SIDA & VIH
AIDS treatment targets and results
An estimated 33 million people were living with HIV at the end of 20071. Someone who is infected with HIV is likely to become sick with AIDS within a few years, but if treated with antiretroviral (ARV) medication their life can be prolonged, often for a long time. ARV treatment has already dramatically cut the rate of AIDS diagnoses and deaths in Western countries where it has been provided since the mid 1990s.
As of December 2007, an estimated 9.7 million of the people living with HIV in low- and middle-income countries urgently needed this life-saving ARV medication. Of these only 2.99 million – just under a third – were accessing the drugs.
Though shockingly small, this figure represents a great advance since 2003, when only 400,000 were receiving treatment. At the UN General Assembly Meeting on HIV/AIDS on 22nd September 2003, WHO, UNAIDS and the Global Fund declared the lack of access to HIV treatment a global health emergency2.
Since that meeting much progress has been made. Many countries have set targets for scaling-up treatment, and global organisations and funding bodies are rolling-out plans to increase ARV coverage.
Never before in the history of the epidemic has so much money been available to finance treatment and care for people with HIV, and never before have life-saving antiretroviral medicines been so cheaply and plentifully available. But still, every day, more than 5,000 people are dying from a disease which can be treated, but which all too often isn't.
Treatment targets
Rapid expansion of ARV treatment programmes is unlikely to happen without clear, ambitious goals to pursue. The most important targets of recent years are “3 by 5” and “All by 2010”.
All by 2010
“All by 2010” describes the goal of universal access to ARV treatment by the year 2010. Achieving this target means putting many more people on treatment than the 9.7 million currently in need. This is because people who started treatment in previous years must continue to receive medication, and each year many hundreds of thousands of people progress to the stage of disease at which treatment is required.
According to the most common definition, universal access to treatment is achieved when 80% of all people in urgent need of treatment are receiving it. Experience has shown that this level of coverage is seldom exceeded even in rich countries, for a variety of reasons including adverse drug reactions and personal choice.
All by 2010: the promises
In July 2005, leaders of the Group of Eight (G8) countries (Canada, France, Germany, Italy, Japan, Russia, the UK and the US) pledged to ensure as near as possible to universal access to antiretroviral (ARV) treatment worldwide by 2010. Two months later, all United Nations Member States endorsed this goal by committing themselves to:
"Developing and implementing a package for HIV prevention, treatment and care with the aim of coming as close as possible to the goal of universal access to treatment by 2010 for all those who need it" 3
This promise was reaffirmed by the world's leaders at the UN High-level Meeting on AIDS in May-June 2006:
"[We commit] to pursue all necessary efforts to scale up nationally driven, sustainable and comprehensive responses … towards the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010." 4
The G8 also repeated their commitment to the universal access goal at their annual summit in July 2008.5
All by 2010: the reality
Despite the promises, there is now little hope that the ‘all by 2010’ target will be achieved. In the 2008 ‘Towards Universal Access’ progress report, the World Health Organisation (WHO) admitted for the first time:
"As we look ahead, it is clear that – even at the increased pace of scale-up – most countries will not meet the goal of universal access by 2010" 6
The graph illustrates progress so far (dark blue) and future progress needed if treatment coverage is to reach 10 million by 2010 (light blue). Even 10 million will be well short of universal access.
Nevertheless, the WHO and international community remain committed to the ‘ambitious and long-term commitment’ of providing anti-AIDS treatment to all those who need it. The WHO says:
"Universal access to HIV prevention, treatment, care and support is not only achievable, it is a public health and human rights imperative, which has been agreed to by the United Nations member states and international donors. Many nations will meet specific universal access targets (such as PMTCT or ART) by 2010, while many others will meet them in 2011, 2012, and/or subsequent years. The focus of WHO,
UNAIDS and others is to ensure that all states meet the goal as early as possible." 7
The ‘3 by 5’ initiative
The World Health Organisation created the first global target for ARV treatment access in 2003. The “3 by 5” initiative called for 3 million people in developing countries to have access to treatment by the end of 2005, which meant meeting 50% of estimated need.
The 3 by 5 logo
Progress towards this goal began well, but then failed to accelerate. At the end of 2005 only 1.3 million people in low- and middle-income countries were receiving ARV medication. This was just 40% of the target. In sub-Saharan Africa, 810,000 were on treatment out of an estimated 4.7 million who needed it8.
Of the 152 countries targeted by the 3 by 5 initiative, only 18 managed to provide treatment to at least half of their needy people by the end of 2005. The list included Poland, Thailand and thirteen countries from the Americas and the Caribbean. Only three African nations - Botswana, Namibia and Uganda - met their 50% targets.
Yet the WHO has stressed that, even though 3 by 5 didn't succeed within the intended timeframe, this doesn't mean it should be deemed a failure. Much of 3 by 5's work was to set up infrastructure and mobilise resources, laying the foundations for future progress. The number of treatment sites in low- and middle-income countries increased tenfold from around 500 in June 2004 to more than 5,100 by the end of 2005.
