Tuesday
Aug122008
Hopes of achieving Universal Access 2010 targets dim
Tuesday, August 12, 2008 at 12:50PM
Panoscope | 05 Aug 2008
By Kristin Palitza
By Kristin Palitza
Only a few countries in the world are likely to achieve universal access to antiretroviral treatment by 2010, and almost 70 per cent of HIV-positive persons in need of treatment have not received it.
With only two years to go before the 2010 deadline, the world’s top HIV experts yesterday called for a dramatic scale up of combination prevention that focusses on abstinence, behaviour change and correct condom use.
“There is a huge need for leadership to form the basis for [better] results in treatment and prevention,” said Alex Coutinho, executive director of the Infectious Diseases Institute in Kampala, Uganda.
It was unacceptable to continue to have 2.7 million new infections per year globally, and more than two million persons per year dying due to lack of access to treatment, Sepulveda said. “For every five people infected, three die without ever getting treatment during their lifetime,” he lamented.
Jaime Sepulveda, director of integrated health solutions development of the Global Health Programme at the Bill and Melinda Gates Foundation noted that countries need to reach the point where the number of people receiving treatment is higher than the number of people with new infections.
“Massive change is required if we are to reach this turning point in the next few years,” Sepulveda said. In Zambia, only 39 per cent of people who have TB and HIV coinfection were receiving treatment according to the 2007 Ministry of Health TB routine monitoring programme.
MANY SUCCESSES, BUT STILL NOT ENOUGH
Although there have been many accomplishments in addressing HIV and AIDS worldwide -– including an unprecedented global mobilisation around a health problem, and massive research efforts related to it -– there were still severe shortfalls that had to be tackled, Sepulveda said.
One of the main challenges remained the tremendous deficit in research and evaluation.
“There still isn’t an accurate estimate of the number of infections prevented by prevention programmes,” he cited as an example. “We need to [seek to] understand local successes and failures to be able to improve global knowledge.”
He also noted that not enough money was invested in prevention although this would ultimately lead to major savings in health care costs.
TECHNICAL AND FINANCIAL SUPPORT
Sepulveda also criticised the shortfall in delivery and called for greater technical and financial support for combination prevention and combination therapy. One of the keys to successful delivery was the implementation of inclusive health systems and support services that reach not only urban but also remote and rural areas.
“More and better prevention should be our common, global goal,” he added. Apart from developing vaccines and microbicides, research needed to focus on developing new behavioural interventions.
In the Panos experience, interventions that target underlying causes of risky behaviours such as cultural beliefs and cultural practices, power relations between men and women, and socioeconomic factors also need to be explored. Women groups of Mazabuka, a district in the Southern part of Zambia lamented to Panos about the high levels of child rape which led to high incidence rates among young girls in the district.
“What makes it difficult to address is that such cases are usually within the family and culturally accepted. Taking legal action against such matters is almost impossible,” said one of the group members on a radio listening club in Chief Mwanachingwala Village in Mazabuka.
The fact that men are culturally tolerated and excused for behaving the way they do makes behaviour change communication difficult.
“Translating knowledge into behaviour has always been a core challenge. If we could get this right, we could change the pandemic,” agreed Coutinho.
The number of persons who did not know their HIV status was still too large. “Less than ten percent of high risk individuals worldwide receive appropriate prevention intervention,” he added. “We should not accept that we cannot provide HIV testing routinely to all who need it.”
Coutinho also highlighted the importance of treatment access in the greater context of the family unit, especially children. Despite the fact that paediatric care and prevention of mother to child transmission (PMTCT) services have improved, adults and children’s access to ART remained insufficient.
In some parts of Africa, people travel long distances and find themselves on long waiting lists to access ARVs. Some die while on the waiting list.
In Lesotho, access to treatment is rather difficult. In selected areas, people in the hilly areas have been saved by nongovernment organisations such as Medicins sans Frontier. Outside of that, the poor resourced government
programme is too weak to cater for remote areas.
Treatment access was important to both people infected and uninfected within the same family.
“Access to ART not only reduces death but also improves the lives and health of uninfected children, and reduces orphanhood,” he said. “Even the best programme for orphans and vulnerable children cannot replace parents, and the best way to support children is by keeping their parents alive.”
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