Greater access to ARVs, but much more to be done

First, the good news: in 2007 about a million more people in poorer countries across the globe began taking antiretroviral (ARV) drugs, bringing the total number to almost three million. The pace of providing the life-prolonging treatment has also accelerated, and an increasing number of children are receiving the medication.

But the bad news is that according to a new report by the World Health Organisation, UNAIDS and UNICEF, Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector, released on 2 June, many of the world's countries are still far from meeting their goal to provide universal access.

The report noted that an estimated 2.5 million people were newly infected with HIV last year and, despite progress made, just under a third of people who need treatment in low- and middle-income countries were receiving it in 2007.

The number of people receiving ARVs jumped by 54 percent in 2007 alone, and over two million people taking ARVs were living in sub-Saharan Africa. Although patient survival rates have increased with the greater availability of ARVs, mortality during the first six months of treatment remained "unacceptably high", as many people living with the virus were unable to access services until it was too late.

Tuberculosis was another major challenge: according to the report, about 12 percent of deaths among people living with HIV worldwide were due to TB. South Africa, for example, is home to less than one percent of the world's population, but accounts for 28 percent of the total number of people co-infected with HIV and TB.

Prevention efforts were also lagging. "The health sector must look beyond simply providing HIV treatment, care and support, to playing a much stronger role in the promotion and delivery of HIV prevention services," the report suggested.

At the end of 2007, nearly 500,000 women were able to access ARVs to prevent transmission of the virus to their unborn children - up from 350,000 in 2006. In the same period, 200,000 children were receiving ARVs, compared to 127,000 at the end of 2006. However, the difficulty of diagnosing HIV in infants remains a major challenge to progress.

"We are seeing encouraging progress in the prevention of HIV transmission from mother to newborn," UNICEF Executive Director Ann M. Veneman said in a statement. "The report should motivate us to focus and redouble our efforts on behalf of children and families affected by HIV/AIDS."

The report warned that the future expansion of access to ARVs was likely to be slowed, owing to weak health systems in the worst-affected countries, and especially the difficulty of training and retaining health-care workers.

Health-care systems in the hardest-hit regions continue to erode because of 'brain drain' - the migration of skilled health-care personnel to other occupations and countries - and high HIV mortality rates among health professionals.

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