Australasian Society for HIV Medicine

Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector, a collaboration between the World Health Organization (WHO), the United Nations Joint Programme on HIV/AIDS (UNAIDS) and United Nations Children's Fund (UNICEF), is the definitive yearly chronicle of the health sector response to HIV prevention, treatment and care. This is the second annual progress report to examine HIV within the context of the health sector. The latest edition features a special focus on women and children. The report is available by following the link for (1).

The conclusions reached by the report (2) include the following:
1) Nearly a million more people (950,000) were receiving antiretroviral therapy (ART) in low- and middle-income countries by the end of 2007 compared to the end of 2006, bringing the total number of people receiving ART therapy to approximately 3 million; a seven-fold increase in just four years.

2) The ‘3 by 5' target of 3 million living in low- and middle-income countries receiving treatment by the end 2005 has been achieved, albeit two years late. This underscores the necessity and utility of setting targets and working towards them.

3) While the availability of HIV testing and counselling in health facilities substantially increased in countries with comparable data, the majority of people living with HIV/AIDS are still unaware of their status, meaning they remain unable to access prevention, treatment and care services. Although global data are unavailable, surveys undertaken in 12 high-prevalence countries reveal that the median percentage of HIV-positive people who know their status is only 20%.

4) Improved follow-up of those individuals diagnosed with HIV and greater access to care, beyond access to ART, are required to maximise the health of people infected and help prevent HIV transmission to others.

5) Successful examples of HIV prevention among high-risk populations such as sex workers and their clients, injecting drug users, men who have sex with men, as well as prisoners, highlight the need to further scale up access to prevention interventions, strengthen surveillance and monitoring, and to ensure that policies and legislation create an environment that encourages effective health service delivery.

6) In 2007, 33% of HIV-positive pregnant women received ART to prevent transmission to their children, as compared to 10% in 2004. That same year the number of pregnant women tested for HIV rose to 18% globally from 16% in 2006 and 10% in 2005.

7) Today, more children are accessing care and treatment services than in previous years. In 2007, 200,000 children living with HIV received antiretroviral therapy, as compared to 127,000 in 2006 and 75,000 in 2005. However, the difficulty of diagnosing HIV in infants remains an obstacle to further gains.

8) Despite substantial progress in 2007, most low- and middle-income countries are still far from achieving universal access goals. Obstacles include weak healthcare systems, a critical shortage of human resources and a lack of sustainable, long-term financing. Countries also require monitoring systems in order to track progress and increase the effectiveness and impact of HIV programmes. At the end of 2007, the gap between required and available funding was estimated to be US$8.1 billion. To meet universal access targets, funding will have to more than quadruple to US$35 billion in 2010 and to US$41 billion in 2015.

For most low- and middle-income countries to achieve the universal access targets of the 2015 Millennium Development Goals and to move forward they and their partners must focus on strengthening the role of the health sector in HIV prevention; increasing awareness of HIV status; strengthening and sustaining efforts to scale up HIV treatment and care; accelerating access to HIV prevention and care for women and children; overcoming health system weaknesses; and improving strategic information to guide the health sector responses. Other key points from the report are available by following the link to (3).

References and links

(1) Towards Universal Access
Scaling up priority HIV/AIDS interventions in the health sector Progress Report June 2008 World Health Organization, UNAIDS and UNICEF
Link to report: http://www.who.int/hiv/pub/Towards_Universal_Access_Report_2008.pdf

(2) At a Glance: Media Summary
Towards Universal Access
Scaling up priority HIV/AIDS interventions in the health sector Progress Report June 2008 World Health Organization, UNAIDS and UNICEF
Link to report summary: http://www.who.int/hiv/mediacentre/Media_summary.pdf

(3) Key Messages
TOWARDS UNIVERSAL ACCESS:
Scaling up Priority HIV/AIDS Interventions in the Health Sector
Progress Report, June 2008 World Health Organization, UNAIDS and UNICEF
Link to report key points: http://www.who.int/hiv/mediacentre/Key_messages.pdf

Footnote: ASHM Members are invited to contribute to ASHM Latest News page with articles under headings of Education, Training, Clinical Issues, Conferences, Resources, International and Research. Please forward information to Paul McQueen (email: paul.mcqueen@ashm.org.au).