Scientific Facts on AIDS

3.2 Do those in need have access to treatment and care?
Access to treatment 2002-2005
Access to treatment 2002-2005

A combination of antiretroviral treatments is effective in preventing or delaying AIDS-related illness and death. However, such lifelong therapies are complex and expensive to deliver, which raises concerns regarding access to treatment in resource-limited settings.

In recent years there has been a worldwide revolution in improving access to treatment.

The 2001 Declaration of Commitment on HIV/AIDS embraced equitable access to care and treatment as fundamental to an effective global HIV response.

In 2003, UNAIDS and WHO launched the "3 by 5" initiative which was a global target to provide three million people living with HIV/AIDS in low- and middle-income countries with life-prolonging antiretroviral treatment (ART) by the end of 2005.

In low- and middle- income countries, the number of sites providing antiretroviral 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 on antiretroviral therapy increased from 240 000 to approximately 1.3 million. This major increase still falls short of the “3 by 5” 3 million target.

As a result of recent unprecedented action across the world to increase access to HIV treatment, some 250 000 to 350 000 lives were saved in 2005.

Twenty-one countries met the 2005 target of providing treatment to at least half of those who need it. Globally, however, antiretroviral drugs still reach only one in five of those who need them.

The expansion of treatment access is hindered, because many individuals cannot afford the treatment-related expenses, or live far from treatment centres. In addition, the needs of certain vulnerable populations, such as sex workers, men who have sex with men, injecting drug users, prisoners, and refugees have been inadequately addressed

To expand delivery of antiretroviral drugs in resource-limited settings, WHO recommended simplified and standardized treatment programmes involving first-line treatment therapy, along with second-line therapy for those whose first-line treatment fails. However, as many second-line 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 treatment requires efforts to:

* increase the use of voluntary HIV counselling and testing services so that more HIV cases can be diagnosed;
* 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 community health workers already available.
* avoid shortages of drugs to make sure that people who need them can receive antiretroviral treatment without delay or interruptions; and
* integrate HIV care with other health services, for instance with tuberculosis diagnosis and treatment and reproductive health care. This can lead to higher-quality care and to more people taking antiretroviral drugs.