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Missing the target #5: Improving AIDS drug access and advancing health care for all
International Treatment Preparedness Coalition (ITPC)
December 2007

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At the G8 meeting in Gleneagles in 2005 and again at the United Nations UNGASS session in 2006, world leaders promised to come as close as possible to providing universal access to AIDS treatment and prevention by 2010. Estimates of HIV incidence and prevalence will change, but by any account, today several million people in desperate need of AIDS treatment do not have access to it. And at the current pace of growth in treatment delivery, several million will not have access by the end of 2010. Broken promises will mean millions of deaths.

Scale up of AIDS treatment is driving unprecedented expansion of health delivery and, in the process, identifying critical challenges to health systems as well as practical solutions to address them. This report identifies many ways in which governments and global agencies must act to correct systems essential to delivery of health. In the area of antiretroviral drug access-a special focus of this report-our research found that in many countries drug registration, procurement, and supply management systems are inadequate, drug stock-outs are common, and most people are not being treated with ARV regimens that are consistent with recent WHO recommendations for improved first-line and standardized second-line treatment combinations.

On-the-ground research by civil society advocates from 17 countries also reveals the close interconnection of AIDS services with other health and social supports. The lessons for successful AIDS treatment are true for all health services: appropriate delivery includes adequate nutrition, clean water, trained health workers, accessible health clinics, integration of prevention and treatment, and free provision of drugs, diagnostic and monitoring tests, and other commodities.

Mobilization around AIDS has raised new resources, built consumer-engagement in providing health care, marshaled enduring public support, and promoted the development of results-oriented approaches to global health. Building on these foundations should be a central strategy in developing comprehensive systems of health care. In Haiti and Rwanda, for example, providers are demonstrating how to deliver AIDS treatment as part of a comprehensive program that includes HIV prevention and a wide range of health services.

We cannot allow responses to AIDS and other chronic health issues to become bogged down in simplistic dichotomies: prevention vs. treatment; horizontal vs. vertical programming; disease-specific funding vs. strong health systems. There is only one appropriate approach: We must do everything, better, for more people, and in an increasingly coherent way.

In this fifth installment of the Missing the Target report series, we are broadening and deepening our approach to monitoring AIDS service delivery in heavily affected countries. Seventeen teams (from Eastern Europe, Africa, Asia, and Latin America) participated in the development of this report. And we are beginning the process of expanding the focus of the report series to incorporate more of the inextricably interwoven aspects of ending AIDS, including HIV prevention, TB services, and support services.

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