AIDS status & challenges of the epidemic
7. What should be done to improve prevention and access to treatment?
- 7.1 How can AIDS prevention be strengthened?
- 7.2 How can treatment access be expanded?
- 7.3 How can human resources and systems be strengthened?
- 7.4 How can HIV prevention and treatment become more available and affordable?
- 7.5 What are the main needs in the field of research and development?
- 7.6 How can the broader social impact of AIDS be countered?
To get as close as possible to the goal of offering
to all those who need it by 2010, a series of key areas require
commitment and action: prevention, access to treatment, human
resources, treatment and prevention products, research, and
7.1 How can AIDS prevention be strengthened?
Community Self Help programme, Kenya
It is critical to renew the emphasis on
prevention and to strengthen it in order to prevent millions of
new infections each year.
Access to clear, factual
prevention information and to HIV testing should be a right.
Each person should know his or her HIV status and have access to
information, counselling and related services.
prevention services and education should target vulnerable
groups, including sex workers, injecting drug users, men who
have sex with men, and prisoners. Other
groups that should benefit from a better access to adequate
prevention services include HIV-infected pregnant women who are
at risk of transmitting the disease to their children (in the
womb, during childbirth, or through breastfeeding) and young
people who account for 40% of all new infections.
7.2 How can treatment access be expanded?
Ensuring that access to
continues to grow rapidly will require a series of
- Access to confidential and voluntary
testing should be broadened so that more people know whether
they are infected or not;
- Additional sites where
can be provided, which are so far largely concentrated in
urban areas, should be established, and all
groups affected, including children, must be assured equal
access to treatment;
- Access to drugs that prevent common HIV-related
infections should be expanded
- HIV-related stigma and discrimination should be
- More medical workers should be trained to deal with
and the drug supply should be improved;
- The public should be made aware of available treatment
services, their benefits and how to use them.
7.3 How can human resources and systems be strengthened?
The shortage of skilled workers in many developing countries
leads to poor surveillance, planning and administration;
bottlenecks in the distribution of funds; failures in the
implementation, monitoring and evaluation of activities; and
inadequate provision of services.
Eliminating these obstacles will require:
- rapid recruitment and training of additional
health-care workers and improving incentives that encourage
them to work in their own countries instead of migrating to
- increasing public financing for training in countries
facing severe human resource shortages,
- encouraging the provision of
care, and support by locals where not enough trained health
professionals are available,
- better integration of
services into other primary health care programmes (such as
programmes addressing mother and child health, sexual and
reproductive health, and diagnosis and treatment of
malaria and sexually transmitted diseases).
7.4 How can HIV prevention and treatment become more available and affordable?
products such as condoms and
drugs are available and affordable will require a series of
- National governments should remove taxes on medicines,
condoms and other products that are used for the prevention,
care and support of
and should also remove laws or regulations that might hinder
access to these products.
- Governments should allow medicines into the market as
soon as they are approved by the WHO in order to speed up
access to new treatment.
- Governments should ensure that the few drugs available
to treat and prevent
in children reach at least 80% of those in need by 2010.
- Many vitally needed medicines are covered by patents
that can limit their use and make them expensive. While drug
companies need a sufficient incentive to invest in research
and development, AIDS medications must be produced as
cheaply and widely as possible to meet the needs of
developing countries. Where necessary, countries should make
use of the flexibilities in the agreements on intellectual
property to ensure they have sustainable supplies of
affordable medicines and health technologies, including
through local production.
7.5 What are the main needs in the field of research and development?
It is vital to promote technological innovation to develop
new generations of drugs, and a preventive vaccine.
Therefore, substantially more money must be allocated to
research, especially by the pharmaceutical and biomedical
industries. In addition, partnerships between the public sector
and private companies should be developed to promote faster
development of new drugs for children with
Stakeholders should also be involved in the planning and conduct
of clinical trials for HIV prevention so as to avoid the
controversies these trials often generate. Finally, systems and
agreements that guarantee wide and
products for HIV and HIV-related diseases must be put into place
by governments, civil society, and the private sector.
7.6 How can the broader social impact of AIDS be countered?
exacerbates every other challenge to human development, such as
food security and conflict avoidance. Therefore, efforts to
reduce the impacts of AIDS must focus at the same time on
preventing new infections, caring for those already infected and
mitigating the economic, institutional and social impacts of
- Efforts to reduce the impact of
should focus first of all on the individuals and families
affected, for instance by providing access to
nutritional assistance, and
infections and other health problems.
- Children who have lost one or both parents to AIDS
need to receive special attention,
- Social protection measures should be taken to preserve
livelihoods of people affected by AIDS, including welfare
programmes, child and orphan support, and public works to
- Refugees or displaced persons are vulnerable
that should be included in prevention, care and treatment
planning in the countries that host them.
- The Chinese AIDS program could serve as a model in
supporting families and societies affected by AIDS, since it
drugs, voluntary counselling and testing, drugs to prevent
mother-to-child transmission, schooling for orphaned
children, and care and economic assistance to affected