Unparalleled global progress in HIV response but sustained investment vital

 

Unparalleled global progress in HIV response but sustained investment vital

globalhivaidsresponse2011GENEVA/ HONG KONG, 30 November 2011 – Global progress in both preventing and treating HIV emphasises the benefits of sustaining investment in HIV/AIDS over the longer term. The latest report by the World Health Organisation (WHO), UNICEF and UNAIDS Report on the Global HIV/AIDS Response indicates that increased access to HIV services resulted in a 15% reduction of new infections over the past decade and a 22% decline in AIDS-related deaths in the last five years.

“It has taken the world ten years to achieve this level of momentum,” says Gottfried Hirnschall, Director of WHO’s HIV Department. “There is now a very real possibility of getting ahead of the epidemic. But this can only be achieved by both sustaining and accelerating this momentum over the next decade and beyond.”

Advances in HIV science and programme innovations over the past year add hope for future progress. In times of economic austerity it will be essential to rapidly apply new science, technologies and approaches to improve the efficiency and effectiveness of HIV programmes in countries.

The report highlights what is already working:
[RELEASE OBTAINED] Natasha Chisenga Simpasa, holding her six-week-old daughter, Mutale, listens as a health worker explains proper dosing of Mutales prophylactic antibiotics during a consultation at the Chelstone Clinic in Lusaka, the capital. Ms. Simpasa is HIV-positive. She participated in the clinics PMTCT programme for her sons, 20-month-old Fanwick and four-year-old Masonda, both of whom are HIV-negative. She is now participating in PMTCT for Mutale. Mutale has just received her first HIV test, but the results will not be known for several weeks. [#8 IN SEQUENCE OF NINE]  In October 2010 in Zambia, the Chelstone Clinic in Lusaka continues to provide vital programmes to treat HIV-positive pregnant women and to prevent mother-to-child transmission of HIV (PMTCT). Some 95,000 Zambian children under age five are infected with HIV; the vast majority contracted the illness from an HIV-positive mother during pregnancy, delivery or breastfeeding. PMTCT programmes include HIV testing during pregnancy, antiretroviral (ARV) regimens for sick HIV-positive pregnant women, and early diagnosis and treatment for infants exposed to HIV in utero. Participating infants receive prophylactic antibiotics and ARVs in the weeks after they are born, and are administered HIV tests at six weeks. If breastfed by an HIV-positive mother, infants continue to receive prophylactics and are tested again at 12 months and 18 months (and three months after breastfeeding ceases or at any age if they fall ill). HIV-positive infants diagnosed and treated within the first 12 weeks of life are 75 per cent less likely to die from the disease. Zambia has recently made great strides in expanding PMTCT programmes. In the second quarter of 2009, ARVs were administered to approximately half of all children in need and to some 57 per cent of HIV-positive pregnant women. However, many infants still do not receive PMTCT services because their caretakers lack access to properly equipped facilities, or fear the stigma associated with HIV, or find it difficult to adhere to the structured course of required tests and services.

•Improved access to HIV testing services enabled 61% of pregnant women in eastern and southern Africa to receive testing and counseling for HIV – up from 14% in 2005.

 

•Close to half (48%) of pregnant women in need receive effective medicines to prevent mother-to-child transmission of HIV (PMTCT) in 2010.

•Antiretroviral therapy (ART), which not only improves the health and well-being of the infected people but also stops further HIV transmission, is available now for 6.65 million people in low- and middle-income countries, accounting for 47% of the 14.2 million people eligible to receive it.

The report acknowledges that investment in HIV services could lead to total gains of up to HK$265.2 billion (US$34 billion) by 2020 in increased economic activity and productivity, more than offsetting the costs of ART programmes.

“2011 has been a game changing year. With new science, unprecedented political leadership and continued progress in the AIDS response, countries have a window of opportunity to take their responses to the next level,” says Paul De Lay, Deputy Executive Director, Programme, UNAIDS. “By investing wisely, countries can increase efficiencies, reduce costs and improve on results. However, gains made to date are being threatened by a decline in resources for AIDS.”

The report also points to what still needs to be done:
[RELEASE OBTAINED] Patients wait outside the Samfya Stage 2 Clinic, in the rural town of Samfya, in Samfya District. The clinic provides PMTCT services as well as other child and maternal health services.  In October 2010 in Zambia, clinics in both urban and rural areas are providing vital programmes to treat HIV-positive pregnant women and to prevent mother-to-child transmission of HIV (PMTCT). PMTCT programmes include HIV testing during pregnancy, antiretroviral (ARV) regimens for sick HIV-positive pregnant women, and early diagnosis and treatment for infants exposed to HIV in utero. These infants receive prophylactic antibiotics and ARVs in the weeks after they are born and are administered HIV tests at six weeks. If breastfed by an HIV-positive mother, infants continue to receive prophylactics and are tested again at 12 months and 18 months (and three months after breastfeeding ceases or at any age if they fall ill). HIV-positive infants diagnosed and treated within the first 12 weeks of life are 75 per cent less likely to die from the disease. However, many infants do not receive PMTCT services because their caregivers lack access to properly equipped facilities or fear the stigma associated with HIV. Zambia has recently made great strides in expanding PMTCT programmes. In the second quarter of 2009, ARVs were administered to approximately half of all children in need and to some 57 per cent of HIV-positive pregnant women. But for PMTCT measures to be effective, infants must adhere to a long-term, structured course of tests and services. Access to PMTCT services is particularly difficult in rural areas, where poverty rates are higher and many remote communities have limited access to health clinics. UNICEF supports the expansion of these services into rural areas, including Samfya District in Luapula Province. The province has the highest child-mortality rates in the country, and Samfyas clinics face critical staff and supply shortages. However, rural areas also tend to have lower HIV infection rates, as well as greater willingness on the part of fathers to participate in PMTCT services.

• More than half of the people who need antiretroviral therapy in low- and middleincome countries are still unable to access it. Many of them do not even know that they have HIV.

 

•Despite the growing body of evidence as to what countries need to focus on to make a real impact on their epidemics, some are still not tailoring their programmes for those who are most at risk and in need. In many cases, groups including adolescent girls, people who inject drugs, men who have sex with men, transgender people, sex workers, prisoners and migrants remain unable to access HIV prevention and treatment services.

Worldwide, the vast majority (64%) of people aged 15-24 living with HIV today are female. The rate is even higher in sub-Saharan Africa where girls and young women make up 71% of all young people living with HIV – essentially because prevention strategies are not reaching them.

Key populations are continually marginalised. In Eastern Europe and Central Asia, more than 60% of those living with HIV are people who inject drugs. But injecting drug users account for only 22% of those receiving ART.

Although better services to prevent mother to child transmission of HIV have averted some 350 000 new infections among children, some 3.4 million children are living with HIV – many of whom lack HIV treatment. Only about one in four children in need of HIV treatment in low- and middle-income countries received it in 2010, as compared to 1 in 2 adults.

“While there have been gains in treatment, care and support available to adults, we note that progress for children is slower,” says Leila Pakkala, Director of the UNICEF Office in Geneva. “The coverage of HIV interventions for children remains alarmingly low. Through concerted action and equity-focused strategies, we must make sure that global efforts are working for children as well as adults.”

[RELEASE OBTAINED] Two-year-old Bright smiles at his aunt Leontina Chalikosa (formerly Mwewa), in Mulebambushi Village, Samfya District. Brights mother, Yvonne, died of AIDS the previous year, and Leontina is now his primary caretaker. PMTCT services were not available when Yvonne was pregnant with Bright, and she did not learn she was HIV-positive until after his birth. Bright became ill around the time his mother died; soon after, he tested positive for HIV. As part of paediatric services at the nearby Chimembe Clinic, Bright is receiving ARVs and his health has improved, though he is currently sick with malaria. [#1 IN SEQUENCE OF FIVE]  In October 2010 in Zambia, clinics in both urban and rural areas are providing vital programmes to treat HIV-positive pregnant women and to prevent mother-to-child transmission of HIV (PMTCT). PMTCT programmes include HIV testing during pregnancy, antiretroviral (ARV) regimens for sick HIV-positive pregnant women, and early diagnosis and treatment for infants exposed to HIV in utero. These infants receive prophylactic antibiotics and ARVs in the weeks after they are born and are administered HIV tests at six weeks. If breastfed by an HIV-positive mother, infants continue to receive prophylactics and are tested again at 12 months and 18 months (and three months after breastfeeding ceases or at any age if they fall ill). HIV-positive infants diagnosed and treated within the first 12 weeks of life are 75 per cent less likely to die from the disease. However, many infants do not receive PMTCT services because their caregivers lack access to properly equipped facilities or fear the stigma associated with HIV. Zambia has recently made great strides in expanding PMTCT programmes. In the second quarter of 2009, ARVs were administered to approximately half of all children in need and to some 57 per cent of HIV-positive pregnant women. But for PMTCT measures to be effective, infants must adhere to a long-term, structured course of tests and services. Access to PMTCT services is particularly difficult in rural areas, where poverty rates are higher and many remote communities have limited access to health clinics. UNICEF supports the expansion of these services into rural areas, including Samfya District in Luapula Province. The province has the highest child-mortality rates in the country, and Samfyas clinics face critical staff and supply shortages. However, rural areas also tend to have lower HIV infection rates, as well as greater willingness on the part of fathers to participate in PMTCT services. On 1 December 2005 in southern Sudan, children wearing 'Unite for Children, Unite Against AIDS' T-shirts attend a local launching of the global campaign of the same name in Juba, the capital of Bahr el Jebel State. The global campaign launch was held at United Nations Headquarters and in several world capitals on 25 October. Worldwide, 15 million children have lost one or both parents to AIDS. Every day, nearly 1,800 children under 15 become HIV-positive and 1,400 die from AIDS-related illness. More than 6,000 young people aged 15-24 acquire the virus daily. Yet children are missing from the global HIV/AIDS agenda.

HIV in regions and countries

In 2010, HIV epidemics and responses in different parts of the world vary with shifting trends, progress rates and outcomes.

Sub-Saharan Africa recorded the biggest overall annual increase–30%–in the number of people accessing ART. Three countries (Botswana, Namibia and Rwanda) have achieved universal coverage (80%) for HIV prevention, treatment and care services. The regional ART coverage rate stood at 39% at the end of 2010. Approximately 50% of pregnant women living with HIV receive treatment to prevent mother-to child transmission of HIV. And 21% of children in need are able to get paediatric HIV treatments. There were 1.9 million new infections in the region, where 22.9 million people are living with HIV. There are some major disparities in progress between different parts of the region. Countries in Eastern and Southern Africa have reached much higher coverage rates for ART (56%) and PMTCT (64%) than countries in Western and Central Africa (30% and 18% respectively).

Asia shows a stabilising epidemic overall, but new infections are very high in some communities. Of the 4.8 million people living with HIV in Asia, nearly half (49%) are in India. Antiretroviral treatment coverage is increasing with 39% of adults and children in need of HIV treatment having access. Coverage of PMTCT services is relatively low- (16%).

Eastern Europe and Central Asia presents a dramatic growth in HIV, with new infections increasing by 250% in the past decade. Over 90% of these infections occur in just two countries: Russia and Ukraine. The region demonstrates high coverage rates for PMTCT and paediatric HIV treatment (with 78% and 65% coverage rates respectively). However, ART coverage is very low at 23%, particularly among the most affected people- the ones who inject drugs.

Middle East and North Africa records the highest number of HIV infections ever in the region (59 000) in 2010, which represents a 36% increase over the past year. Coverage of HIV services are very low in the region: 10% for ART, 5% for paediatric treatment and 4% for PMTCT.

Latin America and the Caribbean have a stabilising epidemic with 1.5 million living with HIV in Latin America and 200 000 in the Caribbean. HIV is predominantly among networks of men who have sex with men in Latin America. In the Caribbean though, women are the more affected group accounting for 53% of people living with HIV. The region has ART coverage of 63% for adults and 39% for children. Coverage for effective PMTCT regimen is relatively high at 74%.

A doctor takes a blood sample from a patient at a UNICEF-supported detoxification centre in the city of Sfax, capital of Sfax Governorate.  In March-April 2011 in Tunisia, children and adolescents continue to be affected by the political changes in several countries in the Middle East and North Africa Region. Protests began in Tunisia in December 2010, leading to a change in government one month later. Political reforms are underway, though changes to address persistent hardships such as unemployment will take many months. Populist demonstrations have also affected nearby countries, with civilians protesting high food prices and unemployment rates, and demanding political change. Adolescents are participating in many of these protests, demanding that their views be considered as well. In neighbouring Libya, protests have resulted in armed conflict, and by early April, some 228,000 people had fled from Libya to Tunisia to escape the violence. Tunisian children and adolescents continue to be affected by both the revolution in their own country and by the displacement crisis on the Libyan border. Lingering insecurity is also affecting Tunisian schools, with schools reporting looting, vandalism or armed attacks in seven out of 23 regions. On 24 May, schoolchildren sing a song during the visit of UNICEF Executive Director Ann M. Veneman to Dvumbe Primary School, in a rural area south-east of Mbabane, capital of Swaziland. Some 30 per cent of children at the school have lost either one or both of their parents to AIDS. To help encourage orphaned and other vulnerable children to stay in school, UNICEF supported the creation of a vegetable garden at the school as well as a programme providing two nutritious meals a day. The meal programme is now being provided by the World Food Programme.  From 22 to 28 May 2005, UNICEF Executive Director Ann M. Veneman travelled to South Africa, Swaziland and Malawi to review the impact of HIV/AIDS on children, as well as UNICEF programmes. All three countries are highly affected by the pandemic, in a region that has the largest number of children in the world affected by HIV/AIDS and the highest percentage of children orphaned by AIDS. Swaziland and Malawi face the 'triple threat' of food insecurity, weakened governance and HIV/AIDS. During her trip, Ms. Veneman met with government officials, donor agencies and other UNICEF partners and visited hospitals and other health facilities, including sites providing services to prevent mother-to-child transmission of HIV; community outreach centres; schools; nutrition programmes; and a child-headed household. She also joined United Nations Special Envoy for Humanitarian Needs in Southern Africa James Morris (who is also World Food Programme Executive Director) and UNAIDS Executive Director Dr. Peter Piot to review joint UN programmes and resource needs to address these issues. This was Ms. Veneman's first official field visit as UNICEF Executive Director.

Sustaining the HIV response through the next 10 years

•Countries are already showing marked efficiency gains in HIV programmes: South Africa reduced HIV drug costs by more than 50% over a two-year period by implementing a new tendering strategy for procurement. Uganda saved HK$15.6 million (US$2 million) by shifting to simpler paediatric regimens. Such efficiencies are promoted through Treatment 2.0 – an initiative launched by WHO and UNAIDS in 2010 to promote simpler, cheaper and easier-to-deliver HIV treatment and diagnostic tools, combined with decentralised services that are supported by communities.

•A WHO, UNAIDS, UNICEF “Elimination Initiative” aims to eliminate new HIV infections among children by 2015 and keep their mothers alive.

•WHO is developing new guidance on the strategic use of antiretroviral drugs for both prevention and treatment.

•WHO’s “Global Health Sector Strategy on HIV/AIDS, 2011-2015”, endorsed by the World Health Assembly in May 2011 highlights the importance of continuing efforts to optimise HIV treatment and “combination” prevention – the use of a range of different approaches to reduce people’s risk of infection.

The 2011 Report on the Global HIV/AIDS Response is the comprehensive report on both the epidemiology and progress rates in access to HIV services globally and in regions and countries. It has been jointly developed by WHO, UNICEF, UNAIDS, in collaboration with national and international partners.