AIDS status & challenges of the epidemic

7. What should be done to improve prevention and access to treatment?

• 7.1 How can AIDS prevention be strengthened?
• 7.2 How can treatment access be expanded?
• 7.3 How can human resources and systems be strengthened?
• 7.4 How can HIV prevention and treatment become more available and affordable?
• 7.5 What are the main needs in the field of research and development?
• 7.6 How can the broader social impact of AIDS be countered?

To get as close as possible to the goal of offering treatment to all those who need it by 2010, a series of key areas require commitment and action: prevention, access to treatment, human resources, treatment and prevention products, research, and social impact. More...

7.1 How can AIDS prevention be strengthened?

It is critical to renew the emphasis on HIV prevention and to strengthen it in order to prevent millions of new infections each year.

Access to clear, factual HIV prevention information and to HIV testing should be a right. Each person should know his or her HIV status and have access to AIDS information, counselling and related services.

HIV prevention services and education should target vulnerable groups, including sex workers, injecting drug users, men who have sex with men, and prisoners. Other population groups that should benefit from a better access to adequate prevention services include HIV-infected pregnant women who are at risk of transmitting the disease to their children (in the womb, during childbirth, or through breastfeeding) and young people who account for 40% of all new infections. More...

7.2 How can treatment access be expanded?

Ensuring that access to HIV treatment continues to grow rapidly will require a series of efforts:

• Access to confidential and voluntary HIV testing should be broadened so that more people know whether they are infected or not;
• Additional sites where treatment can be provided, which are so far largely concentrated in urban areas, should be established, and all population groups affected, including children, must be assured equal access to treatment;
• Access to drugs that prevent common HIV-related infections should be expanded
• HIV-related stigma and discrimination should be reduced;
• More medical workers should be trained to deal with HIV and AIDS, and the drug supply should be improved;
• The public should be made aware of available treatment services, their benefits and how to use them.

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7.3 How can human resources and systems be strengthened?

The shortage of skilled workers in many developing countries leads to poor surveillance, planning and administration; bottlenecks in the distribution of funds; failures in the implementation, monitoring and evaluation of activities; and inadequate provision of services.

Eliminating these obstacles will require:

• rapid recruitment and training of additional health-care workers and improving incentives that encourage them to work in their own countries instead of migrating to industrialized countries,
• increasing public financing for training in countries facing severe human resource shortages,
• encouraging the provision of HIV prevention, treatment, care, and support by locals where not enough trained health professionals are available,
• better integration of AIDS services into other primary health care programmes (such as programmes addressing mother and child health, sexual and reproductive health, and diagnosis and treatment of tuberculosis, malaria and sexually transmitted diseases).

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7.4 How can HIV prevention and treatment become more available and affordable?

Ensuring that HIV prevention and treatment products such as condoms and antiretroviral drugs are available and affordable will require a series of measures:

• National governments should remove taxes on medicines, condoms and other products that are used for the prevention, treatment, care and support of AIDS, and should also remove laws or regulations that might hinder access to these products.
• Governments should allow medicines into the market as soon as they are approved by the WHO in order to speed up access to new treatment.
• Governments should ensure that the few drugs available to treat and prevent HIV in children reach at least 80% of those in need by 2010.
• Many vitally needed medicines are covered by patents that can limit their use and make them expensive. While drug companies need a sufficient incentive to invest in research and development, AIDS medications must be produced as cheaply and widely as possible to meet the needs of developing countries. Where necessary, countries should make use of the flexibilities in the agreements on intellectual property to ensure they have sustainable supplies of affordable medicines and health technologies, including through local production.

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7.5 What are the main needs in the field of research and development?

It is vital to promote technological innovation to develop microbicides, new generations of drugs, and a preventive vaccine.

Therefore, substantially more money must be allocated to research, especially by the pharmaceutical and biomedical industries. In addition, partnerships between the public sector and private companies should be developed to promote faster development of new drugs for children with HIV. Stakeholders should also be involved in the planning and conduct of clinical trials for HIV prevention so as to avoid the controversies these trials often generate. Finally, systems and agreements that guarantee wide and equitable access to treatment products for HIV and HIV-related diseases must be put into place by governments, civil society, and the private sector. More...

7.6 How can the broader social impact of AIDS be countered?

AIDS exacerbates every other challenge to human development, such as food security and conflict avoidance. Therefore, efforts to reduce the impacts of AIDS must focus at the same time on preventing new infections, caring for those already infected and mitigating the economic, institutional and social impacts of AIDS.

• Efforts to reduce the impact of AIDS should focus first of all on the individuals and families affected, for instance by providing access to therapy, nutritional assistance, and treatment for HIV-related infections and other health problems.
• Children who have lost one or both parents to AIDS need to receive special attention,
• Social protection measures should be taken to preserve livelihoods of people affected by AIDS, including welfare programmes, child and orphan support, and public works to provide employment.
• Refugees or displaced persons are vulnerable populations that should be included in prevention, care and treatment planning in the countries that host them.
• The Chinese AIDS program could serve as a model in supporting families and societies affected by AIDS, since it offers free antiretroviral drugs, voluntary counselling and testing, drugs to prevent mother-to-child transmission, schooling for orphaned children, and care and economic assistance to affected households.

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