About one million people in developing countries gained access to antiretroviral drugs in 2007, according to a report released on Monday by UNAIDS, UNICEF and the World Health Organization, the New York Times reports (Dugger, New York Times, 6/3). The report also found that a total of about three million people now have access to the drugs (Maugh, Los Angeles Times, 6/3). In addition, the approximately one million additional people who gained access to antiretrovirals in 2007 represent a 42% increase compared with 2006.

According to the report, the increases in treatment access are because of a number of factors, including:

• Improved drug availability largely attributable to price reductions;
  
  
• Enhanced delivery systems; and
  
  
• Rising demand that follows an increase in the number of people who are tested for and diagnosed with HIV (UNAIDS release, 6/2).
  

The report also said that there has been progress in providing drugs to prevent mother-to-child HIV transmission. About 500,000 pregnant HIV-positive women received such drugs in 2007, an increase compared with 350,000 in 2006. Male circumcision also is promoted more heavily in high-burden countries in sub-Saharan Africa, according to the report. In addition, the report found increases in the availability of HIV testing and counseling services.

According to BBC News, the agencies said that they are two years behind in reaching their three million treatment target (BBC News, 6/2). WHO's 3 by 5 Initiative aimed to provide three million HIV-positive people in developing countries with antiretrovirals by December 2005 (Kaiser Daily HIV/AIDS Report, 12/5/06). "Reaching that target even two years late is quite a remarkable achievement," Kevin De Cock, director of WHO's HIV/AIDS Department, said (Los Angeles Times, 6/3). He added that in "retrospect" the 3 by 5 target "maybe ... was excessively aspirational." However, "aspiration is necessary" in the fight against HIV/AIDS, De Cock said (Russell, San Francisco Chronicle, 6/3).

The report also found that an estimated 6.7 million people in need of antiretrovirals were unable to access the drugs at the end of 2007. Efforts to achieve widespread drug access have been hindered by weak health care systems in highly affected countries, shortages of trained staff and a lack of sustainable, long-term funding, the report said. It added that the migration of skilled health care workers from developing countries to more wealthy nations is a significant hindrance (BBC News, 6/2).

According to the report, there were an additional 2.5 million HIV infections during 2007. "We have to do better with prevention," De Cock said (Los Angeles Times, 6/3). He added, "Treatment doesn't close down the epidemic. More investment in prevention is needed while scaling up treatment" (Reuters, 6/2). In addition, only about 12% of HIV-positive pregnant women were examined to determine if they needed treatment last year (New York Times, 6/3). The number of HIV-positive children with drug access has increased to 200,000 from 75,000 in 2005. However, about one in 10 HIV-positive children has access to antiretrovirals (San Francisco Chronicle, 6/3). The agencies said that funding needs to more than quadruple to $35 billion by 2010 and $41 billion by 2015 to achieve universal treatment access (Los Angeles Times, 6/3).

Comments
"Three million people on treatment is an important milestone and an incredible achievement," As Sy Elhadj, director of partnerships and external relations at UNAIDS, said, adding, "It shows that scale-up is happening and that momentum now needs to be sustained" (UNAIDS release, 6/2). WHO Director-General Margaret Chan said, "This represents a remarkable achievement for public health." She added that the report "proves that, with commitment and determination, all obstacles can be overcome. People living in resource-constrained settings can indeed be brought back to economically and socially productive lives by these drugs" (WHO release, 6/2).

However, Peter Ghys, chief of UNAIDS' Epidemiology and Analysis Division, said, "It is important to note that despite these successes, there were 2.5 million new HIV infections last year. If new infections continue at this rate, it will be impossible to sustain the treatment scale-up successes we are seeing today." The report calls for increased political commitment, improved coordination and additional research to address the barriers to more widespread drug access (UNAIDS release, 6/2). "This report highlights what can be achieved despite the many constraints that countries face and is a real step forwards towards universal access to HIV prevention, treatment care and support," UNAIDS Executive Director Peter Piot said, adding, "Building on this, countries and the international community must now also work together to strengthen both prevention and treatment efforts" (WHO release, 6/2).

NPR's "All Things Considered" on Monday included a discussion with De Cock and Chris Collins from the International Treatment Preparedness Coalition about the report (Wilson, "All Things Considered," NPR, 6/2).

The report is available online.

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