Asian shortage
According to Australia's Ambassador on HIV/AIDS, Murray Proctor, Asia is falling short on HIV/AIDS treatment as almost 400,000 new cases are reported each year. He was attending a regional conference on universal access to treatment for AIDS where he said availability and price of vital anti-retroviral or anti- HIV medications remain a challenge for the region.
Addressing the 200 delegates from the Asia-Pacific region preparing for a United Nations General Assembly meeting in New York in June he said, “New infections are outstripping the response and certainly access to treatment people can have.”
UNAIDS estimates across Asia some five million people are living with HIV, little changed from five years earlier. There are some 360,000 people newly infected with HIV in 2009 from 450,000 in 2001, a fall of 20 per cent. While India, Nepal and Thailand saw new infection rates fall by 25 per cent in the eight years to 2009, new HIV infections rose by more than 25 per cent in Bangladesh and the Philippines over the same period.
Mr Proctor added more attention needs to focus on preventing the spread of the virus. “We haven't been as good with prevention as we have with treatment. There have been some really major successes in reducing the transmission to children from mothers who are HIV positive…The challenge is still though to get the prevention message across to high risk groups and differently in different places,” he said.
In Asia, UNAIDS in a 2009 report warned the group at greatest threat to HIV in the near term will be among men who have sex with men. “So there are needs to get better access to those specific populations - often urban in that case - and get the message through,” Mr. Proctor said. Australia has stepped up financial support to the UN Global Fund on the treatment of AIDS, malaria and tuberculosis to $210 million last year, representing a 50 per cent increase in assistance. Mr Proctor said Australia was also supporting international efforts to “reduce legal impediments” to an effective public health response to HIV.
Delegates from 24 Asia-Pacific countries attending a United Nations meeting in Bangkok on HIV/AIDS in Asia say more work is needed to reverse the epidemic, including better prevention efforts and access to treatment.
The regional director for the U.N. Children’s Fund in East Asia and the Pacific, Anupama Rao Singh, says only 30 percent of adults and 44 percent of children who need the treatments are able to get them. “HIV prevention services still fall short of the level required to reverse the course of HIV in the most populous part of the world. The larger issues of stigma and discrimination, outmoded legislations, inadequate domestic resource commitments and policies that do not adequately take account of equitable access, will remain barriers to effective prevention, treatment, care and support if they are left unaddressed,” Singh said. Singh says Asian heads of state need to better support HIV/AIDS programs.
Rise in treated cases
In less than a year, more than 70,000 people have joined the HIV treatment programme, exerting massive pressure on drugs, facilities and personnel say experts. By the end of November 2010, the number of people on the antiretroviral (ARV) treatment programme was 440,117, excluding those getting drugs through the private sector.
Of these, 404,198 were adults and 35,919 were children. About 8,000 people are now being enrolled on the treatment every month, notes Nascop’s Kenya Anti-Retroviral Drugs Stock Situation - December 2010 report. However it is estimated that over 400,000 HIV/Aids patients in need of HIV treatment are yet to be reached.
The National Aids Control Council (NACC) has set up a Technical Working Group chaired by Prof Richard Muga in response to these rising numbers. The team is expected to present it report and policy recommendations before the June Budget. This move is coming at a time when estimates from the government and organizations working on HIV indicate that by June this year, over half a million people will be on treatment.
Experts believe that this rise is due to two reasons - the rapid results initiative and the adoption by the government of the new WHO guidelines that require a person to start ARV treatment when the CD4 count is 350 and below instead of the 200 and below CD4 count being used by health facilities in line with 2005 government guidelines. This means all persons who have between 200 and 350 CD4 counts are now eligible to enlist in the treatment programme. The increased numbers are also escalating the cost of running CD4 count tests and putting more pressure on the few nurses and doctors who have to manage the now high number of HIV patients.
US President’s Emergency Plan for AIDS Relief (Pepfar), which supports half of the patients on treatment, for instance, has indicated that it is not going to increase the current HIV/Aids funding for the next four years. By September, 2011, the Clinton Health Access Initiative, the main funder for HIV treatment programmes for children, will stop any further procurement of pediatric ARVs, according to Nascop’s Kenya Anti-Retroviral Drugs Stock Situation-December 2010. The Global Fund, has been unable to realize its desired funding which might have adverse future implications on the funding extended to Kenya. In October 2010 at the Fund’s Third Voluntary Replenishment meeting in New York, donor governments pledged US$11.7 billion for the years 2011-2013, but this was less than the US$13 billion ‘lowest funding level’ identified by the Fund as necessary to continue to expand its work and far less than the ‘ideal’ US$20 billion objective.
The Technical Working Group on Sustainability for HIV/Aids, Kenya, 2010 report warns that between 2010 and 2014, the ARV and Prevention of Mother To Child Transmission (PMTCT) programmes are going to experience a funding gap in excess of Sh15 billion. With such trend, the country may not be able to sustain more people on treatment programme unless the current funding sources and levels are sought for.
“We need to start thinking more of how to use resources generated locally to finance these programmes,” says Dr Ibrahim Mohamed, the Head of National Aids and STD Control Programme (Nascop).
Affordability and supply remain critical to the success of long-lasting HIV drug