Grave warning about the state of AIDS treatment scale-up

The new AIDS treatment access numbers released by the World Health Organization (WHO) are a grave warning about the state of AIDS treatment scale-up.

In the last 12 months, treatment access grew by 700,000 to a total of two million people, but many millions more remain in urgent need of antiretroviral therapy. At this rate of expansion, the WHO report explains, the world will fall five million people short of the internationally declared and reaffirmed universal treatment access target of 9.8 million on treatment by 2010 (See Note 1).

"The numbers don't tell the full story of what is happening -- the lives lost, families destroyed, villages decimated," said Obatunde Oladapo, from ITPC and the Treatment Access Movement in Nigeria. "This is an avoidable catastrophe unfolding while the world watches it happen."

Why universal access treatment goals are in peril:

Though access to AIDS treatment has expanded over the last three years, there are many disturbing signs that the momentum of the "3 by 5" campaign has been lost, and the AIDS treatment scale-up effort is stagnating:

• Only 26 of over 100 countries have developed costed national plans for key HIV/AIDS interventions
• a more than 75% failure rate to complete the first agreed upon milestone. This lack of national leadership and commitment is the key barrier to saving millions of lives.
• WHO -- the lead United Nations agency on AIDS treatment -- is not sufficiently funded to maintain a strong focus on AIDS treatment scale- up. The agency is trying to managing a diverse set of priorities with a too small budget for HIV/AIDS programs at its headquarters in Geneva.
• The G8 countries have not adequately honored their 2005 Gleneagles commitments to universal access to treatment, prevention and care. Without the funds they have promised to provide, hundreds of thousands of avoidable deaths are inevitable.
• Some AIDS policy makers and advocates continue to pit treatment and prevention against each other, failing to recognize that only a comprehensive response that integrates treatment, prevention and care will reverse the pandemic.

"There is still time to meet the goal of universal access for HIV treatment, prevention, and care," said Gregg Gonsalves, programme director for the AIDS and Rights Alliance for Southern Africa and a member of ITPC. "But not without an integrated approach. 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."

Six actions to avert needless tragedy:

The International Treatment Preparedness Coalition (ITPC), a network of over 800 people living with HIV/AIDS and their supporters from 125 countries, demands that country governments and international donors and institutions take immediate action to accelerate AIDS treatment delivery, using this effort to build stronger health systems that also provide HIV prevention, TB diagnosis and treatment, and other services.

"There is tremendous worldwide support for scaling-up AIDS treatment at the grassroots -- among ordinary men, women and children, among families that are affected by HIV/AIDS," said Frika Chia Iskandar from ITPC and the Asia Pacific Network of People Living with HIV/AIDS in Indonesia. "This momentum can be used to strengthen health services overall in our communities."

ITPC is calling for the following six actions: 1. All countries must submit their fully-costed universal access plans to UNAIDS, including yearly targets and budgets, by June 30, 2007. UNAIDS must publish a list of countries who have and who have not done so by July 15, 2007. 2. WHO must review the countries' treatment scale-up targets and plans and ensure that they are both ambitious and realistic. Using these targets, WHO must then publicize a single, unified global target for universal access to treatment by 2010. This number should either be the current target of 9.8 million people, or a different, realistic number based on cumulative country targets. 3. The G8 must issue an updated statement of commitment to universal access to AIDS treatment, prevention, and care at their June 2007 meeting in Germany. This statement must include specific resource commitments, targets, and timelines. 4. Multilateral, bilateral and private funders must ensure that WHO has the resources to fulfill its mission and leadership role on HIV/AIDS. 5. Working with its partners, WHO must develop: a) A robust plan on access to second line drugs b) A system to gather lessons learned in scale-up and rapidly share them to advance program operations c) Improved technical support to countries to ensure Global Fund and other programs work d) A fully operational human resources effort through the "Treat, Train, and Retain" program that shows concrete outcomes in the near future WHO, both at its headquarters and at its regional offices, must have strong, committed leadership on HIV treatment and be evaluated on key performance indicators by its Executive Board on an annual basis. This evaluation should be publicly available. 6. A Universal Access Strategic Planning and Monitoring Group must be set- up as a standing committee of WHO, UNAIDS, the Global Fund, PEPFAR, the G8, PLWHA networks, treatment activists and organizations representing key populations. It should hold its first meeting by September 2007.

"There is still a chance to keep these five million human beings alive," said Rodrigo Pascal of ITPC from Chile. "The tragedy is that there are simple, practical steps to move us forward, but the commitment of global and country leaders to fulfill their pledges for universal access to AIDS treatment, prevention, and care is dying."

The International Treatment Preparedness Coalition (ITPC) was born at the International Treatment Preparedness Summit that took place in Cape Town, South Africa in March 2003. That meeting brought together for the first time community-based HIV treatment activists and educators from over 60 countries.

Since the Summit, ITPC has grown to include more than 800 activists from over 125 countries and has emerged as a leading civil society coalition on treatment preparedness and access issues.