HIV Treatment Bulletin - Vol. 7, No. 6, June 2006

In the week prior to the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) the International Treatment Preparedness Coalition (ITPC) issued a report ‘Missing the Target – Off Target for 2010: How to Avoid Breaking the Promise of Universal Access’.

The report is an update of ‘Missing the Target’ – the International report on scale-up of AIDS treatment in six countries around the world, released last November. The report received international media attention and its major recommendations were endorsed by the ‘Lancet Infectious Diseases’ in January 2006.

The report is written by ITPC researchers in Russia, India, Nigeria (three of the “next wave” countries with explosive epidemics), the Dominican Republic, Kenya and South Africa.

ITPC found that the world will fall far short of the internationally declared goal of “near universal access” to AIDS treatment unless specific barriers to treatment scale up are addressed urgently. Our update finds that despite some progress, serious barriers – including halfhearted national and international leadership, weak management at all levels, sluggish implementation of reforms, poor logistics and technical support, and serious funding shortfalls – have not been adequately addressed and continue to plague delivery of AIDS treatment in less developed countries.

While some progress has been made in every country, most of the barriers identified in the original report remain, including:

• In the Dominican Republic treatment delivery is expanding but people in some of the poorest areas with the highest rates of HIV are still not being reached. Government and donor agencies are still not collaborating efficiently, scarce resources have been squandered, and second line drugs cost 10 to 20 times more than first line generics.
• In India, hundreds of thousands of people in need still do not have access to antiretroviral therapy, even though the number of treatment centers has increased. National treatment guidelines need to be reformed and clear action to reach children and ensure greater equity in care is needed.
• In Kenya, AIDS treatment services have been undercut by growing food shortages in some areas. Stigma and critical shortages of healthcare workers continue to be major problems. Government delays in submitting audit reports held-up the release of Global Fund monies.
• In Nigeria, more treatment centers have opened across the country, but the suspension of two grants by the Global Fund -- because the country failed to meet targets on drug access and demonstrate transparency -- is potentially devastating to the government’s pledge to make treatment available and free.
• In Russia, government funding has grown, but these new resources have yet to translate into significant increases in treatment delivery. There is an urgent need for services appropriate for injection drug users, as well better health care worker training, more efficient drug procurement, and comprehensive anti-stigma efforts.
• In South Africa, the number of people on treatment has increased, but scale-up efforts continue to lag due to inadequate national leadership, government efforts to inhibit civil society participation, pervasive AIDS denialism, and a virtually non-functional Global Fund Country Coordinating Mechanism. Children and men also need greater access to treatment.

The report and related documents are available online

2006-06-10
IB060706-26

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