"3 by 5 has helped to mobilize political and financial commitment to achieving much broader access to treatment. This fundamental change in expectations is transforming our hopes of tackling not just HIV/AIDS, but other diseases as well." - Dr Lee Jong-wook, WHO Director-General9
The target of putting three million people on HIV treatment was eventually met at the end of 2007, two years later than originally forecast. Kevin De Cock, director of HIV/AIDS at the WHO said:
‘In retrospect, maybe [3 by 5] was excessively aspirational’ but in battling the AIDS epidemic ‘aspiration is necessary’. He said that ‘reaching that target even two years late is quite a remarkable achievement,’ as in 2003, when the target was created, fewer than half a million people were receiving treatment10.
Treatment results
The number of people receiving ARV medication in low and middle-income countries increased from 400,000 in December 2003 to 2.99 million in December 2007. Despite this massive scale up, global coverage of antiretroviral therapy remains low, at 31% of the need.
Progress has been uneven around the world. While some countries such as Cuba and Brazil have been providing treatment to the majority of those in need for some time, others such as China, Egypt and Russia are yet to reach even 20% coverage.
At the end of 2007, sub-Saharan Africa represented 71% of the estimated total treatment need in low- and middle-income countries and 72% of the total number of people receiving treatment. Treatment coverage in this region is low, although the rate of scale-up has been remarkable; between 2006 and 2007 treatment coverage rose by 54%. Mozambique, Nigeria and Tanzania more than doubled their numbers of people on treatment within a year, although total coverage in these countries remains low.
Regional estimates (low- and middle-income countries only)
| Region | UNAIDS/WHO estimates | ||
|---|---|---|---|
| People receiving treatment in December 2007 | People needing treatment in 2007 | Treatment coverage in December 2007 | |
| Sub-Saharan Africa | 2,120,000 | 7,000,000 | 30% |
| Latin America and the Caribbean | 390,000 | 630,000 | 62% |
| East, South and South-East Asia | 420,000 |
1,700,000 | 25% |
| Europe and Central Asia | 54,000 | 320,000 | 17% |
| North Africa and the Middle East | 7,000 | 100,000 | 7% |
| All developing and transitional countries | 2,990,000 | 9,700,000 | 31% |
The above table shows the estimated number of people who need HIV treatment, and the number of people who are receiving treatment by region. It includes all countries except those of Western Europe and Australia, Antigua and Barbuda, Bahamas, Bahrain, Barbados, Brunei, Canada, Cyprus, Czech Republic, Estonia, Israel, Japan, Kuwait, New Zealand, Qatar, Republic of Korea, Saudi Arabia, Singapore, Trinidad and Tobago, United Arab Emirates and United States of America. These high-income countries are not included in WHO statistics, as on the whole these countries have established medical facilities to provide people living with HIV immediate access to treatment and care.
The total number of people needing treatment is comprised of those already receiving treatment, plus those who should start receiving treatment immediately because they have already reached the advanced stages of HIV infection. It does not include the majority of people living with HIV who have not yet reached the advanced stages of infection.
National estimates
The estimates of people receiving treatment are derived from the latest available reports. So that all data refer to December 2007, numbers from earlier reports have been projected forwards according to average monthly growth rates. The numbers include those accessing treatment through all sources including the private sector.
The estimated number of people needing ARV treatment takes into account UNAIDS/WHO estimates of the number of new HIV infections, AIDS cases and deaths; information about the maturity of the epidemic; and the number of people already receiving treatment.
For a list of individual countries, see our document of treatment coverage [PDF] in all low- and middle-income countries.
Conclusion
AIDS killed an estimated 2 million people in 2007. If everyone had access to ARV therapy then the death toll would be much lower.
Treatment for HIV/AIDS has been shown to be effective and feasible in even the poorest parts of the world. Political momentum is building and governments are beginning to show their willingness to help alleviate the suffering.
Unfortunately, despite an impressive rate of treatment scale-up in many countries in 2007, the current rate of overall treatment expansion is not nearly sufficient to achieve the "All by 2010" target. The world's leaders must now demonstrate real commitment if universal access to HIV treatment is to be achieved in the near future. Millions of lives are at stake.
"Along with other partners, the [3 by 5] initiative ... shattered forever the tacit acceptance in industrialised regions that millions in developing nations would die simply because they were poor. For this outcome, the WHO, UNAIDS, and all those who believed in 3 by 5 deserve unstinting praise. But a shift in thinking, however important, will not be enough without the resources and political leadership to back it up." - Dr. Helene Gayle, President of the International AIDS Society 11
Further reading
There are many challenges to be overcome on the road towards universal access, including a shortage of resources, infrastructure and skilled staff, but none of these problems is insolvable. Read more about these challenges and what is being done to overcome them in our treatment issues page.
At the end of September 2007, funding from the US initiative known as PEPFAR (President's Emergency Plan for AIDS Relief) was helping around 1,445,500 of the 2.990 million people receiving treatment. At the same time the Global Fund to Fight AIDS, TB and Malaria was supporting around 1,448,000. More details can be found in our PEPFAR and Global Fund pages.
