December 1 is World Aids Day and the World Aids Campaign has selected "Universal Access and Human Rights" as the theme for the 2009/2010 campaign. The timing of this campaign is vital as it is linked to the United Nation’s Millennium Development Goals.
In September 2000, the United Nations signed the United Nations Millennium Declaration which included eight international development goals to be achieved by 2015.
The sixth goal was to combat HIV/AIDS, malaria, and other diseases and the measurable target associated with this goal and relevant to the current World Aids Day campaign was target 6B: “Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it”.
Avert have an excellent page detailing where we stood with this target at the end of 2008 and how we have progressed in the years since the declaration was signed. At the end of 2003, only 5% of those that required treatment for HIV/AIDS were receiving it and this rose in a steady curve to 42% at the end of 2008.
While the growth to date has been promising, the trend did start to decline by last year and it is probably safe to say that the goals will not be met by the end of 2010. In fact, by the time the 2008 figures were released, the WHO, UNIADS and INICEF had conceded that most countries would not reach the 2010 target.
What does this mean for the World Aids Day campaign 2009/2010?
I believe that had the UN not set the Millennium Development Goals in 2000, the huge amount of progress made so far may not have been achieved.
There are a couple of important factors that need to be addressed in the race to meet these goals:
Governmental involvement
It is impossible to reach targets of universal access to treatment without governments subscribing to this goal and taking steps to implement it in their countries. By way of an example, the AIDS denialist administration of South African president Thabo Mbeki and his Health Minister Manto Tshabalala-Msimang set the cause of universal treatment of HIV/AIDS back by years. It is estimated that two million people might have died prematurely due to Mbeki’s failure to take decisive action and his denial that HIV causes AIDS [source].
The cost of treatment
The overwhelming factor affecting the provision of universal treatment is lack of funding and the global economic downturn has resulted in funding of projects being reduced or stopped altogether.
“It is estimated that to achieve universal treatment targets an investment of $7 billion will be required in 2010 for treatment and care alone. This is of the estimated $25 billion needed to achieve all targets including prevention, care for orphans and vulnerable children, and other programme support costs. Considering less than $14 billion was invested in tackling HIV and AIDS in 2008, a funding shortfall, while not inevitable, is likely unless dramatic increases in financial commitments are made” - avert.org
I believe it is necessary to balance the current financial situation with the long-term effects on economies as in many countries, it is the working-age population that is being decimated by AIDS deaths leaving only the very young and the very old behind. A similar effect on the population pyramids occurs in times of war.
The commencement of treatment
There are differing beliefs as to when treatment should actually begin. Economically developed countries like the UK are likely to begin treatment earlier i.e. when the CD4 count drops below 350 cells per cubic millimetre of blood. Less economically developed countries like South Africa wait until that level falls below 200. While this fell in line with the WHO recommendations of 2006, the WHO is now recommending treatment begins at the threshold of 350 as studies have clearly shown that starting antiretroviral therapy (ART) earlier reduces rates of death and disease.
Commitment to treatment
We have not discovered a cure for HIV/AIDS yet. Once patients start to take antiretroviral drugs (ARVs), they need to take them for life. It is imperative then that governments or international donors realise that this is a lifelong commitment and that they guarantee this treatment for all patients on ARVs. The difficulty with this idea is that this means that treatment numbers will only ever continue to grow and there will never be reduction in treatment numbers until prevention plans really start to have an effect. Therefore, governments and organisations need to continue to budget ever increasing amounts for treatment.
Mother to child transmission
In 2006, the WHO recommended that ARVs be given to pregnant women in their third trimester to prevent mother to child transmission and they had not yet proven the efficacy of ARVs during breastfeeding. Since then, ARVs have been shown to be effective during breastfeeding in several trials and the 2009 WHO recommendations are that ART be started in the second trimester and that this treatment continue right to the end of the breastfeeding period.
Side effects of antiretroviral drugs
In the past, ARVs have been known to have terrible side effects and this has been a major factor in the lack of retention of ART patients. Specifically, Stavudine has long-term, irreversible side-effects and the WHO has now recommended that countries phase out use of this drug and use the equally effective and less toxic Zidovudine (AZT) or Tenofovir (TDF).
Links
New HIV recommendations to improve health, reduce infections and save lives [UNAIDS]
Universal access to AIDS treatment: targets and challenges [avert.org]
This post was part of a Bloggers Unite action day. Click to read more Bloggers Unite World Aids Day posts.
