The United States and other wealthy nations are trying to avoid setting another target for HIV treatment access ahead of the UN General Assembly’s Special Session on AIDS (UNGASS), which starts tomorrow in New York. Advocates charge that donors see another target like `3 x 5` (which advocated for three million to receive treatment by the end of 2005) as a hostage to fortune.
The declaration that will be issued by the summit has been the result of lengthy negotiations, with particular conflict between the United States and other nations on setting numerical targets for the numbers who will receive treatment by 2010. The US is also resisting the inclusion of passages in the declaration which promote the rights of `vulnerable groups`, and empowerment of women.
The push for `universal access` began with a commitment made by G8 leaders at last year’s Gleneagles summit, at which heads of government committed to make
Definitions of universal access are controversial. Whilst UNAIDS has been working on the assumption that universal access is achieved if 80% of the HIV-positive population have access to treatment.
Earlier this month the African Union, meeting in Abuja, Nigeria, committed to ensuring universal access to treatment in Africa, and to vastly improve coverage of services that can prevent mother to child transmission of HIV using antiretroviral drugs.
However, Nigeria’s president Olusegun Obasanjo said: "We have now agreed that we are going to have universal access. Universal access is not talking of 80 percent, not even 90 percent. It's 100 percent access to preventive and treatment services."
The failure to agree on targets for numbers on treatment has also angered many non-governmental organisations, who believe that governments, donors and multilateral institutions such as the World Health Organization and UNAIDS need global targets like “3 by 5” in order to be held accountable.
“Left to their own devices, some developing country governments will set targets that are not adequate, that lack ambition or are too narrowly defined to bring about the changes in health and social systems that will secure universal access,” said Dr Alvaro Bermejo, executive director of the International HIV/AIDS Alliance.
“Equally, without internationally agreed targets, we run the risk of letting rich countries and donor governments believe this is no longer their fight”, he added.
Unsurprisingly these institutions disagree, pointing to problems caused at country-level by the imposition of external targets. This time, says UNAIDS, countries will be encouraged to come up with their own `ambitious` numbers, and it recommended that “no credible plan should go unfunded”.
The International HIV/AIDS Alliance has called for a target of ten million on treatment by 2010; at a WHO stakeholders consultation last month its new HIV director Dr Kevin de Cock said that he expected between nine and 14 million will be receiving treatment by 2010, but that it would be damaging for WHO to set another target that it doesn’t have the power to enact.
But former 3 x 5 boss Dr Paolo Teixiera, who quit the post due to illness, said: “WHO has a responsibility to say `if the condition are in place, how many people is it possible to treat by 2010?`.”
Last minute lobbying by civil society organisations, including people living with HIV from around the world, is now taking place in New York.