-to-child HIV transmission.
Africa is the region with the greatest number of people now receiving treatment (1.3 million), but this represents coverage of only 28%.
Dr Kevin de Cock, WHO’s HIV/AIDS director refuted criticisms at a press conference in London that the momentum behind universal access to treatment was waning.
“The rate of treatment scale-up has not faltered – 700,000 people began treatment last year. The data don’t support that there’s been a reduction [in momentum].”
However the International Treatment Preparedness Coalition, a network of treatment activists, said that at the current rate of expansion, “the world will fall five million short of the internationally declared and reaffirmed universal treatment access target of 9.8 million on treatment by 2010.”
(However, the UN General Assembly Special Session in 2006 which endorsed universal access did not put a figure on what counted as universal access, either in terms of numbers treated or the proportion of eligible people reached. In developed world health systems, universal access is generally considered to mean treatment coverage of around 80% of the population).
But, said Obatunde Oladapo, of the Treatment Access Movement in Nigeria: “The numbers don’t tell the full story of what is happening – the lives lost, families destroyed, villages decimated. This is an avoidable catastrophe unfolding while the world watches it happen.”
WHO and UNAIDS stressed the importance of better prevention efforts to stem the numbers who become infected.
“If we don’t do better with prevention we will never, never achieve universal access to HIV treatment because the number becoming infected is growing all the time. We cannot treat our way out of this epidemic,” said Kevin de Cock.
Although 700,000 people began antiretroviral treatment last year, said Kevin de Cock, four million people became infected with HIV.
“For every case going onto treatment, six more are going to the back of the line.”
Michel Sidibe of UNAIDS agreed. “The only way to make the investment [in treatment] sustainable is by turning off the tap [of new infections].”
However, some treatment activists are angered by what they see as a failure to make the case for a commitment to universal treatment access, regardless of the scale of the scale of the epidemic.
“Increased prevention efforts are critical, but those who say that treatment is unsustainable with the current number of people living with HIV/AIDS should understand that this is an implicit call to sacrifice millions of lives rather than provide the necessary resources to save them,” claimed Gregg Gonsalves of the AIDS and Rights Alliance for Southern Africa.
Treatment activists are also highly critical of country progress towards setting treatment targets. In contrast to the rosy picture painted by WHO, the International Treatment Preparedness Coalition today highlighted the fact that only 26 of over 100 countries have developed fully costed national plans for key HIV/AIDS interventions.
“This lack of national leadership and commitment is the key barrier to saving millions of lives,” an ITPC press release stated. ITPC is calling for all countries to submit their fully-funded universal access plans to UNAIDS, including yearly targets and budgets, by June 30, 2007. In addition they call on UNAIDS to publish a list of countries that have not done so by July 15, 2007.
The WHO report highlights progress towards target setting and scale-up in high burden countries:
- In India treatment coverage had expanded to a maximum of 15% of eligible adults with HIV by December 2006 (95,000), and the Indian government’s AIDS control programme has set a target of providing treatment to 62% of eligible adults and children by 2010.
- In Kenya treatment coverage had expanded to reach 44% of eligible adults by December 2006, and the country has set a national target of reaching 75% of eligible men and 80% of eligible women by 2010.
- In Mozambique treatment was reaching approximately 14% of those who needed it by December 2006, and the national plan has set a target of providing antiretroviral treatment to 39% of eligible adults by 2009.
- In Tanzania, treatment was reaching around 18% of those who needed by the end of 2006. The national target is to reach 62% of those who need treatment by 2010.
WHO says that fears about long-term sustainability of treatment programmes are limiting the scope and rate of scale-up in many countries.
Michel Sidibe of UNAIDS stressed that a further financial commitment was needed at the forthcoming G7 meeting of the most wealthy industrialised nations in early June, in Germany.
“We need between $20 billion and $23 billion by 2010,” said Michel Sidibe.