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?

The source document for this Digest states:

At the 2005 meeting of the G8 nations and the September 2005 United Nations World Summit, world leaders committed to a massive scale-up of HIV prevention, treatment and care, with the aim of coming as close as possible to the goal of universal access to treatment by 2010 for all who need it. Making this commitment a reality will require commitment and action in each of the following key areas

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The movement towards universal access, p. 20

For more information on this question, see:
 Chapter 12 From crisis management to strategic response,
Towards universal access, p.286
of the full 2006 Report on the global AIDS epidemic  by UNAIDS

7.1 How can AIDS prevention be strengthened?

The source document for this Digest states:

A renewed emphasis on HIV prevention is critically needed to prevent millions of new infections each year.

• HIV prevention services and education must be targeted to vulnerable groups, including sex workers, injecting drug users, men who have sex with men, and prisoners. Access to services to prevent mother-to-child HIV transmission must increase significantly to reduce the unacceptable and largely preventable burden of HIV on newborns.
• Access to clear, factual HIV prevention information and to HIV testing should be a right. Countries should promote the idea that each person knows his or her HIV status and has access to AIDS information, counselling and related services, in an environment that is safe for confidential testing and voluntary disclosure of HIV status.
• Even though available evidence indicates that coverage of prevention programmes is higher in sex workers—compared to men who have sex with men and injecting drug users—additional efforts are critical to ensure an adequate rate of coverage in all three groups.
• On a more encouraging note, the percentage of young people having sex before the age of 15 declined and condom use increased between 2000 and 2005 in nine of 13 subSaharan countries studied. However, HIV prevention efforts remain notably inadequate for young people, who account for over 40% of all new infections. Investing in prevention programmes for young people is critical.

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The movement towards universal access, Strengthen AIDS prevention, p. 20

For more information on this question, see:
 Chapter 12 From crisis management to strategic response,
Strengthen AIDS prevention, p.286, and
 Chapter 06 Comprehensive HIV prevention, Intensifying HIV prevention, p.124,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS

7.2 How can treatment access be expanded?

The source document for this Digest states:

Continuing and expanding rapid scale-up of HIV treatment access will require:

• expanding and diversifying treatment access sites, which are now concentrated largely in urban areas, along with efforts to ensure equity in access among all affected populations, including children;
• expanded efforts to increase access to drugs that prevent common opportunistic infections, such as the antibiotic cotrimoxazole;
• broadening confidential and voluntary access to HIV testing, to increase knowledge of serostatus;
• efforts to reduce HIV-related stigma and discrimination, build human resource capacity in health systems settings and improve supply management; and
• expanded treatment advocacy and education to build awareness of treatment services, their benefits and how to use them.

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The movement towards universal access, Build treatment access, p. 21

For more information on this question, see:
 Chapter 12 From crisis management to strategic response,
Build treatment access, p.290,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS

7.3 How can human resources and systems be strengthened?

The source document for this Digest states:

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 human resource obstacles will require:

• speeding recruitment and training of health-care workers at all levels and improving working conditions, remuneration and other incentives to encourage trained health-care professionals to work in their home countries rather than migrating to industrialized countries;
• action by national governments and international donors to increase financing for training and accreditation centres in countries facing severe human resource shortages;
• the adoption, where needed, of alternative and simplified delivery models to strengthen the community-level provision of HIV prevention, treatment, care and support; and
• increased integration of AIDS interventions into programmes for primary health care, mother and child health, sexual and reproductive health and diagnosis and treatment of tuberculosis, malaria and sexually transmitted diseases.

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The movement towards universal access, Build treatment access, p. 21

For more information on this question, see:
 Chapter 12 From crisis management to strategic response,
Strengthen human resources and systems, p.288,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS

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

The source document for this Digest states:

Increasing action to ensure the affordability of prevention and treatment products, from condoms to antiretroviral drugs, will require the following actions.

