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HIV treatment on rise but still falls short
Sarah Boseley, Guardian (UK)
August 17, 2006

http://www.guardian.co.uk/aids/story/0,,1851835,00.html

More than a million people in sub-Saharan Africa are on the drugs used for treating HIV that until a few years ago were the exclusive preserve of the rich, it was announced yesterday.

In three years, the number of people on Aids drugs in the area has risen 10-fold, said Kevin De Cock, the head of the World Health Organisation's Aids department, at the International Aids Conference in Toronto. He said the WHO estimated that by the end of June, 1.65 million people in low- and middle-income countries were on the treatment, representing 24% of the 6.8 million who urgently need it. More than half of the 40 million people infected with HIV live in sub-Saharan Africa.

"While the 76% still untreated represents a predominantly empty glass, trends in scale-up have none the less been encouraging in the areas with the most people with HIV," he said.

Introduction of treatment accelerated after the WHO set a target in 2003 of getting 3 million on antiretroviral drugs by 2005. It generated substantial political momentum in donor countries and in Africa and Asia. Unprecedented funding was made available for government treatment programmes through the UN-inspired Global Fund but also through the US President's Emergency Plan for Aids Relief (Pepfar). The "three by five" target was not met, but yesterday Mr De Cock, who took office this year and was not involved in setting it, said that it "helped change the landscape for HIV/Aids treatment internationally forever".

The G8 has since committed itself to universal access for treatment by 2010, but Mr De Cock acknowledged yesterday that it would be hard going.

"Right now the rate of increase is pretty steady," he said, but added that "treatment scale-up concentrates on where it is easiest to do initially".

The new figures show that the proportions of men and women receiving Aids drugs are roughly equal, which will surprise many who believed women were not getting equal access. But they show that few children are on the treatment - they represent 14% of Aids deaths but only 6% of those on drugs. "We must conclude that scale-up has so far left children behind," Mr De Cock said.

Pregnant women and their babies are being failed. Giving tablets to the woman in labour and her child when it is born can prevent transmission of the infection. But less than 10% of HIV-infected women in poor countries get the drugs they need, a situation Mr De Cock described as a "crisis". The intravenous drug users of eastern Europe and central Asia are also not getting equal access.

Drug prices have come down dramatically to around $130 a person a year for the basic three-drug cocktail, but that best price is not universally available, Mr De Cock said. Before long, the virus will develop resistance to the basic drugs and if they are to stay alive, thousands of people will need second-line drugs, which are still at unaffordable prices.

In Africa, most people in need of drugs are diagnosed and treated at a late stage, when they are sick, and their chances of surviving are much lower. Mr De Cock called for an urgent expansion of HIV testing. Only about 10% of those infected worldwide know they have the virus, which he called "an indictment of our commitment to public health and to affected communities, whose most basic rights - life and health - are compromised by the unforgiving natural history of undiagnosed and untreated HIV infection".

But though there is widespread support for wider testing, human rights activists and some Aids campaigners are concerned that some people may be coerced into being tested and not given the support and treatment they need. Human Rights Watch recently claimed that it had found HIV-testing practices that were not voluntary, were not linked to counselling and care, and failed to protect confidentiality in the Dominican Republic, Romania and Zimbabwe.

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