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. HIV Treatment Goal Elusive

Intravenous drug users, a group that contributes significantly to the spread of HIV in many countries, also lack access to treatment.
by Olga Pierce
UPI Health Business Correspondent
Washington (UPI) April 17, 2007
The world has made great strides toward its pledge of getting HIV treatment to everyone who needs it, but there is still a long way to go, a new report says.

"In many ways we are still at the beginning of this commitment," said Margaret Chan, director general of the World Health Organization, which released a report on the state of anti-retroviral treatment access with UNAIDS and UNICEF Tuesday.

"We need ambitious national programs, much greater global mobilization, and increased accountability if we are going to succeed."

In 2005, leaders at the G8 summit in Gleneagles, Scotland, pledged to get anti-retroviral treatments to every HIV-positive person who needs them by 2010. Since then, access to the drugs has been rapidly growing.

By the end of 2006, 2 million people in low- and middle-income countries were receiving the treatment, a 54 percent increase over the year before, according to a report released Tuesday by the World Health Organization. But that still means that just 28 percent of the 7.1 million people in those countries who need treatment are receiving it.

Priority populations like children, pregnant women and intravenous drug users are not being reached, the report says, and many countries still lack the health systems to deliver drugs effectively.

Meanwhile, a new crisis looms as more individuals need access to expensive second-line treatments that are prescribed when standard treatments fail, according to the agency, and the goal of universal access to treatment will never be reached as long as new infections continue at such a high rate.

Only 15 percent of the 780,000 children in low- and middle-income countries who needed HIV treatment were receiving it at the end of 2006, according to the report.

While that represents a 50 percent increase over 2005 levels, it is still not enough, WHO HIV/AIDS Director Kevin De Cock told reporters during a teleconference.

"The encouraging increase comes from a very low base," he said. "(Children) continue to be underserved."

Countries are also not reaching pregnant women with treatments that could protect their babies from HIV infection, the report says. Only seven of the 100 countries studied were getting necessary drugs to more than 40 percent of HIV-infected pregnant women, while some were reaching less than 1 percent.

Intravenous drug users, a group that contributes significantly to the spread of HIV in many countries, also lack access to treatment, the authors write.

The main barrier to universal coverage is ensuring funding stability so countries are able to keep their promises to treat people with HIV, said Michel Sidibe, director of country and regional support at UNAIDS.

But other barriers within countries also have an impact, Sidibe told United Press International. The lack of data and planning, combined with the stigma attached to some vulnerable populations, means that resources are not always sent where they are most needed.

Countries need evidence-based plans so they can "know their epidemic and act on it," he said.

Once countries have plans, they need strong enough health systems to actually diagnose cases and deliver drugs to patients, he added.

"It's the weakness of health systems that is a formidable barrier to dealing with a complicated problem like HIV/AIDS," De Cock agreed.

The goal of universal access to HIV drugs has been greatly facilitated by rapidly decreasing prices, the report found. Between 2003 and 2006, the prices of commonly used anti-retroviral treatments decreased between 37 percent and 53 percent in low- and middle-income countries.

As more patients need help affording second-line treatments, those used when commonly used treatments become less effective, cost becomes more of an issue, De Cock said.

Almost none of the treatments are available in generic form, though some are sold to poor countries at a negotiated discount, he said. "We are very concerned about the high prices of second-line therapy."

Ultimately, the report concludes, universal access can only be achieved by focusing on prevention. About 700,000 new patients started treatment in 2006, but there were 4.2 million new infections.

"If we don't strengthen prevention," De Cock said, "the goal of universal access will be increasingly elusive."

The pharmaceutical industry has been working to make drugs more affordable, said Mark Grayson, a spokesman for the Pharmaceutical Research and Manufacturers of America, a trade group representing drug manufacturers.

"Our industry has continually worked to get medicines to more and more people," he told UPI.

Drug companies, however, cannot do it alone no matter how much they lower drug prices, Grayson said. Governments and multinational organizations also need to contribute to ensure adequate funding and make sure systems are in place for drug delivery.

Companies are working to make second-line treatments more affordable, but "they are difficult drugs to make and expensive drugs.

"We need to work will all affected parties to make sure treatments are accessible."

Source: United Press International

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