In AIDS Progress Report, Next Steps Are Key

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The end of today’s UNAIDS progress report, detailing the latest figures on access to ARVs, is in some ways more important than the beginning. “The Way Forward,” the report’s conclusion, lays out important next steps in the campaign for universal access, at a time when the global economic crisis and questions about sustainability have cast a cloud over global AIDS initiatives.

To be sure, today’s report, put out by UNAIDS, WHO, and UNICEF, leads with some excellent news:

*1 million new HIV patients in need of life-saving treatment were added to the ARV rolls in the developing world last year, for a total of 4 million people now getting HIV therapy in low- and middle-income countries

*HIV testing and counseling became more widely available and more frequently used last year

*Almost half, 45 percent, of HIV-positive pregnant women received ARVs to prevent transmission of the virus to their babies in 2008, up from 35 percent in 2007

Now for the hard part. More than five million people who desperately need treatment still aren’t getting it, concludes the report, “Toward Universal Access, Scaling up priority HIV/AIDS interventions in the health sector.” And although 1 million new HIV-positive people were put on ARVs last year, there were an estimated 2.7 million new infections in 2007, not exactly a good ratio. And many patients are not being diagnosed until they have end-stage disease, when HIV therapy may be too late. Click here for the news release, which summarizes the report.

“Without significant acceleration in the rate at which services are expanded and people are reached, millions of new infections will occur, more lives will be lost and the human and economic burden on future generations will continue to increase,” the report’s authors write in the conclusion.

And all these new numbers must been seen through the prism of new evidence demonstrating that earlier initiation of ART has a significant positive effect on mortality and survival; indeed, the authors of today’s report make a passing reference to the WHO’s plans to review the new scientific evidence on that matter and “proceed with any necessary revisions to its treatment guidelines” later this year.

In the conclusion, the report’s authors lay out for several key steps for moving forward, including:

*significant scale up of prevention efforts such as male circumcision

*more attention to high-risk populations, such as injection drug users, men who have sex with men, and prisoners

*a more robust response to HIV/TB co-infection

*and a more significant effort to bolster health systems and use HIV programs to have “a lasting and broad-based transformative effect on health systems”

“The hard won gains of recent years are fragile and call for renewed commitment by all stakeholders,” write Margaret Chan, Michel Sidibe, and Ann Veneman in the report’s foreward. “This is especially the case considering the unprecedented scope and depth of the crisis that has hit the world economy. Nevertheless, it is precisely due to the potential disruptive effects of the global economic downturn that we must redouble our efforts and build on the current operational momentum” to move toward universal access.

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