AIDS status & challenges of the epidemic
3. How has HIV prevention and treatment evolved since 2001?
- 3.1 Has HIV Prevention improved?
- 3.2 Do those in need have access to treatment and care?
HIV positive man and antiretroviral medicines,
Credit: UNAIDS/O. O'Hanlon
Overall, governments are now tackling
much more actively.
Indeed, within world regions, many countries are building
international partnerships to coordinate the fight against
so as to get as close as possible to offering
to all those who need it by 2010.
Most countries now have a national plan to deal with
and a single organization to coordinate efforts, and about half
of them also have a plan to measure the progress made. However,
systems to put these plans into effect and the involvement from
civil society and from people living with
are still uneven.
3.1 Has HIV Prevention improved?
Prevention programmes involve a series of services that aim to
transmission through sexual intercourse, from mother to child,
through injecting drug use, and through blood transfusions.
Such prevention services include for instance access to
counselling and testing, prevention education for young people,
provision of condoms to those who are sexually active,
programmes to reduce HIV-related stigma and discrimination, and
of other sexually transmitted diseases.
While in some countries
prevention services are much more widely available now than in
2001, they only reach a small minority of those in need, and a
number of target groups are not being reached.
Programmes aimed at changing behaviour have succeeded in
reducing the frequency of risky sexual
behaviours. Countries that have lowered
incidence have benefited from the emergence of new sexual
behaviour patterns – fewer commercial sex transactions in
Cambodia and Thailand, delayed sexual debut in Zimbabwe,
increasing emphasis on monogamy in Uganda and an increase in
condom use overall.
Most countries, however, have missed the target of ensuring
that 90% of young people have access to
prevention services by 2005. In fact, less than 50% of young
people in the 18 countries surveyed were well informed about
prevention and transmission.
The global supply of condoms by the public
sector covers less than half the present need and three times
more funding is required for this purpose.
More than 340 million people contract a curable
sexually transmitted infection each year
and women are especially vulnerable. Despite the fact that
untreated sexually transmitted infections greatly increase the
transmission, diagnosis and
of sexually transmitted infections and HIV are not very
Though prevention strategies are cost-effective, there are
disturbing signs that some countries are reducing their
Unsafe medical injections and contaminated
blood transfusions are still cause for concern, and
sound infection control practices should be promoted in
3.2 Do those in need have access to treatment and care?
A combination of
is effective in preventing or delaying
illness and death. However, such lifelong
are complex and expensive to deliver, which raises concerns
regarding access to
in resource-limited settings.
In recent years there has been a worldwide revolution in
improving access to
The 2001 Declaration of Commitment on
access to care and
as fundamental to an effective global
In 2003, UNAIDS and WHO launched the "3 by 5" initiative which
was a global target to provide three million people living with
in low- and middle-income countries with life-prolonging
(ART) by the end of 2005.
In low- and middle- income countries, the number of sites
drugs increased from roughly 500 in 2004 to more than 5000 by
the end of 2005 and, between 2001 and 2005, the number of people
increased from 240 000 to approximately 1.3 million. This major
increase still falls short of the “3 by 5” 3 million
As a result of recent unprecedented action across the world to
increase access to
some 250 000 to 350 000 lives were saved in 2005.
Twenty-one countries met the 2005 target of providing
to at least half of those who need it. Globally, however,
drugs still reach only one in five of those who need them.
The expansion of
access is hindered, because many individuals cannot afford the
expenses, or live far from treatment centres. In addition, the
needs of certain vulnerable
such as sex workers, men who have sex with men, injecting drug
users, prisoners, and refugees have been inadequately addressed
To expand delivery of
drugs in resource-limited settings, WHO recommended simplified
treatment therapy, along with
therapy for those whose first-line treatment fails.
However, as many
antiretroviral drugs remain too costly for use in many
countries, lower prices will probably be needed in order to
sustain and expand treatment access.
Making progress towards universal access to
requires efforts to:
- increase the use of voluntary
counselling and testing services so that more HIV cases can
- reduce HIV stigma and discrimination against people
living with HIV or those perceived to be at risk;
- train more health-care workers and make better use of
local medical assistants and other
health workers already available.
- avoid shortages of drugs to make sure that people who
need them can receive
without delay or interruptions; and
- integrate HIV care with other health services, for
diagnosis and treatment and reproductive health care. This
can lead to higher-quality care and to more people taking