• National governments should remove barriers in pricing, tariffs and trade and regulatory policy to medicines, and diagnostics, and should reduce or eliminate user fees for AIDS-related prevention, treatment, care and support. Legal or regulatory barriers that block access to effective HIV prevention interventions and commodities such as condoms, harm reduction services and other prevention measures should also be removed.
• To speed the flow of treatment, governments should allow WHO prequalified medicines to obtain provisional marketing approval prior to full registration by national drug regulatory authorities.
• Access to the few paediatric formulations of antiretroviral drugs and drugs to prevent opportunistic infections is seriously inadequate. Leaders should review and enact the recommendations of the 2005 UNICEF and UNAIDS "call to action" to ensure that antiretroviral therapy or antibiotic prophylaxis, or both, reaches 80% of children in need by 2010.
• Ensuring the availability and affordability of vitally needed medicines—including second, third and fourth generations of drugs—means addressing the complex, sensitive and contentious issues of pharmaceutical patents. Where necessary, countries should employ the flexibilities of the WTO Agreement on Trade-related Aspects of Intellectual Property Rights to secure access to sustainable supplies of affordable HIV medicines and health technologies, including through local production where feasible.

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The movement towards universal access,
Ensure available and affordable products for HIV prevention and treatment, p. 22

For more information on this question, see:
 Chapter 12 From crisis management to strategic response,
Ensure available and affordable commodities, p.289,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS

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

The source document for this Digest states:

Continued technological innovation is vital for the development of microbicides, new generations of drugs and a preventive vaccine.

• Substantially greater research funding must be mobilized, especially from the pharmaceutical and biomedical industries.
• The needs of children with HIV have been largely left out of the research agenda. Pharmaceutical companies, international donors, multilateral organizations and other partners should develop public-private partnerships to promote faster development of new paediatric drug formulations.
• HIV prevention clinical trials often generate controversy, highlighting the need for researchers to engage a broad range of community and national stakeholders in the planning and conduct of those trials.
• Government, civil society and private sector leaders must put into place the systems and agreements that will guarantee wide and equitable access to microbicides, new generations of drugs, and vaccines for HIV and sexually transmitted infections, as well as improved treatments for diseases such as tuberculosis, which now accounts for the largest proportion of global AIDS-related deaths.

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The movement towards universal access,
Invest in research and development for drugs, microbicides and vaccines, p. 22

For more information on this question, see:
 Chapter 12 From crisis management to strategic response,
Invest in Research and Development, p.291,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS

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

The source document for this Digest states:

Percentage of distribution of deaths by age in southern Africa, 1985-1990 and 2000-2005

AIDS exacerbates every other challenge to human development, from maintenance of public services to food security and conflict avoidance. Efforts to address the epidemic must simultaneously focus on preventing new infections, caring for those already infected and mitigating the economic, institutional and social impacts of AIDS.

• Efforts to mitigate the impact of AIDS must focus first on the individuals and families affected through interventions such as access to therapy, nutritional assistance and treatment for opportunistic infections and other health issues.
• The needs of children who have lost one or more parents to AIDS, which include approximately 9% of children under the age of 15in sub-Saharan Africa, should be prominently included in national AIDS plans and strategies.
• Social protection measures to preserve livelihoods of people affected by AIDS, including welfare programmes, child and orphan support, public works to provide employment, state pension systems and micro-financing should be part of AIDS planning and services.
• Leaders of countries that host refugees or displaced persons must incorporate these large and vulnerable populations into their prevention, care and treatment planning.
• China’s “Four Frees and One Care” program, which 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, may provide a model for other nations in supporting families and societies affected by AIDS.”

Source & ©: UNAIDS  Report on the global AIDS epidemic: Executive summary, (2006),
The movement towards universal access, Counter the impact of AIDS, p. 23

For more information on this question, see:
 Chapter 12 From crisis management to strategic response,
Invest in Research and Development, p.291,
 Chapter 08 Reducing the impact of AIDS, p.178,
of the full 2006 Report on the global AIDS epidemic  by UNAIDS