One Year After "3 by 5" AIDS Treatment Campaign, International Advocacy Group Warns Effort Is Stagnating
Without Immediate Action, Pledge to Provide "Universal Access" to AIDS Drugs Will Fall Five Million People Short by 2010
"The international community must now finally keep its word"
-- Stephen Lewis, UN Envoy on HIV/AIDS in Africa
Cape Town and New York -- The International Treatment Preparedness Coalition (ITPC), a group of 800 treatment activists from more than 125 countries, today released a new analysis of the global AIDS treatment scale up effort titled, Missing the Target #3: Stagnation in AIDS Treatment Scale Up Puts Millions of Lives at Risk. The report finds that the urgency and energy that marked treatment scale up efforts from 2003 to 2005 is dissipating in the absence of clear goals and an all-out mobilization by country governments and international agencies.
"The time for incremental efforts is over," said Stephen Lewis, UN Envoy on HIV/AIDS in Africa, whose Special Assistant Anurita Bains joined report authors on a media teleconference to release the report. "There is new evidence the AIDS epidemic is worsening. The international community must now finally keep its word and mobilize for global AIDS treatment delivery. By scaling up AIDS treatment we will be saving millions of lives, transforming communities and advancing HIV prevention. It is a moral imperative that global leaders and institutions keep their promises and scale up AIDS services with urgency and increased resources."
The new ITPC report, which calls for specific and immediate action to avoid massive shortfalls on global AIDS commitments, is available at www.aidstreatmentaccess.org.
Missing the Target, ITPC's third analysis of global treatment access, was researched and written by civil society leaders on the frontlines in six of the countries hardest hit by AIDS -- Dominican Republic, India, Kenya, Nigeria, Russia, and South Africa. It is being released one year after the end of the World Health Organization's "3 by 5" campaign, which aimed to focus global efforts on significantly increasing treatment access in low and middle-income countries. As that campaign was ending, the G8 countries and a special United Nations session on AIDS pledged to come "as close as possible to universal access" to treatment and prevention by 2010. Missing the Target finds that while there is progress to report, the deadline-driven urgency of 3 by 5 is missing, and scale up is proceeding slowly and unevenly. As a result, millions are now threatened with imminent sickness and death.
Universal Access: A Slogan or a Plan?
"The G8 and UN universal access pledge is in danger of becoming a slogan rather than a plan of action," said ITPC member Chris Collins. "This World AIDS Day, everyone engaged in the response to AIDS has a decision to make. Will we launch a full mobilization or settle for incremental gains that fall millions of lives short?"
Although the international community has not clearly defined what universal access means, a UNAIDS report from May 2006 quantified it as 9.8 million people on treatment by 2010.1 "At the current rate, the world will miss the 2010 universal access goal by five million people," Collins added.
Integrated Approach to Treatment and Prevention Needed
Missing the Target #3
was written by people working to both treat those who are living with HIV and to prevent new infections in their communities.
"AIDS treatment scale up is a unique opportunity to change the status quo in global health. But we need a renewed and real commitment to an integrated approach," said Gregg Gonsalves, programme director for the AIDS and Rights Alliance for Southern Africa and a member of ITPC.
"Recently, some have argued that effective treatment scale up is impossible without a hugely expanded prevention effort. While that is absolutely true, prevention will also ultimately fail without a greatly expanded treatment response," Gonsalves said.
"We need to be building sustainable health systems that can deliver both HIV treatment and HIV prevention, as well as TB and other services," said Fatima Hassan of the AIDS Law Project, who headed the South African research team.
"In South Africa and every other country, we need to be reaching people in both rural and urban areas, the marginalized as well as the privileged, and children as well as adults. This will require a tremendous amount of work in our communities, and our countries, and globally, but it can and must be done," Hassan added.
Immediate Action Required
To reverse the current stagnation in HIV treatment scale up, ITPC calls for the following actions by June 2007:
- Incoming director-general of WHO, Dr. Margaret Chan, should reassert that agency's profile and leadership in the fight for treatment access and declare a "3 by 5"-like campaign to reach universal access by 2010.
- The Global Fund, PEPFAR and other agencies should put clear systems, lines of accountability and guidelines in place to avoid country-level failures to meet goals associated with their programs.
- Multilateral agencies and country governments should agree on a consensus statement on what "universal access" to treatment means quantitatively for the world.
- National governments within the next 30-60 days should complete ambitious, costed national plans in consultation with people living with HIV/AIDS with specific targets to reach universal access by 2010.
- Donors should commit to specific year-over-year increases in funding for the Global Fund and other programs to finance the agreed-upon targets.
- Governments, donors and multilaterals should negotiate lower prices for HIV treatments, particularly newer and second line drugs.
Country Level Progress and Needs
The report describes progress made in each of the six countries covered in the report and calls for specific national-level actions by June 2007. While each country situation is unique, their end stories are similar: treatment coverage is rising, yet the modest gains are dwarfed by the number of people who need ART, are not getting it, and thus face imminent death. Missing the Target #3
- In the Dominican Republic, treatment has reached several thousand new people in the past two years and diagnostics are now more accessible. However, fewer than half of those who need ART have access; women and marginalized people receive substandard care; and a proposed new health insurance scheme explicitly excludes people living with HIV/AIDS and the disabled.
- In India, the increasing number of people receiving treatment represents only one in 14 of those in need; more treatment sites opened this year, though the number of sites is still insufficient; action is needed to secure access to second line drugs; pediatric ARV formulations are not widely available; and marginalized groups face significant barriers in accessing ART at government-supported centers.
- In Kenya, although national treatment targets are said to be achievable and the PEPFAR program has been praised, the country is grappling with an acute shortage of health care workers; a Global Fund grant at risk; limited ART access for children; and increasing need for expensive second-line drugs.
- In Nigeria, a free treatment policy is being implemented and more treatment centers are open. Yet, costs associated with treatment are keeping many from care; the availability of treatment and voluntary testing is not well publicized; care centers remain concentrated in urban areas; and stigma is a significant barrier to access.
- In Russia, a rapidly expanding epidemic is being met with increasing government commitment. Yet major access barriers persist, such as a lack of support services for treatment uptake among vulnerable groups, including injecting drug users who represent the majority of those in need. Other barriers include lack of an approved national treatment protocol; poor coordination of provider training; and limited inclusion of civil society input.
- In South Africa, activists have persuaded the government to pledge dramatic improvements in its response to AIDS. Public-sector officials must now follow through with swift action to establish widely supported treatment targets; address severe human resources shortfalls; revise national pediatric guidelines; and greatly accelerate the pace of treatment scale up.
- UNAIDS, Report on the global AIDS epidemic, UNAIDS, Geneva, May 2006, pp. 227-228.