AIDS status & challenges of the epidemic

3. How has HIV prevention and treatment evolved since 2001?

• 3.1 Has HIV Prevention improved?
• 3.2 Do those in need have access to treatment and care?

The source document for this Digest states:

Overall, leadership and political action on AIDS have increased significantly since 2001.

• Internationally, in 2005 the United Nations World Summit, the G8 industrialized countries. ⁷ and the African Union all endorsed the universal access goal, while the Group of 77 countries acted to prioritize enhanced South-South cooperation on HIV prevention, treatment, care and support. Increased regional collaboration has been demonstrated by the efforts of the Pan Caribbean Partnership against HIV/AIDS; the Asia Pacific Leadership Forum on HIV/AIDS and Development; the European Union and the Commonwealth of Independent States focus on increased action against AIDS in eastern Europe; and the collaborative efforts of Latin American countries to negotiate antiretroviral drug price reductions.
• Ninety per cent of reporting countries now have a national AIDS strategy; 85% have a single national body to coordinate AIDS efforts; and 50% have a national monitoring and evaluation framework and plan.
• Systems to implement these plans remain inconsistent, however, as does civil society involvement and, specifically, involvement of people living with HIV.

⁷ In the final communiqué of the 2005 Gleneagles Summit, the G-8 nations committed to “working with WHO, UNAIDS and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of coming as close as possible to universal access to treatment for all those who need it by 2010”

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The declaration of commitment on HIV/AIDS: Progress since 2001, Leadership, p.10

For more information on this question, see:
 Chapter 03 Progress in countries, Leadership, p.54,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS

3.1 Has HIV Prevention improved?

The source document for this Digest states:

While some countries have significantly increased prevention coverage, prevention programmes still reach only a small minority of those in need, and a number of prevention targets are not being reached.

• Analyses consistently show that interventions to change behaviour reduce the frequency of sexual risk behaviours. Countries that have lowered HIV incidence have benefited from the emergence of new sexual behaviour patterns—fewer commercial sex transactions in Cambodia and Thailand, delayed sexual debut in Zimbabwe, increasing emphasis on monogamy in Uganda and an increase in condom use overall.
• Most countries, however, appear to have missed the Declaration target of ensuring that 90% of young people in 2005 have access to critical HIV prevention services including services to develop the life-skills needed to reduce vulnerability to HIV. In fact, none of the 18 countries in which young people were surveyed by the Demographic Health Survey/AIDS Indicator Survey between 2001 and 2005 had knowledge levels exceeding 50%.
• UNFPA, the largest public-sector purchaser of male condoms, estimates the global supply of public-sector condoms is less than 50% of that needed and that current funding for condom procurement and distribution must increase threefold.
• More than 340 million people contract a curable sexually transmitted infection each year, with women having greater vulnerability to infection than men. Despite the fact that untreated sexually transmitted infections increase the risk of HIV transmission by several orders of magnitude, coordination of diagnosis and treatment of sexually transmitted infections and HIV remains very low.
• There are also disturbing signs that support for HIV prevention may be diminishing in some regions. This represents a tremendous lost opportunity, as scaling up available prevention strategies in 125 low - and middle- income countries would avert an estimated 28 million new HIV infections between 2005 and 2015—more than half of those that are projected to occur during this period —and would save US$ 24 billion.
• Unsafe injections and contaminated blood transfusions in healthcare settings are still cause for concern. National HIV prevention programmes should promote adherence to sound infection control practices in health-care settings.

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The declaration of commitment on HIV/AIDS: Progress since 2001, HIV Prevention, p.11

For more information on this question, see:
 Chapter 03 Progress in countries, Prevention, p.59,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS

3.2 Do those in need have access to treatment and care?

The source document for this Digest states:

Number of people on antiretroviral therapy in low and middle income countries, 2002-2005

In recent years, AIDS has helped drive a global revolution in the delivery of complex therapy in resource limited settings. The 2001 Declaration of Commitment on HIV/AIDS embraced equitable access to care and treatment as fundamental to an effective global HIV response. Since then, the “3 by 5” initiative, the US President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and initiatives such as employer programs have definitively demonstrated the feasibility of delivering HIV treatment in resource-limited settings.

• Between 2001 and 2005, the number of people on antiretroviral therapy in low - and middle- income countries increased from 240 000 to approximately 1.3 million.
• The number of sites providing antiretroviral drugs increased from roughly 500 in 2004 to more than 5000 by the end of 2005.
• By the end of 2005, 21 countries met the “3 by 5” target of providing treatment to at least half of those who need it.
• Expanded treatment access was estimated to have averted 250 000 to 350 000 AIDS deaths between 2003 and 2005.
• Globally, however, antiretroviral drugs still reach only one in five who need them.
• Ongoing obstacles to expanding treatment access include out-of-pocket costs for patients, the concentration of treatment sites in urban areas, and inadequate efforts to address the needs of vulnerable populations, including sex workers, men who have sex with men, injecting drug users, prisoners and refugees.
• As many second-line antiretroviral drugs remain too costly for use in many countries, further price declines are likely to be needed to sustain and expand treatment access initiatives.
• Maintaining and expanding momentum in treatment scale-up towards the universal access goal will require more leadership to overcome key barriers to treatment access through efforts to:
  
  
  • increase individual knowledge of HIV status through a sharp increase in use of voluntary HIV counselling and testing services;
  • reduce HIV stigma including fear, misinformation and discrimination against people living with or perceived to be at risk of HIV, both among health providers and among the general public;
  • build human capacity to sustain treatment through training and better use of current human resources. WHO’s training tools for the Integrated Management of Adolescent and Adult Illness and the Integrated Management of Childhood Illness have enabled the training of more than 15 000 providers of HIV-related services in an integrated approach to antiretroviral therapy, care and prevention;
  • improve supply management to minimize delays in procurement and disbursement of antiretroviral drugs by building capacity to gauge future demand for antiretroviral drugs and to implement reliable procurement, delivery and supply systems; and
  • integrate HIV care with other health services to increase uptake of antiretroviral therapy and deliver more comprehensive, higher-quality care, for example by linking HIV care with tuberculosis diagnosis and treatment, and with antenatal and reproductive health care.

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The declaration of commitment on HIV/AIDS: Progress since 2001, Care, Support and Treatment, p.12

For more information on this question, see:
 Chapter 03 Progress in countries, Care, support and treatment, p.67, and
 Chapter 07 Treatment and care, p.150,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS