全球愛滋病病毒應對工作取得空前進展 持續投放資源仍至關重要

 

全球愛滋病病毒應對工作取得空前進展 持續投放資源仍至關重要

globalhivaidsresponse2011日內瓦/香港,2011年11月30日——在預防和治療愛滋病病毒方面取得的全球進展,凸顯了在愛滋病病毒/愛滋病領域長期持續投放資源的好處。世界衞生組織、聯合國兒童基金會和聯合國愛滋病規劃署最新發表的《全球愛滋病病毒/愛滋病應對報告》表明,擴大愛滋病病毒服務,令過去10年間的新增感染病例下降了15%,而過去5年間的愛滋病相關死亡亦下降了22%。

世衞組織愛滋病病毒/愛滋病司司長Gottfried Hirnschall說:「全世界用了10年時間才實現這項進展。現在人類真正有可能減慢疾病發展趨勢,但要做到這一點,就必須在今後10年及以後,保持並加快應對工作。」

去年愛滋病病毒科學和規劃創新方面的進展,給未來的進步增加了希望。在經濟緊縮的年代,各國迅速應用提高愛滋病病毒規劃效率和有效性的新科技和新方法至關重要。

報告提出了正在發揮作用的措施重點:

[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.

• 改進愛滋病病毒檢測服務,東部和南部非洲孕婦接受愛滋病病毒檢測和諮詢的比率,由2005年的14%大大提高至61%。

• 2010年,近一半(48%)有需要的孕婦得到預防愛滋病病毒母嬰傳播的有效藥物。

• 抗逆轉錄病毒治療不僅能夠改善被感染者的健康和福祉,而且能夠阻斷愛滋病病毒的進一步傳播。現在低收入和中等收入國家有665萬人能夠獲得抗逆轉錄病毒治療,佔符合接受治療條件的1,420萬人的47%。

報告指出,到2020年,在愛滋病病毒服務方面的投資可能帶來高達港幣2,652億元(約340億美元)的經濟活動和生產率增量,大大超過抗逆轉錄病毒治療規劃的費用。

聯合國愛滋病規劃署副執行主任保羅•德萊表示:「2011年是形勢逆轉的一年。有了新的科學、前所未有的政治領導力和在愛滋病應對方面取得的持續進展,各國有機會抓住當前的進展,將他們的應對工作提高到新水準。各國可以通過明智投資提高效率、降低成本並改進結果。但是,若減少投放資源於愛滋病工作,迄今為止所取得的成就,仍有可能喪失。」

報告還指出了需要繼續進行的工作:

[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.

• 低收入和中等收入國家仍有超過一半需要抗逆轉錄病毒治療的人無法獲得治療。當中許多人甚至還不知道自己感染了愛滋病病毒。

• 雖然有越來越多的證據表明各國應該關注哪些領域才能產生實效,但仍有一些國家的相關工作未能針對風險最大、最有需要的人群。在很多情況下,少女、注射吸毒者、男男性行為者、跨性別人群、性工作者、囚犯和流動人口等群體,仍無法獲得愛滋病病毒預防和治療服務。

現時,全世界15至24歲愛滋病病毒感染者大部分(64%)是女性。這一比例在撒哈拉以南非洲還更高,當地少女和年輕婦女佔所有愛滋病病毒感染年輕人的71%,主要是由於預防措施還沒有延伸到他們。

關鍵人群繼續被邊緣化。在東歐和中亞,60%以上愛滋病病毒感染者是注射吸毒者。但注射吸毒者僅佔接受抗逆轉錄病毒治療者的22%。

雖然在阻止愛滋病病毒母嬰傳播方面,更好的服務已經成功地避免了35萬例新增兒童感染,但仍有340萬兒童感染愛滋病病毒,其中許多人缺乏愛滋病病毒治療。2010年,在低收入和中等收入國家,每4名需要愛滋病病毒治療的兒童中,只有1人獲得治療。與此相比,每2名需要治療的成人就有1名得到治療。

聯合國兒童基金會駐日內瓦辦事處主任莱拉.帕卡拉說:「雖然在成人可獲得的治療、保健和支持方面取得了進展,我們注意到在兒童方面進展緩慢。兒童愛滋病病毒干預措施的覆蓋率仍然非常低。我們必須通過共同行動和公平的戰略,確保全球努力不僅考慮到成人,也考慮到兒童。」

[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.

各區域和國家的愛滋病病毒情況

2010年,世界各地愛滋病病毒流行情況和地區上的應對工作各有不同,相關趨勢、進展率和結果也發生了變化。

撒哈拉以南非洲地區獲得抗逆轉錄病毒治療的人數增加30%,是增幅最多的一年。博茨瓦納、納米比亞和盧旺達3國已經實現愛滋病病毒預防、治療和保健服務的普遍覆蓋(80%)。2010年底,該地區抗逆轉錄病毒治療覆蓋率達39%。近半感染愛滋病病毒的孕婦接受預防病毒母嬰傳播的治療。21%有需要的兒童能夠獲得兒科愛滋病病毒治療。該地區新增感染病例為190萬,感染者人數為2,290萬。該地區不同地方的進展情況差別巨大。在抗逆轉錄病毒治療和預防母嬰傳播覆蓋率方面,東部(56%)和南部(64%)非洲國家顯著高於西部(30%)和中部(18%)非洲國家。

亞洲總體流行情況趨於穩定,但有些社區新增感染數量很高。亞洲480萬愛滋病病毒感染者中,接近一半(49%)生活在印度。抗逆轉錄病毒治療覆蓋率正在增加,需要愛滋病病毒治療的成人和兒童有39%獲得了治療。預防母嬰傳播服務的覆蓋率相對較低(16%)。

東歐和中亞愛滋病病毒急劇增長,過去10年間新增感染增加了25%。新增感染90%以上發生在俄羅斯和烏克蘭兩國。該地區預防母嬰傳播和兒科愛滋病病毒治療覆蓋率高(分別是78%和65%)。但是,抗逆轉錄病毒治療覆蓋率只有23%,特別是最受影響的人群——注射吸毒者——的治療覆蓋率很低。

中東和北非地區2010年愛滋病病毒感染者人數達到最高(59,000人),比前1年增加了36%。愛滋病病毒服務覆蓋率非常低:抗逆轉錄病毒治療覆蓋率為10%,兒科治療覆蓋率為5%,預防母嬰傳播覆蓋率為4%。

拉丁美洲和加勒比地區總體流行情況趨於穩定,拉美有150萬愛滋病病毒感染者,加勒比地區是20萬。在拉丁美洲,愛滋病病毒主要存在於男男性行為者中。但在加勒比地區,婦女是最受影響的人群,佔愛滋病病毒感染者的53%。該地區成人抗逆轉錄病毒治療覆蓋率是63%,兒童覆蓋率是39%。有效預防母嬰傳播治療方案的覆蓋率較高,為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.

今後10年繼續堅持應對愛滋病病毒

• 各國愛滋病病毒規劃帶來的效益優勢已十分明顯:南非實施了一項新的採購招標策略,在兩年之內將愛滋病病毒藥物費用減少了一半以上。烏干達轉向使用更簡單的兒科治療方案,節省了港幣1,560萬元(約200萬美元)。實現這些效益是因為2010年世衞組織和聯合國愛滋病規劃署推出了「治療2.0」倡議,促進更簡單、更便宜、更易於提供的愛滋病病毒治療和診斷工具,同時由社區對分散的服務提供支援。

• 世衞組織、聯合國愛滋病規劃署和聯合國兒童基金會提出「消除倡議」,旨在到2015年消除新增兒童愛滋病病毒感染並確保其母親的生存。

• 世衞組織正在就戰略性使用抗逆轉錄病毒藥物預防和治療愛滋病制定新的指導檔。

• 世衞組織「2011至2015年全球衞生部門愛滋病病毒/愛滋病戰略」2011年5月獲得世界衞生大會支持,該戰略強調繼續努力優化愛滋病病毒治療和聯合預防——使用各種不同方法降低人們感染風險——的重要性。

2011年《全球愛滋病病毒/愛滋病應對報告》全面報告了全球、各地區和國家的流行病學情況和獲得愛滋病病毒服務方面的進展情況。該報告由世衞組織、聯合國兒童基金會和聯合國愛滋病規劃署經與各國和國際夥伴合作共同撰寫。