This is according to a report released yesterday (30/09/2009) by the World Health Organisation (WHO), the Joint United Nations’€™ Programme on HIV/AIDS (UNAIDS) and the United Nations’€™ Children’€™s Fund (UNICEF) on public health sector interventions to address the AIDS epidemic. The report, which surveyed about 160 countries, the bulk majority of whom are low and middle-income countries, shows significant changes in how health systems have responded to the epidemic.  

‘€œA big jump has been in the number of people who have accessed antiretroviral therapy. Last year we had just over four million people getting ART in low and middle income countries. This represents a 36% jump in one year, but it represents a 10-fold increase in the last five years. In sub-Saharan Africa, this jump’€¦ for people who lived with HIV who have ART’€¦ went from 2.1 million people in 2007 to 2.9 million people in 2008. This represents a 39% jump in the one year, but it represents a 30-fold increase over the last five years’€, announced Dr Stella Anyangwe, WHO representative for South Africa.                  

But as more people accessed treatment last year, many more were still left out.    

‘€œWe know that four million people are on treatment now. But we know that that four million represents only 42% of those who really need treatment. There are over nine million people who need treatment and just four million have got treatment. Therefore, there is still a big gap to fill’€, Anyangwe cautioned.

Closing the gap seems increasingly difficult because of rising HIV infections. Two-thirds of the global epidemic is in Africa. Last year alone, about 1.7 million new infections occurred on the continent, compared to 900 000 people who started treatment.   Add to the mix the current economic climate, the prospect towards universal access to treatment becomes even bleaker, and countries are advised to start becoming self-reliant.

‘€œHealth financing in countries need to look into the possibility of countries taking on their own treatment programmes and funding some of them and not necessarily relying only on external partners like the Global Fund or PEPFAR… these funds will dry up. In my opinion, I don’€™t think it will ever be possible to close that gap completely. Countries will have to come up with innovative ways’€¦ strategies’€¦ health insurance schemes’€¦ ways to lessen the amount of help that they need from external sources’€, Anyangwe said.

On a positive note, the report notes significant drops of between 10% – 40% in the costs of ARVs, especially first-line treatment, in the various countries surveyed. The proportion of people accessing testing and counseling services has also increased, although the problem of people testing late is still rife. Progress has also been noted in prevention of mother-to-child prevention programmes and paediatric AIDS.

Although access to treatment and testing and counseling services is improving the report warns that unless human resources for health are beefed up success will be very limited. Another problem has to do with procurement of medicines and equipment. Some countries are still experiencing stock-outs, while finances are making it virtually impossible to provide treatment on a wider scale.