Only 28 percent of the 7.1 million people estimated to be in need of antiretroviral (ARV) drugs are receiving the life-prolonging medication, with "far greater action" needed to meet international commitments on access, according to a United Nations report released on Monday.
By December 2006, two million people in low and middle income countries were receiving ARVs; 700,000 more than a year earlier, but well behind schedule to meet the goal of universal access to prevention, treatment and care by 2010, noted the report, released to mark a year since the adoption of a political declaration of commitment to tackle the pandemic by UN member states.
Speaking at a General Assembly session focused on the HIV and AIDS response on Monday, UN Secretary-General Ban Ki-moon noted that, "For every person who starts antiretroviral treatment, six more become infected," and added, "Every new infection adds to the burden on individuals, families, households, communities, and society as a whole."
He acknowledged that in the past year, 90 countries had set national targets relating to treatment, prevention and care and many countries had made special services available for children orphaned by the epidemic.
The report noted that setting national targets was an important first step, but "few countries have demonstrated clearly how they will overcome key obstacles to universal access, such as weak health systems, insufficient human resources, lack of predictable and sustainable financing and lack of access to affordable services."
Many countries have failed to estimate the cost of ambitious targets and of those that have, said the report, the process has been a "reality check" regarding the availability of funds and the sustainability of such plans. Without significant financial contributions from the developed world, low and middle-income countries will not achieve universal access goals, the report warned.
Highlighting the pressing need for more and better coordinated international funding, it noted that just over half of the US$18 million needed to implement HIV-related programmes in 2007 was currently available. According to the report, international funding efforts "have often given priority to the achievement of rapid results over long-term, sustainable impact." When strategically used, however, HIV funding can provide an opportunity to strengthen health systems generally and to move from an emergency response to a longer-term approach.
The report also noted the failure of prevention measures to keep pace with the epidemic's growth. It attributes this failure to lack of investment in prevention; lack of interventions addressing the social, economic and cultural drivers of HIV infection, such as gender inequality and stigma; and lack of access to prevention services for high risk populations such as sex workers, prisoners, and men who have sex with men. Ban Ki-Moon pointed out, however, that several countries with generalised epidemics, have achieved declines in HIV prevalence through sustained prevention efforts. Botswana, Kenya, Malawi, Rwanda and Zimbabwe were among the countries that reported declines in HIV prevalence among young people in 2006.
A more comprehensive review of the progress made towards achieving the objectives set last year at the High-Level Meeting on AIDS, where UN Member States renewed pledges made in 2001 at the United Nation's General Assembly Special Session (UNGASS) on the pandemic, is planned for 2008. UNAIDS will release its annual report on the status of the epidemic in June.
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