Geneva, Switzerland -- Responding to a recent UN report demonstrating a 36% increase in global coverage for HIV treatment during 2008, the International AIDS Society (IAS) today urged world leaders not to mistake recent progress for "mission accomplished" and emphasized the need for sustained political leadership and financing by the G8 and other donors to maintain recent momentum and leverage similar results for HIV prevention.

"Although four million people in low- and middle-income countries are now receiving antiretroviral therapy, another five and a half million HIV infected adults and children lack life saving access to care," said IAS President Julio Montaner. "While significant, these recent gains are also fragile and urgently require increased and sustained financial commitments by the G8 and other donors to reach the goal of universal access to HIV prevention, treatment, care and support."

Issued by the WHO, UNAIDS and UNICEF, Towards universal access: scaling up priority HIV/AIDS interventions in the health sector is the third annual review of progress towards the UN goal of providing universal access to HIV prevention, treatment, care and support by 2010.¹ Key findings from the report include:

• Four million people in low- and middle-income countries were receiving antiretroviral therapy (ART) at the end of 2008, representing a ten-fold increase in treatment access over the past five years (from 400,000 at the end of 2003);
• 45% of HIV-positive pregnant women received antiretroviral drugs to prevent HIV transmission to their children, up from 35% in 2007;
• 21% of pregnant women in low- and middle-income countries received an HIV test, up from 15% in 2007; and
• The number of children under 15 years of age who received ART also increased, reaching 38% of those in need at the end of 2008.

Spotlight on Treatment Access in Africa

An estimated 2.9 million people in sub-Saharan Africa received ART in 2008, representing a 39% increase in the last year and boosting overall coverage in the most heavily-affected region of the world from 33% in 2007 to 44% in 2008. Within the African continent, greater access (48%) is available in Eastern and Southern Africa than in Western and Central Africa (30%).

ART coverage varies globally by region as well: coverage in 2008 stood at 37% in Asia and the Pacific, 54% in Latin America and the Caribbean, and remains quite low in North Africa and the Middle East at just 14%.

Greater Progress on HIV Prevention Urged

Towards Universal Access also summarizes recent developments in HIV prevention, illustrating some progress, yet a continued reluctance by some governments to make use of the full range of proven HIV prevention tools and to target interventions to key affected populations. Examples of key prevention-related findings include:

• Of 149 low- and middle-income countries, only 41 reported conducting systematic surveillance of HIV among people who inject drugs, 44 among men who have sex with men and 65 among sex workers; coverage data for these groups are also limited.
• Injecting drug users continue to face legal and social barriers in accessing health services, and homophobia and criminalization of same-sex behaviour continue to hinder the response among men who have sex with men.
• All 13 priority countries in sub-Saharan Africa with high rates of heterosexual HIV transmission and low rates of male circumcision have established policies and programmes to scale up male circumcision.
• Among sex workers, the median reported rate of condom use with their most recent client was promising: 86% among 56 low- and middle- income countries. Programmes promoting 100% condom use by sex workers have been successfully implemented in many settings.
• In 39 low- and middle-income countries that reported comparable data in 2007 and 2008, the combined reported number of HIV tests more than doubled over the two-year period.

"We have the tools to effectively prevent HIV, but we are not making full use of the scientifically-proven interventions at our disposal or targeting them appropriately to groups most in need," said IAS Executive Director Robin Gorna. "The longer we allow ideology or politics to trump science, the longer it will take us to reach the goal of universal access."

Call for Continued G8 Leadership

Last week's report on progress toward universal access comes at a time when there are indications that the long-term financial and political commitment of wealthier countries may be waning. Due to insufficient donor contributions, the Global Fund to Fight AIDS, TB and Malaria is facing significant funding shortfalls this year and has yet to confirm if it will be able to issue a round of new grants in 2010. The Fund is also aiming to gain back costs by increasing efficiency of its current grants.

"We're just beginning to understand the broad benefits of HIV scale-up, including the preventive benefits of treatment scale-up not just as a tool to decrease HIV transmission but also other diseases, including tuberculosis," said Dr. Montaner. "With just over a year to go until the 2010 universal access deadline, it would be terribly irresponsible for the G8 to contemplate retrenchment," he added.

Reference

1. Universal access commitment contained in the 2006 UN Political Declaration on HIV/AIDS: We Heads of State and Governments and representatives of States and Governments commit ourselves to pursuing all necessary efforts to scale up nationally driven, sustainable and comprehensive responses to achieve broad multisectoral coverage for prevention, treatment, care and support, with full and active participation of people living with HIV, vulnerable groups, most affected communities, civil society and the private sector, towards the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010. (Point #20)