Treatment numbers growing, but universal access elusive

More than two million HIV-positive people in low- and middle-income countries were receiving life-prolonging antiretroviral (ARV) medication by December 2006, but universal access still has a long way to go, according to a new report jointly published by UNAIDS, the World Health Organisation (WHO) and UNICEF.

'Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector', released on Tuesday, said the two million figure represented a 54 percent increase in the number of people receiving ARV treatment since 2005.

This achievement was partly made possible by decreases in the cost of first-line ARVs, which fell by between 37 percent and 53 percent from 2003 to 2006.

The report also cited the significant financial contributions of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the United States President's Emergency Plan for AIDS Relief, which were supporting ARV treatment for more than one million individuals by the end of 2006.

"The significant progress outlined in this report in scaling up access to treatment is a positive step forward for many countries in achieving their ambitious goals of universal access to HIV prevention, treatment, care and support," UNAIDS executive director Peter Piot said in a statement.

However, the report noted that efforts to scale up services were insufficient in several key areas: for instance, just 11 percent of HIV-positive pregnant women had access to ARVs to prevent mother-to-child transmission of the virus.

According to the report: Tanzania’s ART coverage went up from 0.6 percent in 2003 to 18 percent in 2006 South Africa increased its ART coverage from 2.7 percent in 2003 to 32 percent in 2006 Kenya's ART coverage increased from 5 percent in 2003 to 44 percent in 2006

"In many ways we are still at the beginning of this commitment [to universal access]," said WHO's director-general, Margaret Chan. "We need ambitious national programmes, much greater global mobilisation and increased accountability if we are going to succeed."

Availability of ARV treatment for children was particularly poor, with just 15 percent of the 780,000 children estimated to be in need of treatment having access to it.

"Children continue to be the missing face of the AIDS epidemic, with too many children still missing out on life-saving treatment and access to other essential services," said Ann Veneman, executive director of UNICEF.

Inadequate political commitment and chronic underinvestment in fighting TB in many countries with high HIV prevalence had resulted in high rates of co-infection and the development of drug resistance, while the emergence of extensively drug-resistant TB (XDR-TB) had increased the need for quality TB prevention, diagnostic and treatment services.

The report highlighted recent research demonstrating a significant reduction in the risk of HIV transmission among circumcised men and recommended that countries with high HIV prevalence and low rates of male circumcision should make safe circumcision services more widely available.

The report's other recommendations included, introducing strategies such as routine HIV testing and counselling to increase the low numbers of people who currently know their HIV status; improving access to prevention, treatment and care services for at-risk groups such as injecting drug users and men who have sex with men; investing in prevention for people living with HIV; and addressing concerns about the long-term financial sustainability of treatment programmes.

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