"Getting to Zero: Zero new HIV infections. Zero deaths from AIDS-related illness. Zero discrimination" is the theme of World AIDS Day 2012. Given the spread of the epidemic today, getting to zero may sound difficult but significant progress is underway.
Progress attributed to antiretrovirals
Much of the progress is attributed to the life-saving medications, called antiretrovirals, to treat those infected with HIV. These medicines reduce the amount of virus in the blood, which increases the chance they will stay healthy and decreases the risk they can pass the virus to someone else. In 2011, at the UN General Assembly, governments agreed to set the goal of getting 15 million HIV-infected people worldwide on the life-saving antiretroviral medicines by 2015. The latest global statistics suggest that, provided countries are able to sustain current efforts, this target is within reach.
“Many countries are facing economic difficulties, yet most are managing to continue expansion of access to antiretroviral medicines,” said Dr Gottfried Hirnschall, Director of the World Health Organization’s HIV Department. “The 2015 target looks more achievable now than ever before.”
Currently 8 million people in low- and middle-income countries are accessing the treatment they need, up from only 0.4 million in 2003.
“The challenge now is to ensure that global progress is mirrored at all levels and in all places so that people, whoever they are and wherever they live, can obtain antiretroviral therapy when they need it,” adds Dr Hirnschall.
Some groups not able to access HIV prevention and treatment
In all regions of the world, some groups of people are still not able to access HIV prevention and treatment. Children, for example, are lagging badly behind: only 28% of children who need antiretrovirals can obtain them.
There are many reasons for this. Sometimes geographical factors make it more difficult to deliver services. Stigma, discrimination and legal issues are often significant barriers to accessing effective care. Adolescent girls, sex workers, men who have sex with men and people who use drugs often remain vulnerable and marginalized. Migrants frequently have only limited access to health services. As a result, they often struggle to obtain the health services they need, including the provision of antiretroviral therapy.
Universal health coverage
One of WHO’s priorities is to help countries move closer to universal health coverage. The Organization works with partners to combat stigma and discrimination. It supports countries in improving service delivery in all geographic areas, for example by increasing access to medicines and diagnostics, and through mechanisms to encourage health workers to work in remote areas. It supports the establishment and maintenance of financing mechanisms that ensure that no one is thrust into poverty because they have to pay for services out of their own pockets.
Strategic use of antiretrovirals offers new benefits
While countries redouble their efforts to offer antiretrovirals to all those who need them, there is growing evidence that a wider, more strategic use of these medicines offers new benefits. Studies show that the same medicines we use to save lives and keep people healthy can also stop people from transmitting HIV to sexual partners and to infants through mother-to-child transmission.
Earlier in 2012, WHO issued new guidelines for treating people with HIV who have uninfected partners: up to half of all HIV-positive people in ongoing relationships are estimated to have HIV-negative partners. The Organization now recommends offering antiretroviral therapy to the HIV-positive partner, regardless of the strength of his or her immune system, to reduce the likelihood of HIV transmission to the uninfected partner.
Some countries are also considering initiating treatment at an even earlier stage in the course of HIV, and by offering all HIV-positive pregnant women antiretroviral therapy for life.
WHO is currently reviewing new scientific research and country experiences in order to publish updated and consolidated guidance on the use of antiretrovirals in mid-2013.