Aug 06, 2008 News
Reversing HIV/AIDS cannot be achieved unless related programmes are linked to other disease responses and general health care services.
The Global Health Council is admonishing that this critical fact be acknowledged at the ongoing XVII International AIDS Conference in Mexico City.
Noting the vital need to achieve universal access to HIV/AIDS prevention, care and treatment advocates and programme implementers have recognised four key principles towards achieving this goal.
Underscoring the importance of incorporating HIV/AIDS initiatives into regular health care programmes, the Global Health Council notes that there is no victory in securing antiretroviral treatment for an HIV-infected person if the person is also infected with drug-resistant tuberculosis that remains undetected.
“There is no happy ending for a family where an HIV-positive mother receives services that prevent the transmission of her infection to her unborn child if that mother dies in childbirth due to a lack of access to prenatal care or access to skilled care during obstructed labour.”
The Global AIDS Roundtable also called for systems that provide care for persons who are HIV-positive to be strengthened, while acknowledging that the tools to manage their treatment and care to enable them to continue living productive lives for many years are available.
Resources for chronic care and case management are costly but quantifiable.
Thirdly, it was recognized that the need for a worldwide emergency response to HIV/AIDS is not yet over. Although an HIV infection is no longer the death sentence it once was, it is still a life sentence.
The expansion of evidence-based prevention methods is therefore urgently needed.
In addition to the fundamental moral and humanitarian reasons that compel all governments and private donors to invest in effective prevention services, the stark reality of the growing costs of HIV/AIDS treatment as the world strives for universal access provides another rationale for making more effort to prevent infections.
“And fourth, we still need a cure. The first step trial results for an AIDS vaccine were disappointing but not cause to lose hope. Many of the vaccines we take for granted today took decades to develop.
The critical need to invest in all promising new prevention and treatment interventions, particularly an AIDS vaccine, remains. Round one of this fight may not have gone the way we wished – but we are in it to win it.”
Worldwide efforts to slow and reverse the HIV/AIDS pandemic have seen some recent successes.
Prevention efforts have played a part in revisions of the number of people estimated to be infected with HIV.
Research has highlighted new opportunities, such as male circumcision, and renewed interest in the development of more effective paediatric AIDS drugs. More HIV-positive people are receiving treatment than ever before.
This year’s International AIDS Conference themes have focused on achieving universal access for HIV prevention, treatment and care services and commitments to halve the number of people living with HIV/AIDS by 2015. Universal access has not been achieved. Most of the countries with the highest HIV infection rates are far from reaching HIV prevention, treatment and care goals.
To attain universal access, U.S. advocates are seeking improved linkages between services provided for HIV/AIDS and other global health issues, including malaria, tuberculosis and primary care programmes focused on women and children’s health needs. However, reversing the spread of HIV/AIDS requires that improvements are achieved across issues and throughout health systems.
Highlighting some of the global successes in the fight, it was noted that strong political leadership in several countries supporting comprehensive HIV prevention has reduced prevalence of the virus.
Successful strategies include implementing comprehensive sexuality and AIDS education, especially for young people, both in and out of schools, promoting voluntary counseling and testing of HIV, ensuring access to both male and female condoms, providing access to sterile syringes for injection drug users and linking HIV/AIDS services with reproductive health and other primary care services.
In 2008, over three million people in low- and middle-income countries will receive antiretroviral treatment for HIV. However, a significant number of challenges still exist.
Fewer than 20% of those at high risk of HIV infection have access to the most basic HIV prevention services. Unfortunately, too, only 34% of pregnant mothers who are HIV-positive receive services to prevent transmission to their children.
69% of people with HIV in clinical need of antiretroviral treatment for HIV do not receive it because of inadequate funding, weak health systems, policies that limit access to affordable generic medicines and lack of political will. The number of children on treatment has not kept pace with the infection rate, and without early intervention, approximately half die before their second birthday.
In this regard, the need for hasty affirmative action was highlighted. These include increased investment in the full range of current and future HIV prevention interventions – including prevention of mother to child transmission services for at least 80 percent of pregnant women who are HIV-positive in the next five years.
Treatment and care for people with HIV infection must be equitable, effective, affordable and accessible.
It was also advocated that donor countries should pay to support treatment for their fair-share of the number of people with HIV in clinical need. The US should commit to supporting treatment for at least four million people with HIV over the next five years through bi- and multilateral programmes.
The need for Orphans and Vulnerable Children (OVC) not to be left out of international HIV/AIDS programming was also emphasized.
Highlighting the successes in this regard, it was noted that funding mechanisms, such as PEPFAR and the Global Fund, have supported millions of orphans and vulnerable children since 2003. As of December
2006, the Global Fund had supported and provided 1.2 million orphans with care and PEPFAR is supporting at least 2.7 million orphans and vulnerable children.
However, more than 13 million children around the world have lost one or both parents to HIV/AIDS, and recent estimates suggest this number will nearly double to 25 million by 2010.
It was touted that care for OVC must be community-based, flexible and holistic, and include mechanisms for monitoring and evaluation to effectively target those children in greatest need. Funding for advocacy on behalf of OVC is necessary to create a higher degree of visibility and to highlight OVC program
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