An estimated 3 million HIV-positive patients in low- and middle-income countries were receiving antiretroviral therapy at the end of 2007, according to a report released today. Although this is being praised as a “remarkable” public health achievement it means that less than a third of the 9 million-plus patients in need of anti-HIV drugs in the world’s poorer countries are actually being treated with them.
Other encouraging progress contained in the report, which was prepared by the World Health Organization, UNAIDS and UNICEF, includes expanded access to interventions to prevention mother-to-child transmission of HIV, and increasing levels of HIV testing and counselling.
However, the report, Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, also showed that significant obstacles remain in the way of delivering anti-HIV treatment to those who need it most.
Provision of anti-HIV therapy to 3 million people by the end of 2007 means that the target of the “3 by 5” initiative, which aimed to provide anti-HIV drugs to 3 million people in middle- and low-income countries by the end of 2005 has been met – albeit two years late.
“This represents a remarkable achievement for public health”, said Dr Margaret Chan, Director-General of WHO. She added the provision of anti-HIV treatment to this number of people “proves that, with commitment and determination, all obstacles can be overcome”.
Dr Chan was keen to emphasise the economic rationale for expanding access to antiretroviral treatment, commenting “people living in resource-constrained settings can indeed be brought back to economically and socially productive lives with these drugs.”
It is estimated that 950,000 additional patients received anti-HIV drugs in 2007 compared to the year before. This near-33% expansion in access to anti-HIV treatment in a single year has been credited to a number of factors particularly increased availability of drugs, not least because of significant price reductions. Health systems are also better at delivering fixed-dose antiretroviral therapy, according to the report.
2007 also saw 500,000 HIV-positive women access treatment to prevent the transmission of HIV to their children, an increase from 350,000 in the year before. And there was also an increase in 2007 in the number of children treated with antiretrovirals – 200,000 compared to 127,000 in 2006.
“We are seeing encouraging progress in the prevention of HIV transmission from mother to newborn”, said Ann Veneman of UNICEF, adding “this report should motivate us to focus and redouble our efforts on behalf of children and families affected by HIV”.
Dr Peter Piot was of UNAIDS was also upbeat about the report’s findings, saying it “highlights what can be achieved despite constraints that countries face and is a real step towards universal access to HIV prevention, treatment care and support.”
The report also highlighted increased commitment to male circumcision in some sub-Saharan African countries, an intervention which some prevention workers believe could significantly reduce the risk of HIV infection for men.
But the report’s optimism by tempered by an acknowledgement of the difficulties preventing further access to anti-HIV treatment. In particular the authors note that there are still large numbers of undiagnosed patients in many resource-limited countries. Furthermore, significant numbers of patients are having their HIV diagnosed so late that they are unable to benefit from anti-HIV treatment and die in the first six months of treatment, before anti-HIV treatment has had a chance to work.
Other patients are unable to obtain the long-lasting benefits of anti-HIV treatment because they are being not being retained by healthcare systems, the report also found.
What’s more, although tuberculosis (TB) is the single biggest cause of illness and death in HIV-positive individuals, HIV and TB services are rarely integrated. The report states that this is resulting in many avoidable deaths.
Further expansion of access to anti-HIV treatment is being threatened by weak healthcare systems, with a lack of key staff and facilities. And the report observes that many of the countries hardest hit by HIV are being affected by a “brain drain” with essential personnel being recruited to jobs in richer countries.
“Countries and the international community must now…work together to strengthen both prevention and treatment efforts”, said Peter Piot of UNAIDS.