Access to Prevention Interventions Severely Limited in Every Region

[Guest guest]

5.13.2003

New report from leading AIDS experts documents large gap between HIV

prevention needs and current efforts. Current Annual Prevention

Spending Falls Nearly $4 Billion Short of Need. Access to Prevention

Interventions Severely Limited in Every Region

Fewer than one in five people at risk of HIV infection today have

access to prevention programs, and annual global spending on

prevention falls $3.8 billion short of what will be needed by 2005,

according to a new report released today by the Global HIV Prevention

Working Group.

The report, Access to HIV Prevention: Closing the Gap, is the first-

ever analysis of the gap between HIV prevention needs and current

efforts, and provides recommendations for expanding access to

information and services that could help save lives and reverse the

global epidemic.

" Twenty years into the AIDS epidemic, most people in the world still

don't have access to effective HIV prevention, " said Helene D. Gayle,

M.D., M.P.H., director of the Bill & Melinda Gates Foundation's

global HIV/AIDS program and co-chair of the Working Group. " A

dramatic scaling up of HIV prevention, combined with increased access

to treatment for the millions already infected, can control and

ultimately reverse AIDS. "

" There is no magic bullet to prevent the spread of HIV. Only a

combination of approaches that addresses the needs of different

populations at risk can be effective, " said Serwadda,

M.B.Ch.B., M.P.H., of the Institute of Public Health at Makerere

University in Kampala, Uganda, and co-chair of the Working

Group. " In Uganda, we have brought a severe HIV epidemic under

control through the use of combination prevention, including

abstinence education, condom promotion, voluntary HIV counseling and

testing, and STD control. Other nations must be supported in their

efforts to introduce a wide range of science-based prevention

interventions, tailored to the needs of their people. "

The Global HIV Prevention Working Group is composed of nearly 40

leaders in public health, clinical care, biomedical, behavioral, and

social research, and people affected by HIV/AIDS from around the

world. (See attached list). It was convened in 2002 by the Bill &

Melinda Gates Foundation and the Henry J. Kaiser Family Foundation to

inform global HIV prevention policy-making and program planning.

Access

According to the report, most people at greatest risk do not have

access to proven prevention interventions, and access varies widely

depending on the region and the intervention. Globally:

Only 5% of pregnant women at risk have access to drugs to prevent

mother-to-child transmission

12% of people have access to voluntary HIV counseling and testing

19% of injecting drug users have access to harm reduction programs

24% of people at high risk have access to AIDS education

42% of people in need have access to condoms

Access to treatment is even more limited, and both prevention and

treatment will need to be scaled up simultaneously. Careful

integration of prevention and treatment services will help ensure

those who test positive are quickly linked to treatment, and that

those in treatment have the tools necessary to protect others from

infection.

Spending

The report found that current HIV prevention spending in 2002 totaled

$1.9 billion, far short of the $5.7 billion that UNAIDS estimates

will be needed annually by 2005, and the $6.6 billion that will be

needed by 2007. (See attached fact sheet for spending data on each

region). UNAIDS and WHO estimate that these resource levels could

avert 29 million of the 45 million infections projected to occur by

2010.

" The resource needs are acute, but to date too many donor governments

have not contributed their share, " said Drew Altman, Ph.D., President

of the Kaiser Family Foundation and co-convener of the Working

Group. " We found that developing countries themselves are actually

the greatest financial contributors to AIDS programs, which is

important. But developed nations need to do much more. Many donor

governments are contributing amounts that would be expected of

private foundations, not wealthy countries. "

The Working Group estimates that in 2002 developing countries

contributed $782 million to prevention, donor governments $780

million, foundations and non-governmental organizations $160 million,

the United Nations system $100 million, and the World Bank $64

million.

Prevention Priorities

The report identifies key prevention priorities in each region:

Sub-Saharan Africa: Prevention programs for youth and for adults at

greatest risk are urgently needed, and mother-to-child transmission

programs should be dramatically expanded.

Asia and the Pacific: The diverse epidemics of Asia require

expansion of a broad range of approaches, including behavior-change

programs targeted at high-risk groups such as sex workers and men who

have sex with men, new efforts to curb rising STD rates, harm

reduction programs for injection drug users, and interventions to

address the gender inequities that often drive the epidemic.

