A total of 1.3 million people in resource-limited and middle-income countries were receiving antiretroviral therapy for HIV infection at the end of 2005, according to figures released today by the World Health Organization (WHO) and UNAIDS. This is well short of the target of the 3 million target (3 by 5) set on World AIDS Day 2003. Nevertheless, WHO and UNAIDS are heralding the expansion of HIV treatment access which, they estimate has saved as many as 350,000 lives. They are also hopeful that the lessons learned from 3 by 5 will lead to a foundation for efforts to provide universal access to anti-HIV treatment by 2010.
Treatment access increases – but falls short of target
Access to HIV treatment expanded in every region of the world by the end of 2005. In 2003, when the 3 by 5 target was set 400,000 people in poorer countries had access to HIV therapy, and WHO and UNAIDS have been eager to emphasise that although the “ambitious” target of 3 million on treatment was not met, treatment access did treble.
“3 by 5 has helped to mobilise political and financial commitment to achieving much broader access to treatment” said WHO Director-General, Dr Lee Jong-wook.
Particular attention is being drawn to sub-Saharan Africa, the world region worst affected by HIV, where access to antiretroviral therapy increased over eight-fold from 100,000 in 2003 to 810,000 by the end of 2005.
A total of 18 poorer countries, thirteen of which were in Latin America, met the 3 by 5 target of providing antiretroviral therapy to 50% of individuals with HIV. There was also a substantial increase in the number of public sector healthcare facilities in low- and middle-income countries proving HIV treatment, from only 500 in 2003 to 5,100 by the end of 2005. In Zambia, the number of treatment sites increased from only three to over 110 facilities in just two years.
Progress differs by world region
In sub-Saharan Africa 17% of those in need of anti-HIV treatment were receiving it at the end of last year. A substantial increase in treatment access was also seen in east, south and southeast Asia, where the number of people taking antiretrovirals increased from 70,000 in late 2003 to 180,000 by the close of 2005, with the greatest expansion of treatment access occurring in Thailand.
The number of people on HIV treatment increased by 50% in Latin America and the Caribbean to 315,000, but there were only a limited expansion in treatment access in Eastern Europe, Central Asia, the Middle East and North Africa, where 25,000 people were receiving treatment in late 2005 compared to 16,000 in 2003. WHO and UNAIDS comment, “virtually all the countries in these regions are experiencing low-level epidemics that involve difficult-to-reach populations such as injecting drug users and sex workers.”
Only 10% of HIV-positive pregnant women receiving ARVs to prevent mother-to-child transmission
Some WHO/UNAIDS statistics also demonstrated how much work needs to be done before widespread access to anti-HIV therapy becomes a reality. Between 2003 and 2005, only 10% of pregnant HIV-positive women received antiretroviral prophylaxis to prevent the mother-to-child transmission of HIV resulting in 1,800 babies a day being born with HIV.
The treatment needs of injecting drug users also remain largely unmet. Worldwide, only 36,000 are on antiretroviral therapy, 30,000 of which are in Brazil. WHO/UNAIDS estimate that injecting drug users comprise 70% of the HIV cases in Eastern Europe, yet represent only a quarter of those receiving treatment.
Stigma and discrimination are hampering prevention, treatment and care efforts. “If we are to get ahead of the AIDS epidemic, we must tackle stigma, ensure that the available funds are spent effectively to scale-up HIV prevention, care and treatment programmes and mobilise more resources,” said UNAIDS director, Dr Peter Piot.
What now for 2010 target of universal access?
Valuable lessons have been learnt from 3 by 5 that should provide a “road map” for the more ambitious goal set at the G8 summit last July of universal access to antiretrovirals by 2010, according to WHO/UNAIDS. Said Kevin De Cock of the World Health Organization, “the past two years have provided a wealth of experience and information on which we must now continue to build…it is particularly important that scaling-up HIV prevention, treatment and care services contributes to strengthening of health services overall.”
Among the lessons learnt are:
- The importance of targets for creating and sustaining momentum and in increasing accountability.
- The need to strengthen healthcare generally.
- A community-based, decentralised approach to the delivery of healthcare.
- The need to intensify prevention efforts.
More money is also needed to realise the ambition of universal treatment access by 2010. It is estimated that there is a $18 billion shortfall in HIV prevention treatment and care funding for the 2005 – 2007 period and that this will increase to $22 billion by 2008.