UN reports show progress but member nations fall short of goals

Two years after a historic Special Session of the United Nations General Assembly on HIV/AIDS, despite considerable progress, many UN Member States will not meet basic AIDS prevention and care goals established at the 2001 meeting unless efforts are dramatically scaled up, according to reports released today by the UN Secretary-General and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

"We have come a long way, but not far enough," said UN Secretary-General Kofi Annan. "Clearly, we will have to work harder to ensure that our commitment to the fight against AIDS is matched by the necessary resources and action."

The reports clearly state that the current pace of country activity on HIV/AIDS is insufficient to meet the 2005 goals agreed to by all nations at the Special Session. Those goals, which focus on the rapid expansion of HIV prevention, care and impact alleviation programmes, are seen as a vital foundation to achieving the UN Millennium Development Goal of halting and reversing the epidemic by 2015. For example, one of the goals is to ensure that by 2005 at least 80% of pregnant women have access to information, counseling and treatment to prevent HIV transmission to their children. But today these services remain virtually non-existent in countries worst-affected by HIV/AIDS.

"Today's reports are a dramatic wake-up call to the world," said Dr. Peter Piot, UNAIDS Executive Director. "The goals, set by the Member States themselves two years ago, must be met if we are going to have any realistic chance of reversing this devastating epidemic. While there has been some concrete progress, the current pace and scope of the world's response to HIV/AIDS remains wholly insufficient. The 2005 goals can still be met, but only if significantly greater and sustained commitments to the global HIV/AIDS epidemic are realized."

Although the reports highlight countries' lack of response in many key areas, they do point to progress on some fronts. Of the 103 countries surveyed, 93% have set up comprehensive national HIV/AIDS strategies and national bodies coordinating the response and 88% have increased public awareness of HIV/AIDS through media campaigns, school-based AIDS education and peer education programmes. The amount of funding for AIDS in low- and middle-income countries has also increased substantially in the last year.

Key Report Findings: Funding

Almost all countries surveyed reported improvements in the availability of financial resources to address HIV/AIDS since 2001:

• Spending on HIV/AIDS programmes in low- and middle-income countries will amount to US$4.7 billion in 2003 - a 20% increase over 2002 funding levels. It is expected that 57% of this funding will come from non-domestic sources.
• In 2002, total domestic government spending in 58 low- and middle-income countries was estimated to be US$995 million, a doubling of the amount documented in 1999.


However, despite the improvement, current spending is less than half of the US$10 billion that will be required for an effective response to AIDS in 2005 alone.

Regarding biomedical research, the reports note that despite significant increases since 2001 in funding for research on HIV-related vaccines and microbicides, these important prevention measures still only account for a small fraction of overall public sector research investment.

Prevention

Turning to prevention, the reports indicate that, while most countries have developed strategic frameworks for HIV prevention, only a fraction of people at risk have meaningful access to basic prevention services.


• Services to prevent mother-to-child transmission of HIV (PMTCT) remain virtually non-existent in many heavily affected countries. With the exception of Botswana, less than 1% of pregnant women in these countries receive information and treatment that would help them avoid transmitting HIV to their children.
• Of 17 countries in sub-Saharan Africa reporting on PMTCT, 12 countries, with HIV prevalence rates among newborn babies reaching 25%, have no antiretroviral prophylaxis programme.
• Only one quarter of sub-Saharan African countries report that at least 50% of patients with sexually transmitted infections are appropriately diagnosed, counseled and treated. Improved STD diagnosis and treatment is considered to be key to identifying people at increased risk for or already infected with HIV.
• Fewer than 5% of injecting drug users receive recommended HIV prevention services.
  
  Treatment
  
  Two years after the Special Session on HIV/AIDS, antiretroviral therapy coverage for people in low- and middle-income countries remains extremely low, with only 300,000 receiving medication in 2002, out of an estimated 5-6 million people who need therapy.
  
  While 80% of responding countries reported having a policy in place to improve or ensure access to HIV-related drugs, more than one-third of countries in the Asia-Pacific region, home to more than 7 million people with HIV/AIDS, have yet to adopt treatment access policies. No country in this region reported treatment coverage above 5%.
  
  In sub-Saharan Africa, only an estimated 50,000 people had access to antiretroviral treatment at the end of 2002, or about 1% of the 4.1 million people in need.
  
  Orphans
  
  Globally more than 14 million children under the age of 15 have lost one or both parents to HIV/AIDS - a number projected to increase to 25 million by 2010. Yet 39% of countries with generalized epidemics have no national policy in place to provide essential support to children orphaned or made vulnerable by AIDS. While four of these countries - Cambodia, Namibia, Tanzania, and Uganda - are in the process of developing such policies, one-quarter of respondent countries reportedly have no plans at present to develop orphan support strategies.
  
  Discrimination
  
  HIV stigma and discrimination is recognized as a key obstacle to implementing the targets in the Declaration of Commitment - yet 38% of countries, including almost half of those in sub-Saharan Africa, have yet to adopt anti-discrimination legislation to protect people living with HIV/AIDS, and only 36% of countries have instituted legal measures to prohibit discrimination against populations that are especially vulnerable to HIV/AIDS, such as injecting drug users and sex workers.
  
  The full report can be accessed on the righthand side of this page