Universal Treatment - Not Yet

posted: 04/10/2010

World leaders pledged to make sure everyone who needed HIV treatment would be receiving this by the end of 2010 - but that target will be missed. While more lives are being saved from HIV than ever and eight developing countries now give drug treatment to all those who need it, two thirds of the people in the world who need HIV treatment are still not getting this.
 

Treated and untreated

About 5.2 million people with HIV now receive HIV treatment that keeps people not simply alive, but fit and well – an increase of more than 1.2 million people in a year, says the report from the World Health Organisation, Unicef and UNAids. More than a third of those who need the drugs (36%) are now taking them.
 

Sub-Saharan Africa, the worst-affected region, saw the biggest increase in HIV treatment supply, from 2.9 million people in December 2008 to 3.9 million at the end of last year. Botswana, Cambodia, Croatia, Cuba, Guyana, Oman, Romania and Rwanda now provide universal access to HIV treatments – defined as giving the drugs to at least 80% of those who need them. The goal world leaders set themselves was worldwide universal access by the end of 2010. Experts believe 14.6m people in total need HIV treatment.
 

Spend more

The joint progress report is from the World Health Organisation (WHO), the UN's AIDS programme and UNICEF. It warns that poorer countries must "substantially ramp up" what they spend on HIV.
“Most countries need to look seriously into increasing their domestic spending on HIV/AIDS” said Dr Gottfried Hirnschall of the World Health Organisation.
The report says there have been "hard-won gains" - but it also makes clear how much work remains to be done. "Zimbabwe has increased access by 50% in the past year - despite being heavily compromised, politically and economically. And South Africa has had an incredible catch-up phase, despite being a late starter. But given those success stories, we need to sustain the momentum - and be smarter in making the case."
 

UNAIDS recommends that countries most affected by the virus should allocate between 0.5% and 3% of their government revenue to tackling the problem. Dr Hirnschall said: "Most of the countries that need to do this aren't yet reaching the 0.5% mark. "They have to chip in their own resources and look seriously into increasing their domestic spending, to better complement external funding."
 

The report’s authors say: "Millions of people are alive today as a result of investments in HIV over the past few years. Yet … the global economic crisis has put the sustainability of many HIV programmes at risk. After years of considerable increases in international assistance, funding remained essentially flat over the current period."

Sources
BBC       Guardian

HIV, Human and Sexual Health Rights

posted: 15/04/2010

A groundbreaking guide Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV has been produced by UNAIDS. Now, policy makers, programme managers, health professionals, donors and advocates have an important tool to better support the sexual and reproductive health and rights of people living with HIV.
 

Networks of people with HIV worldwide contributed to this guide, which explains what people involved in advocacy, health systems, policy making and law can do to support and advance the sexual and reproductive health of people living with HIV, and why these issues matter.

