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More than 1m on ARVs in sub-Saharan Africa
Mail & Guardian (SA)
August 17, 2006

http://www.mg.co.za/articlepage.aspx?area=/breaking_news/breaking_news__africa/&articleid=280980

For the first time the number of people in sub-Saharan Africa receiving anti-retroviral (ARV) therapy has passed the one-million mark, the International Aids Conference heard in Toronto on Wednesday.

The 1,6-million people currently on treatment is a 24% increase over the 1,3-million on treatment in 2005, Kevin de Cock, director of the World Health Organisation's (WHO) department of HIV/Aids, told a plenary session.

ARV therapies have "dramatically evolved" over the past decade, he said, as expanding universal access took centre stage on the fourth day of the conference.

De Kock said the WHO and United Nations Joint Programme on HIV/Aids' "three by five" call to action -- to get three million people in low- and middle-income countries on ARV therapy by 2005 -- has helped change the way the disease is treated internationally forever. He said the treatment scale-up has shown that a strong health sector is essential for a comprehensive response to HIV/Aids.

"Universal access will require that the health sector play a central role," he said.

Ruth Nduati, a Kenyan epidemiologist at the University of Nairobi, said that while the "three by five" target has not been reached, the call to action was a great success. "If you walk through a village in Africa, people know what a CD4 count is; they know what ARVs are," she said.

De Cock hesitated in giving a new deadline for the treatment of three million people, saying the rate of increase is "pretty steady".

Ninety-five percent of people living with HIV/Aids live in the developing world.

Julio Montaner, president-elect of the International Aids Society, said there is a consensus that treatment should be given when someone's CD4 count falls below 200. It can be considered when the count is between 200 and 350. The CD4 cells are those affected by HIV, reflecting the state of the immune system.

"We want everyone below 200 to be on treatment, regardless of their viral load," he said.

Montaner said that while ARVs have dramatically evolved, they need to be spread more widely. "This is not to replace prevention; this is to enhance prevention. We cannot ignore the fact that ARV therapy has the ability to decrease infection," he said.

"Treatments are blind to race, to continents. If you use these treatments and use them properly, they work everywhere."

De Cock said one of the key obstacles to providing HIV treatment is the frailty of health systems. This includes human resources, infrastructure and laboratory capacity, among others.

According to Physicians for Human Rights, Africa needs one million more health workers. Currently 1% of health workers are fighting 25% of the global disease burden.

This shortage is directly caused by such factors as the burden of care by HIV/Aids, the pandemic's toll on the health workers themselves and the large-scale emigration of health workers.

Several sessions at the conference have been interrupted with protesters calling for more nurses in developing countries.

De Cock outlined five areas the health sector needs to focus on to make progress towards universal access. These are the expansion of HIV testing and counselling, increasing access to treatment and care, strengthening health systems, and investing in strategic information. He said prevention in health care settings also needs to be maximised.

Nduati highlighted the need for prevention of mother-to-child transmission services, as sub-Saharan Africa's child-mortality figures are 29 times higher than those in developing countries.

Meanwhile, experts at the conference called for intensified collaboration on tuberculosis (TB) control among the HIV community, to prevent the deaths of 250 000 people living with HIV a year.

"TB prevention, diagnostic and treatment services must become core functions of all HIV services," said De Cock. "TB can be treated and cured, so most of these deaths are absolutely preventable." -- Sapa

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