All HIV success stories attributed to expansion of ART

The introduction of anti-retroviral therapy (ART) in middle- and low-income countries is arguably one of the most meaningful outcomes recorded in the fight against HIV and AIDS. 

Anti-retroviral therapy has brought hope and saved lives. Thanks to all involved in distributing and making sure that ART reaches the people in need in those countries, fewer and fewer people are dying as a result of HIV and AIDS related causes compared to the past. 

According to reports, eight million people worldwide have received ART, with Sub-Saharan Africa –  the region hit hardest – making the most dramatic progress.

UNAIDS recently revealed that a record 6.2 million people living with HIV and AIDS are benefiting from the therapy   rise of 19 percent between 2010 and 2011. 

Our region, the South African Development Community, has enjoyed a significant decline in AIDS mortality. 

The number of AIDS-related deaths, has dropped from 1.8 million in 2005 to 1.2 million in 2011. So has morbidity. All this is good news, and the success stories are largely attributable to the rapid expansion of ART.

In Southern Africa, where most countries have large numbers of people living with HIV or high HIV prevalence, the number of people acquiring HIV has dramatically reduced. 

Between 2001 and 2011, Malawi’s rate of new HIV infections dropped by 73 percent, Botswana by 71 percent, Namibia by 68 percent, Zambia by 58 percent and Zimbabwe by 50 percent. South Africa, the country with the largest number of HIV infections, reduced new HIV infections by 41 percent while Swaziland, which has the highest HIV prevalence in the world, new HIV infections dropped by 37 percent.

At the end of 2011, UNAIDS reported that 11 low- and middle-income countries, among them, Botswana, Namibia, Rwanda, Swaziland and Zambia, and six countries with low- and concentrated epidemics such as Cambodia, Cuba, Dominican Republic, Fiji, Guyana and Mexico, had already achieved universal access to anti-retroviral therapy   providing anti-retroviral therapy to at least 80 percent of the people in need. Croatia and Slovakia were also on the list last year, but are now classified as high-income and are no longer included in the list.

Irrespective of these encouraging trends, a number of challenges and problems have been encountered following the introduction of ART and in relation to its expansion. 

The need to maintain equitable access, failure to reach those who haven’t known their Zero-status, and difficulty of convincing people living with HIV and AIDS (PLWHA), who are unwilling to receive the  therapy  until they see AIDS-related illness, are some of the challenges observed along the expansion of ART. 

Poor adherence often leading to drug resistance, complete discontinuation of the treatment, some long-term and short-term side-effects resulting from ART management, are other key problems occurring following ARV therapy. The issue of maintaining the pace at which HIV treatment is currently expanding is also another related challenge, according to new Consolidated Guidelines on the use of Antiretroviral Drugs for Treating and Preventing HIV Infection, released recently by the World Health Organisation (WHO).

Although in most parts of the world we have seen a reduction in new HIV infections, a lot still needa to be done to achieve Millennium Development Goals and the United Nations Political Declaration on HIV/AIDS of HIV-free generation.

Joint United Nations Programme on HIV/AIDS (UNAIDS) is calling for countries to rapidly scale up access to Anti-retroviral drugs to maximise HIV treatment and prevention gains.

Through the framework entitled “Treatment 2015”, UNAIDS offers countries and partners both practical and innovative ways to increase the number of people accessing antiretroviral medicines in order to reach its target of 15 million people on anti-retroviral treatment by 2015.

Treatment 2015 outlines three fundamental pillars essential to reaching the 2015 target which are increasing demand for HIV testing and treatment services; mobilising resources and improving the efficiency and effectiveness of spending; and  ensuring more people have access to antiretroviral therapy.

The report further point out that countries and partners need to urgently and strategically invest resources and efforts to ensure that everyone has access to HIV prevention and treatment services, adding that  the treatment will not only enable people living with HIV to live longer and healthier lives, they will also help prevent new HIV infections.

Through Treatment 2015, UNAIDS encourages countries to enhance public health programmes and leverage services provided by civil society and community based groups. It outlines that community health workers have the capacity to provide almost 40 percent of HIV service-related tasks and that HIV testing and treatment services need to be decentralised to promote easier access. The framework also underscores the need to ensure that underserved key populations have equitable access to HIV testing and treatment services.

Dr Margaret Chan, Director-General of WHO, was quoted by the report saying that the scale up of ART is an unprecedented global success story for public health. Maintaining this momentum will require earlier treatment and innovative ways for enabling more people to take the medicine such as the one-pill daily regimen recommended by the new WHO guidelines.

“Substantial further scale-up of access to these medicines provides us with a unique opportunity to push this epidemic into irreversible decline,” she said.

While Ambassador Eric Goosby, US Global AIDS Coordinator, was also quoted saying that scaling up access to anti-retroviral treatment is critical to achieving an AIDS-free generation. Amb Goosby said PEPFAR is firmly committed to continue working with partner countries and other stakeholders to help make this vision a reality.

Apart from that, Treatment 2015 also emphasizes the importance of HIV testing and counselling as a gateway to expanding access to anti-retroviral therapy and that further efforts are required to normalise HIV testing. It highlights that community testing campaigns have proven to be particularly effective in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zambia.

“We have to work hard to defeat HIV and end it as a public health threat, and it will require concerted effort from all partners to get there,” the report recommends.

August 2013
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