12 recommendations

1. HIV testing should never be mandatory and always be based on the ‘three Cs’: confidential, based on informed consent, and conducted with counselling. This applies equally to marginalised groups, including sex workers, injecting drug users, prisoners, migrants, refugees, and members of lesbian, gay, bisexual, and transgender and intersex communities.
2. Systems for HIV prevention, treatment, care, and support must be strengthened to deal with increased demand at the same time that HIV testing is scaled up, to ensure that HIV testing results in referral to HIV prevention, treatment, care and support programmes. In particular, pregnant women should not be tested only to prevent transmission from parent to child; they must also be offered prevention, treatment and care services.
3. National laws should be reformed and enforced to ensure that:
   ¤    Laws explicitly ban discrimination based on sexual orientation, gender identity, and HIV status;    ¤    Anal sex, sex work, same-sex relationships, and transgender relationships are decriminalized;    ¤    Disclosure of HIV status is not required by law if a person is practicing safer sex, their HIV status is oherwise known, or there is a well founded fear of harm by the other person;    ¤    HIV transmission is not considered a crime except for rare cases where there is evidence beyond a reasonable doubt that one person deliberately tried to infect another and indeed did so;    ¤    HIV status alone does not affect a person’s right to marry or found a family, is not grounds for divorce, and is not relevant in child custody decisions;    ¤    Young people have the right to confidentiality and do not need parental permission for age-appropriate information and sexual and reproductive health care, even if they are below the age of majority;    ¤    Women’s property rights are ensured and protected, particularly following divorce, abandonment or a spouse’s death;    ¤    Sexual violence, including incest, forced or early marriage, sexual assault or rape (including in the context of sex work or in marriage) is recognised and prosecuted as a crime;    ¤    Injecting drug users are provided with treatment, including opioid substitution therapy, and harm reduction programmes as an alternative to incarceration; and    ¤    Transgender people are legally recognised and clear procedures are in place for changing name and sex on official documents.
4. All people living with HIV – including members of marginalised groups, such as sex workers, injecting drug users, prisoners, migrants, refugees, and members of lesbian, gay, bisexual, transgender and intersex communities – should have access to a full range of sexual and reproductive health services, including:
   ¤    All available contraceptive options and help with dual protection, without coercion toward any method;   ¤    Counselling and support for positive prevention and voluntary disclosure   ¤     Access to safe abortion (where legal) and post-abortion care;    ¤    Counselling and support for safe ways to become pregnant;    ¤    Counselling and practical support for infant feeding, whether breastfeeding or replacement feeding;    ¤    Diagnosis and treatment of STIs;    ¤    Cancer prevention and care;    ¤    Counselling related to violence;    ¤    Sexual dysfunction treatment; and    ¤    Male circumcision for men living with HIV if, when fully informed, they want the procedure.
5. Health workers should receive training in human rights and universal precautions, as well as specific training in sexual and reproductive health care for people living with HIV, including technical skills and stigma reduction. People living with HIV should participate in these programmes as trainers.
6. Health service providers and advocates should support closer linkages between HIV prevention, care, and treatment; comprehensive sexual and reproductive health services; drug substitution therapy; mental health and psychosocial services; and anti-discrimination and antiviolence initiatives.
7. Advocates should ensure that special centres and programmes are developed to deliver information and services to hard-to-reach populations.
8. Governments, international agencies, and NGOs, in collaboration with organizations of young people living with HIV, should develop specific guidelines for counselling, support and care for people born with HIV as they move into adolescence and adulthood.
9. Governments, international agencies, and NGOs should better research and monitor the sexual and reproductive health of people living with HIV, including data disaggregated by gender, age, marital status, geographic location and sexual orientation. This research should be conducted with the input and supervision of people living with HIV.
10. Governments, international agencies, and NGOs should set and monitor concrete targets for involving people living with HIV in all relevant activities, including positive prevention programmes.
11. Governments, international agencies, and NGOs should support income-generating programmes. This includes directly employing people living with HIV, and paying them for their work.
12. Advocates should ensure that programmes to bolster participation of people living with HIV also help build needed skills. In particular, women and young people should be provided with ‘know your rights / laws’ education and advocacy training.
     

• The UNAIDS Guide Advancing the Sexual and Reproductive Health and Human Rights of People Living with HIV  pdf 2.3Mb

Source 

Global Treatments Working

posted: 24/11/2009

The death toll from HIV across the world fell by more than 10% over the past five years, latest figures show. The World Health Organization and the Joint UN Programme on HIV/AIDS (UNAids) say that since effective treatments first became available in 1996, some 2.9 million lives have been saved.

As the number of deaths has fallen, the number of people living with HIV has risen slightly - an estimated 33.4 million people worldwide are infected with HIV, up from 33 million in 2007 because of fewer deaths.
 

New infections fall
The latest report also shows there has been a significant drop in the number of new HIV infections. The report suggests that HIV prevention programmes are having a significant impact - new HIV infections have fallen by 17% over the past eight years.
 

