Mail & Guardian Online - June 4, 2008

Nearly three-million people in the developing world are now on drugs to prevent their HIV infection becoming Aids, two years after the original deadline to reach that figure was set by the World Health Organisation. The struggle to get antiretroviral drugs into poor countries has still been only partly successful. Only a third (31%) of those who are in immediate need of treatment were getting the drugs in 2007, figures compiled and released by the WHO, UNAIDS and Unicef show. A further 6,7-million will soon die without the drugs and more are infected every day -- an estimated 2,5-million last year alone. "Despite substantial progress in 2007, most low and middle-income countries are still far from achieving universal access goals. Obstacles include weak healthcare systems, a critical shortage of human resources and a lack of sustainable, long-term funding," says the report.

The target to get three-million people on treatment by 2005 was considered ambitious by some when it was set by the WHO in 2003. Although it was missed, it is widely credited with concentrating efforts on the struggle to make Aids drugs available at an affordable price in Africa and Asia. Margaret Chan, director general of the WHO, hailed the progress that has been made to date. "This proves that, with commitment and determination, all obstacles can be overcome," she said. Yet there is much still to do if the death toll is to be reduced further. While a growing number of pregnant women -- 33% last year -- are being given drugs at the onset of labour to prevent transmission of the infection to their baby, only 12% were assessed to decide whether they needed to be on the drugs themselves. That raises the possibility that the baby might survive, but the mother die soon afterwards. Large numbers of people with HIV still do not know their status, the report says, and therefore do not get advice on preventing transmission to their partners, or treatment, or care. Although the number of children on antiretroviral drugs has increased from 127 000 in 2006 to 200 000 last year, many are very vulnerable to disease because HIV is hard to diagnose in infants. The target now set by the G8 is for universal access not only to Aids drugs but also to prevention and care. The report notes that few of the hoped-for technologies to prevent the spread of infection have been successful. The only method that appears to reduce risk is male circumcision. Countries with high HIV rates are now exploring culturally acceptable ways to increase the take-up of circumcision.

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