U.N. agencies' report examines global progress in fight against HIV/AIDS

"A record 1.2 million people in low- and middle-income countries started antiretroviral therapy for HIV/AIDS in 2009" - a 30 percent increase from the previous year and a 13-fold increase in six years, according to a joint report released Tuesday by the WHO, UNICEF and UNAIDS, Reuters reports. In total, the report found that 5.25 million people received antiretroviral therapy (ART) in 2009, three-quarters of them living in Africa (Migiro, 9/28).

Nearly one million more people started on ART in sub-Saharan Africa in 2009, which now means 37 percent of those in need are getting treatment there, Xinhua reports. "Latin America and the Caribbean region reached 50 percent coverage for ART, East, South and Southeast Asia - 31 percent, Europe and Central Asia - 19 percent, and North Africa and the Middle East - 11 percent," the article writes (Ooko, 9/28).

"Despite accelerating progress, the report covering 183 nations underlined that only one-third of those in need worldwide have access to life-saving antiretroviral drugs to counter the human immunodeficiency virus (HIV) that causes AIDS," Agence France-Presse reports. Additionally, the report "estimated that most people with HIV were still unaware that they were infected - about 60 percent of people in low- and middle-income countries." The report also noted that stigmatization still hampers people's ability to get treatment and care (Capella, 9/28). Only 28 percent of children living with HIV/AIDS in need of ARVs had access to the drugs, Health-e adds (Thom, 9/28). 

"The report warned that 'on a global scale, targets for universal access to HIV prevention, treatment and care will not be met by 2010', raising doubts over the G8 nations' commitment to reach 'as close as possible' to treatment for all who need it by 2015," the Financial Times reports. "The gap between forecast needs and current programmes has widened in recent months following new international treatment guidelines that recommend patients are given antiretroviral medicines earlier after contracting HIV, extending the estimates of those who would benefit from drugs from 10m to nearly 15m," the newspaper writes (Jack, 9/28).

The report, did, however document signs of "significant progress in improving access to HIV/AIDS services in 37 developing countries," U.N. News Centre writes. According to the report, "15 countries were able to provide more than 80 percent of HIV-positive pregnant women with the services and medicines needed to prevent mother-to-child transmission, while 14 countries provided HIV treatment to more than 80 percent of their HIV-positive children" (9/28).

Additionally, "[t]he report said eight low- and middle-income countries - Botswana, Cambodia, Croatia, Cuba, Guyana, Oman, Romania and Rwanda - met the goal of giving treatment to at least 80 percent of patients in need in 2009, well ahead of the end-2010 deadline agreed by world leaders in 2006," Reuters continues (9/28).

"Countries in all parts of the world are demonstrating that universal access is achievable," Hiroki Nakatani, WHO's assistant director-general for HIV/AIDS, tuberculosis, malaria and neglected tropical diseases, said in a WHO press release. "But globally, it remains an unfulfilled commitment. And we must join forces to make it a worldwide reality in the coming years," Nakatani added.

The release notes the "[r]emarkable progress in Eastern and Southern Africa, the region most severely affected by HIV," where "HIV treatment coverage has increased from 32% to 41% in one year. And half of the pregnant women were able to access HIV testing and counseling in 2009," as well as the obstacles to scaling up HIV treatment in developing countries, "including funding shortages, limited human resources, and weak procurement and supply management systems for HIV drugs and diagnostics and other health systems bottlenecks" (9/28).

Also, "[a]mong infants and children exposed to HIV, access to early testing, care and treatment is still a challenge. More than 90 percent of children living with HIV are infected through mother-to-child transmission during pregnancy, around the time of birth or through breastfeeding," Inter Press Service reports in an article that examines the HIV testing and treatment rates of pregnant women and children living in sub-Saharan Africa. "The challenges facing Sub-Saharan Africa include weak integration of services, persistent drug stock-outs and little follow-up of patients started on treatment." The article examines several contributing factors to the disparities in progress in treating pregnant women living with HIV/AIDS in different regions of Africa, as indicated in the report (Anyangu-Amu, 9/28).

Report Calls For International Donors, National Governments To Recommit To Global HIV/AIDS Programs

"We're on the right track," Paul De Lay, deputy executive director of UNAIDS, said, according to BERNAMA. "We've shown what works and now we need to do more of it. But we're US$10 billion short," he said (9/29).

The release of the report precedes next week's meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Associated Press/Independent Mail reports (9/28). The Global Fund, a major donor to HIV/AIDS programs worldwide, "will hold a conference in New York on Oct. 4-5 in which it is seeking between [$13 billion] and $20 billion in pledges between 2011 and 2013," Reuters adds (9/28).

Though the meeting is expected to present an opportunity for "donor countries [to] reaffirm their commitments" to the Global Fund, Inter Press Service reports that there is growing recognition among health experts that the current economic situation will require national governments to also invest more in HIV/AIDS programs to meet the needs of their populations.

"Because of the financial situation globally and the fact that the money is unlikely to get larger, national governments [in developing countries] themselves need to pick up the slack," Jimmy Kolker, chief of HIV and AIDS at UNICEF said. "The good news is that more of the AIDS expenditure proportionally is coming from national governments. Decisions in countries like Kenya, Botswana, South Africa, Namibia to pay for the antiretrovirals themselves is a huge step forward, and that needs to be encouraged," he added (Berger/Boaz, 9/28).

"Under the Abuja Declaration, made in the Nigerian capital in 2001, African Union member states pledged to raise their domestic health allocation to at least 15 percent of the national budget, but few countries have met that commitment," IRIN/PlusNews reports in an article that also examines the need "to enhance the impact of current investments" in HIV/AIDS programs. "The report notes that allocations would have to grow by over 50 percent, on average, to meet the Abuja target," according to the article (9/28).

"We are not going to be able to reverse the epidemic unless national partners and especially national governments see this as a good investment of their own resources," Kolker added, according to IPS. The article also includes comments by Bernhard Schwartlander, director of evidence, strategy and results at UNAIDS, who discusses more efficient funding for HIV/AIDS, including the integration of HIV/AIDS care into other health services (Berger/Boaz, 9/28).

The WHO release notes that the report concludes with an appeal "for a clear set of actions to be taken by the international community including: renewing political and funding commitments to achieve universal access to HIV/AIDS prevention, treatment and care; improving integration and linkages between HIV/AIDS and related services such as tuberculosis, maternal and child health, sexual health and harm reduction for drug users; strengthening health systems to achieve broader public health outcomes; and taking bold measures to address legal and structural barriers that increase HIV vulnerability, particularly for most-at-risk populations" (9/28).

A Reuters factbox provides a breakdown of the major findings of the report (9/28).