In sub-Saharan Africa, the epicentre of the global pandemic, the number of new infections has fallen by around 15% since 2001 - equating to about 400,000 fewer infections in 2008 alone. In the same period, infection rates were down by nearly 25% in East Asia, and by 10% in South and South East Asia. In Eastern Europe, after a dramatic increase in new infections among injecting drug users, the rate of infection has levelled off considerably.
 

UNAids executive director Michel Sidibe said although prevention programmes had helped cut new infections, they were often "off the mark". "If we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved," he said.

Prioritise Gay Men in UK

Deborah Jack, chief executive of National AIDS Trust, said: “The downward trend in new infections is a testament to the work of the international HIV community. It’s the result of the roll-out of treatment and increased investment in prevention initiatives.

"However today’s report shows there are gaps in prevention programmes that meet the needs of key groups, such as over 25s and gay men. We need to get smarter about HIV prevention and also sustain efforts to find new tools such as microbicides and a vaccine, if we are to seriously reduce new infections.

"Worryingly, the global decrease in new infections is not being seen in the UK. Here new diagnoses have trebled in the past ten years. HIV diagnoses among men who have sex with men in the UK rose by 74 per cent between 2000 and 2007. The UK needs to re-prioritise HIV prevention among gay men, otherwise we risk falling further behind.”
 

UNAIDS global HIV epidemic update 2009

Source

5M Still Waiting for Treatment

posted: 01/10/2009

Although four million people are now receiving antiretroviral treatment in low and middle-income countries, another five million adults and children lack access to treatment, according to figures released today by United Nations agencies.

The report Towards universal access: scaling up priority HIV/AIDS interventions in the health sector is published by the World Health Organization, UNAIDS and UNICEF, and is the third annual review of international progress towards the goal of universal access to treatment and prevention by 2010.

Although more than a million people are estimated to have been enrolled into treatment programmes during 2008 alone, the biggest annual increase since treatment scale-up began, only 42% of those in need of treatment in low and middle-income countries are currently being reached.

Mothers and babies

The report also reveals major gaps in two priority areas, the prevention of mother to child transmission and treatment of children.

The report estimates that 21% of pregnant women received an HIV test in 2008, and 45% received drugs to prevent mother to child transmission, of whom around one-third received only single-dose nevirapine, the least effective form of preventive treatment. Only one-third of those who tested positive were assessed for eligibility for antiretroviral treatment for their own health.

Although 38% of children with HIV in low- and middle-income countries in need of treatment received it, infant diagnosis continues to lag behind. In 41 reporting low- and middle-income countries only 15% of children born to HIV-infected mothers were tested for HIV within the first two months of life.

Background to universal access
In 2001 the convening of The United Nations Special Session on HIV/AIDS marked an historic beginning. For the first time a global set of targets was agreed in response to the crisis. In 2006 at the second United Nations General Assembly High Level Meeting on HIV/AIDS, countries agreed to work towards the goal of “universal access to comprehensive prevention programmes, treatment, care and support” by 2010. The G8 Final declaration in L’Aquila, Italy in July 2009 claimed “We will implement further efforts towards universal access to HIV/AIDS prevention, treatment, care and support by 2010”

WHO, UNICEF and UNAIDS in collaboration with other international monitoring and reporting mechanisms have been monitoring progress, nationally, regionally and globally, of the health sector’s response to HIV. The report presented today is the third in a series of annual progress reports towards universal access that includes HIV services for women and children.

Reports standardised

WHO together with UNICEF developed a joint reporting tool to request information from national programmes to collect data on the scale-up of health sector interventions in response to HIV. The goal of this process is to facilitate the collection of a standardised set of information.

By the end of 2008 between 3.7 and 4.3 million people were on antiretroviral treatment including an estimated 275,700 children (38% of those in need) under the age of 15 years.

Progress varies by country and region. In sub-Saharan Africa, for example, where two-thirds of all global infections occur, an estimated 2.9 million people were on treatment by the end of 2008, with an approximate increase of 800,000 people during 2008.

edited from aidsmap

Reference
WHO, UNICEF, UNAIDS. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. September 2009.