Eastern Europe and Central Asia: Because the rapidly spreading

epidemic in this region is driven by injecting drug use, harm

reduction, including needle and syringe programs, is essential to

prevent HIV from spreading to the broader population.

North Africa and the Middle East: Programs in this region should

target high-risk populations, including injecting drug users, sex

workers, and men who have sex with men.

Recommendations

Based on its analysis, the Working Group recommends:

Funding: Global spending on HIV prevention activities from all

sources should increase three-fold by 2005 to $5.7 billion, and to

$6.6 billion by 2007. Donor governments should increase spending on

HIV prevention to 0.02 percent of national GDP. No donor nation is

currently at this level. Annual spending on treatment, care and

orphan support should increase from $1.6 billion today to $5.5

billion in 2005.

Scale-Up: Prevention scale-up must be a central priority in every

region, focusing on especially cost-effective, high-impact

interventions, such as behavior change programs to delay the

initiation of sexual activity, reduce the number of sexual partners,

and promote the use of condoms, voluntary counseling and testing, STD

control, and prevention of mother-to-child transmission, among other

proven strategies.

Prevention and Treatment: As both prevention and treatment programs

are brought to scale, these initiatives should be carefully

integrated to ensure those who test positive are quickly linked to

treatment, and to ensure those in treatment have the tools necessary

to protect others from infection.

Building Capacity: In addition to funding for prevention

interventions themselves, donors should provide extensive additional

support to build long-term human capacity and infrastructure.

Policy Reforms and Aid: Policy reforms and international aid should

address the social and economic conditions – such as gender

inequality, stigma, and poverty – that increase vulnerability to, and

facilitate the rapid spread of, HIV/AIDS.

Prevention Research: Research into new prevention strategies and

technologies should be significantly accelerated.

THe Global HIV Prevention Working Group

Co-Chairs:

* Helene Gayle, Bill & Melinda Gates Foundation

* Serwadda, Makerere University, Uganda

Meenakshi Datta Ghosh, National AIDS Control Organization, India

Co-Convener:

* Drew Altman, Kaiser Family Foundation, USA

Members:

Judith D. Auerbach, National Institutes of Health, USA

* Bassett

* Seth Berkley, International AIDS Vaccine Initiative, USA

* Jordi Casabona, Hospital Universitari Germans Trias i Pujol, Spain

* Tom Coates, Center for AIDS Prevention Studies, University of

California, San Francisco, USA

Awa Marie Coll-Seck, Minister of Health, Senegal

J. Figueroa, Ministry of Health, Jamaica

* Geeta Rao Gupta, International Center for Research on Women, USA

* Hankins, UNAIDS, Geneva

* Salim Abdool Karim, University of Natal, South Africa

* Milly Katana, Health Rights Action Group, Uganda

* Kippax, University of New South Wales, Australia

Lamptey, Family Health International, USA

* Kgapa Mabusela, loveLife, South Africa

* Marina Mahathir, Malaysian AIDS Council, Malaysia

Makgoba, Medical Research Council, South Africa

* Mazin, Pan American Health Organization, USA

* Merson, Yale School of Medicine, USA

Philip Nieburg, Centers for Disease Control and Prevention, USA

* O'Malley, International HIV/AIDS Alliance, United Kingdom

Piot, UNAIDS, Geneva

Vadim Pokrovsky, Russian Center for AIDS Prevention and Control,

Russia

* Tim , Imperial College, University of London, United Kingdom

* Zeda Rosenberg, International Partnership for Microbicides, USA

Bernhard Schwartlander, WHO, Geneva

* Yiming Shao, National Center for AIDS/STD Prevention and Control,

China

Moses Sichone, UNICEF, Zambia

Mark Stirling, UNICEF, New York

* Sutherland, Centre for Infectious Disease Prevention and

Control, Health Canada

* Paolo Teixeira, Ministry of Health, Brazil

O. Valdiserri, Centers for Disease Control and Prevention, USA

* Mechai Viravaidya, Population and Community Development

Association, Thailand

* Wilfert, Glaser Pediatric AIDS Foundation, USA

* Debrework Zewdie, World Bank, USA

Organizational affiliations are provided for identification purposes

only, and do not indicate organizational endorsement of the report's

recommendations.

* Members of the Working Group who have officially endorsed the

report at the time of publication