Epidemic outpacing response says UNAIDS

In less than two months, government officials and AIDS activists from around the world will convene in New York to review the global HIV/AIDS response.

National progress reports, submitted earlier this year, will be compared to targets adopted by the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in 2001.

Based on a review of the reports from Eastern and Southern Africa, the regions worst affected by the HIV/AIDS crisis, experts from UNAIDS have already concluded that despite significant progress in areas such as treatment, many of the UNGASS goals are still far from being reached.

"The data presented by countries confirms that overall the rate of progress in expanding access to all services is failing to keep pace with the expansion of the epidemic in this region," said Mark Stirling, director of UNAIDS for Eastern and Southern Africa.

Countries were asked to provide data on 25 core indicators designed to track progress on a number of fronts, including HIV prevalence, education, provision of antiretroviral treatment (ART), uptake of condoms, and assistance to orphans.

The rate of progress in expanding access to all services is failing to keep pace with the expansion of the epidemic in this region

In the area of prevention, described in the 2001 document as the "mainstay of the response", progress has been particularly disappointing, with some countries even documenting a backward slide since the last round of reporting in 2006.

Zambia, Uganda, Rwanda and Angola reported declines in condom use between 2005 and 2007, while the uptake of services to prevent mother-to-child HIV transmission decreased in Angola, Tanzania and Zambia.

Children still accounted for one in six of new HIV infections globally in 2007, according to UNAIDS. Although some countries in the region saw a decrease in HIV prevalence among people aged 15 to 24 - the age group that provides the best indication of new adult infections - others saw no change or slight increases.

In 11 countries with high HIV prevalence that recently conducted surveys, only about 15 percent of orphans were living in households that received some form of medical, financial or psychosocial assistance - an increase of just 5 percent from 2005.

Acknowledging the discouraging trends reported by some countries, Andy Seale, a regional advisor with UNAIDS, emphasised the importance of looking at figures in the context of the background detail supplied in the reports.

Many countries struggled to pull together data for all 25 indicators. "It's very difficult for some of them to align their monitoring and evaluation mechanisms with what we're asking for," Seale noted, adding that the reports did not rely solely on government sources.

"We've made a big effort to ensure they're national reports, not just government ones; I think we can be reasonably confidant about the data," he told IRIN/PlusNews.

South Africa's country report claimed that no data was available for 17 of the 25 indicators, in many cases because surveys were only conducted every five years.

The UNAIDS summary recognised the "extraordinary" increases in treatment coverage in countries such as Rwanda, where 60 percent of people in need of ART were receiving it by 2007, compared to one percent in 2003. An estimated three million people in low- and middle-income countries were receiving ARVs by the end of 2007, a 50 percent increase since December 2006.

Longer term

Expectations around this year's UNGASS meeting in New York are likely to be influenced by what many described as a disappointing outcome from the last meeting, in June 2006. An attempt to reach consensus between countries with conflicting attitudes and priorities resulted in a declaration that most civil society groups regarded as weak and lacking targets.

Sisonke Msimang, HIV/AIDS programme manager at the Open Society Initiative for Southern Africa (OSISA), which was highly involved in an international effort to support organisations to go to New York in 2006, said her organisation would be scaling down its efforts for this year's meeting.

"It remains important that African actors and their voices are represented in these spaces and fora - we just don't expect as much as we would have in the past," Msimang wrote in an emailed response to questions from IRIN/PlusNews. "A lot of our resources are going towards longer-term processes ... Civil society has been burned too many times with these big global events, and I am not sure how much more we can get out of them."

Civil society has been burned too many times with these big global events, and I am not sure how much more we can get out of them

In the area of prevention, a number of AIDS organisations are now questioning the usefulness of short-term targets like those set by UNGASS, and shifting their efforts towards strategies with an extended timeframe that focus on the social and cultural factors driving the HIV/AIDS epidemic.

"I think the short-term targets were set when people were coming to terms with AIDS as a major epidemic; understandably, people were keen to treat it as an emergency," said Seale of UNAIDS. "We still need to do that, but there's a lot of impetus now to look at longer-term models."

This year's meeting will dispense with the declaration and instead produce an "outcome document" that simply reports on the sessions.

Seale insisted that the event would still provide important opportunities for cross-country learning, for strengthening links between donors and beneficiaries, and for providing "that extra bit of pressure on countries, to make sure they are tracking this data and inviting input."

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