UNAIDS 2004 Report on the Global AIDS Epidemic - Executive Summary

V. Treatment, care and support for people living with HIV

Access to antiretroviral treatment and other HIV-related disease care remains low. The World Health Organization estimates that nine out of ten people who urgently need HIV treatment are not being reached. Around five to six million people in developing countries will die in the next two years if they do not receive antiretroviral treatment.

In sub-Saharan Africa, an estimated 4.3 million people need AIDS home-based care but only about 12% receive it. In South Asia, coverage drops to 2%.

Yet the global movement to scale up access to HIV treatment has made critical gains during the past few years. There has never before been such a level of financial resources to fund treatment, care and support, nor the strength of political will in countries to provide them. The price of many medicines and diagnostics has fallen dramatically.

Improving access

• Most countries with national AIDS plans have incorporated antiretroviral treatment into them and have set specific antiretroviral treatment coverage targets. Some have allocated funds from national budgets and debt relief to support treatment service.
• Several countries in Latin America and the Caribbean now offer universal coverage for antiretroviral treatment; these include Argentina, Barbados, Chile, Costa Rica, Cuba, Mexico and Uruguay. The Government of Brazil has estimated that antiretroviral treatment has made savings of about US$ 2.2 billion in hospital care that would otherwise have been needed by people living with HIV.
• Donors are increasingly focusing on treatment and care as part of their commitment to scaling up the global HIV response. For example, the World Bank’s Multi-country AIDS programme, which amounts to US$ 1 billion for Africa and US$ 155 million for the Caribbean, is allowing governments and other beneficiaries to use its funds flexibly for HIV treatment. Grant monies from the Global Fund to Fight AIDS, Tuberculosis and Malaria mean that 700 000 people will be able to receive antiretroviral treatment. Bilateral donors such as France and the United States of America have launched funds to help support antiretroviral programmes.
• Private sector efforts are growing. Increasing numbers of companies are establishing HIV treatment programmes for their employees – for example, Anglo American, Eskom, and Heineken.
• Nongovernmental organisations have been treatment pioneers – for example, Haiti’s Zanmi Lasante (Partners in Health) and Médecins sans Frontières, proving that antiretroviral treatment can be delivered safely and effectively in places with limited resources.
• The ‘3 by 5’ Initiative was launched by WHO and UNAIDS in September 2003. The aim – an interim target only, part of a global movement to mobilize support ultimately for universal access – is to provide antiretrovirals to three million people in developing countries by the end of 2005. To date, 56 countries have formally said they want to participate in the Initiative.

Falling prices

• In recent years, the prices of antiretroviral medicine have fallen dramatically. In 2000, the price of a first-line WHO-recommended combination antiretroviral regimen to treat one patient for one year was between US$ 10 000 and US$ 12 000 on world markets. Now the price for certain generic combinations is US$ 300 per person per year. Advocacy by people living with HIV and by world leaders has helped bring down prices. However the price for antiretroviral treatment remains extremely high in a number of middle-income countries such as Russia, Serbia and other central and Eastern Europe countries where the epidemic is rapidly growing.
• Cooperation continues to increase between those countries with antiretroviral medicine manufacturing capacity – for example, Brazil, India, Thailand, and those in Africa wishing to set up local production facilities. There is also cooperation between some developing countries and industrialized countries in Europe and North America, to jointly promote and undertake antiretroviral production technology transfer to developing countries interested and able to produce the medicines locally.

Next agenda:

• Strengthen human capacity in those countries whose scarcity of health workers is a barrier to antiretroviral programme success. In certain countries, the size of the health workforce must triple or quadruple if universal coverage of antiretroviral treatment is to be achieved. In countries most affected by AIDS, vacancy rates for doctors, nurses and other health staff are extremely high; in 2001, for example, Malawi had only filled half its public sector nursing posts. Incentives and working conditions need to be improved to prevent migration to higher income countries.
• Expand voluntary counselling and testing to ensure widespread knowledge of HIV status, since it is the gateway to HIV treatment and prevention.
• Provide greater support for technology transfer and exports – from countries with antiretroviral manufacturing capacity to countries without it. All partners within the pharmaceutical industry must be part of the AIDS response to guarantee the huge increase in treatment access currently being planned.
• Ensure countries can take advantage of their rights to use trade agreement provisions to widen access to HIV medicines and technologies. This includes resisting stricter-then-necessary patient provisions in regional trade agreements that will otherwise undermine much of the flexibility provided in global trade agreements and declarations for developing countries.
• Reduce HIV-related stigma so that treatment can reach people in need.
• Place equity at the forefront of policies and programmes to ensure fair access to treatment. If universal access is to become a reality, the barriers to treatment for women, children and other groups such as sex workers, injecting drug users and men who have sex with men, must be removed.