UNAIDS is urging countries to rapidly expand access to antiretroviral medication to maximise benefits of HIV prevention and treatment in a bid to meet the 2015 goal to combat HIV.
Javier Hourcade Bellocq reports from Argentina:
UNAIDS is urging countries to rapidly expand access to antiretroviral medication to maximise benefits of HIV prevention and treatment in a bid to meet the 2015 goal to combat HIV.
On 13 July, at the Abuja+12 summit of the African Union, UNAIDS launched a new framework called Treatment 2015 to accelerate access to antiretroviral treatment for 15 million people.
The new framework highlights three main pillars for reaching the 2015 goal: demand, investment and results. This is backed by scientific evidence on the highly positive effects on public health of a rapid extension of antiretroviral treatment coverage, including benefits to the economy and development of countries.
Demand, investment and results
Promotion of HIV testing is central to creating demand for antiretroviral treatment. It is a process that must be led by people living with HIV, including key populations such as sex workers, transgender people, gays, men who have sex with men and drug users. Supply must be supported by civil society and the international community.
It must not be overlooked that this framework and goal are very ambitious and will require a significant investment of resources, not only for the acquisition of medications and supplies but also to strengthen health and community systems. The great challenge is to narrow the financial gap in the world response with international and domestic resources and non-traditional innovative mechanisms. A strong discourse is needed on investment in HIV treatment to entice more contributions, and increase effectiveness and efficiency. This includes using more affordable quality medications, such as generic drugs, enforcing and using the flexibilities of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).
To achieve better results a strict monitoring and evaluation framework is fundamental. Key actions needed are: empowering communities to take control of their health programs, redesigning and decentralising distribution systems; closing the gap in the provision of treatment.
What did leaders say at the Latin American launch?
HIV, STI, TB and Hepatitis unit coordinator for WHO Dr Rafael Mazín said: “The goal of 15 million by 2015 is perfectly feasible in the next two and a half years. We must focus our efforts on understanding the barriers to healthcare access and overcome those obstacles quickly. The secret lies in getting the services to the tested people.”
Dr Carlos Falistocco, Argentina program director and HTCG president, commented that: “We know in many countries there are many people living with HIV and don’t know about it (in Argentina it is 40%). We must not think that a change in guidelines will generate an avalanche of patients. For the last two years in Argentina we have adopted this recommendation (500 CD4) and we have not been overwhelmed by demand. Governments and healthcare services alone cannot ensure people living with HIV get the services they need, we need help from civil society and organisations, and programs that are not necessarily dedicated to healthcare.”
Carlos Fiorentino of the Youth Network added: “The priority for us is to get HIV back on the international agenda, because we have been sold this idea that HIV/AIDS is no longer a problem and this has been detrimental to our work. We also believe this framework offers the opportunity for the creation of youth-friendly clinics. Our network seeks to promote the notion that we young people are an opportunity for change.”
15,000 people by 2015
Just a few weeks ago we reached the desired goal of getting 10 million people living with HIV into treatment, and this was achieved after 30 years of epidemic and over ten years with the Global Fund and other government initiatives. We are two thirds of the way there but the final third will be the most difficult, especially as AIDS has lost its attraction and place on global and national agendas.
The reality is that many average-income and above-average-income countries will experience a surplus in supply. There will be supplies available but there will not be demand. Because most people living with HIV in Latin America are still unaware of their status, plus the notion of friendly services is just wishful thinking for most of our countries.
An access problem persists insidiously: public, private and community services cannot significantly broaden their coverage due to many complex factors. And the higher-risk populations simply do not have access to quality healthcare services.
Seeking a solution
The solution may involve understanding why our people neither reach nor remain in the health services. To understand and advance, our governments must re-establish a significant relationship with civil society organisations, particularly with key populations, but without the conditioning of a Global Fund requisite such as the country coordination mechanisms.
The structure, the what, is clearly and completely presented in the Treatment 2015 framework document; the how will depend on national dialogue translating into an effective and efficient multi-sector program. The when, as we know, is just around the corner, in 2015.
Together, we need to urgently bring this framework into action.
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