Turning global 2010 commitments into reality

29 November 2005

Providing comprehensive HIV prevention and treatment services, building health systems, and supporting the engagement of communities will be crucial to achieve the global 2010 target for universal access to life-saving anti-retroviral treatment, says Alvaro Bermejo, executive director of the International HIV/AIDS Alliance. The UK government has a key responsibility to ensure its own spending delivers this on the ground in affected countries and a key role providing global leadership.

The devastating effects of the HIV/AIDS epidemic are personal, social and economic. 20 million people have already died of AIDS, and 4.9 million people were infected with HIV in 2004 alone. In some countries in sub-Saharan Africa nearly 40% of adults are now living with HIV. People are losing loved ones and friends, millions of children are growing up without parents, and the premature deaths of so many workers are draining economies of their skills base. While treatment is readily available for people in rich developed nations, over six and a half million people around the world who need treatment have no access to these life saving drugs. Until we respond effectively to HIV and AIDS, other development work will continue to take place with one hand tied behind its back.

The UK played a leading role in getting governments to agree a commitment to universal access to treatment by 2010, both at the G8 in July and subsequently at the UN Millennium summit in September. It has also played a big role in bringing greater coordination between donors and aligning programmes with country priorities. But if the 2010 commitment is to become a reality, crucial issues must be addressed.

Increased and predictable funding is imperative. The global response to HIV and AIDS, after over 20 years, remains seriously under-funded; UNAIDS estimates a shortfall of $4 billion this year, and $16 billion for the period 2005-7. In September, international governments conspicuously failed to significantly increase their funding to the Global Fund to Fight AIDS, TB and Malaria at its replenishment conference. The UK must influence other governments by example and significantly increase its funding to HIV/AIDS.

But money is not the answer on its own. Capacity development is also crucial to curb the HIV/AIDS epidemic – underlined in a recent report from a World Bank-led task force1. Comprehensive HIV prevention and treatment programmes, which address stigma and discrimination in society need to be made accessible to all. Strengthened health systems must be at the centre of these programmes. And engaged communities – that participate in decision making, contribute to the delivery of services and hold authorities to account – must be supported.

Comprehensive services. Prevention and treatment must go hand in hand. Availability of anti-retroviral treatment gives people a reason to find out whether they are HIV positive. HIV testing and counselling is also a key opportunity to get prevention messages across to those who test HIV positive and HIV negative. And without more successful HIV prevention work, treatment programmes will struggle to stay sustainable under the burden of ever increasing demand.

Anti-retroviral treatment programmes also need to be free at the point of access to ensure that they are accessible to all.

Strengthening health systems. In many areas there is a lack of clinics, diagnostics, drugs, and facilities for supply, distribution and storage. There is also a lack of health care workers, a large number of who are HIV positive themselves, or who move to richer nations where they can get treatment, and better pay and conditions. Fiscal space needs to be created in order to increase spending on public health care, including decent wages for health workers, as part of scaling up access to treatment and prevention.

Community engagement. There also needs to be clear recognition and resources given to communities and community-based organisations for the work they do. Studies consistently identify that government programmes find it increasingly difficult to reach marginalized and stigmatised groups that are key to the epidemic. Community-based organisations are best positioned to reach these groups, help them become more actively engaged in the HIV/AIDS response, and support prevention and treatment interventions – helping them to understand the way that often complex, life-long drug regimes need to be taken. Community engagement will not just ensure programmes are more effective and sustainable: it will also ensure authorities are held accountable.

So what can the UK government do to take forward its successful leadership and support for the 2010 targets? It must continue to provide global leadership in the fight against HIV/AIDS. The forthcoming World Trade Organization global trade negotiations provide an important opportunity for this, particularly addressing drug pricing, that cannot be missed. The Department for International Development in particular must ensure that its own spending and commitments on HIV/AIDS make a difference to countries’ responses. This might require looking at its current funding mechanisms to ensure its aid is effective, and re-examining its priority partners to ensure comprehensive services, strengthened health systems and community engagement are achieved and the most vulnerable populations reached.

The UK government has successfully pushed the HIV/AIDS agenda in 2005, but the next phase of action is crucial if universal access to prevention, treatment and care is to become a sustainable reality. Millions of lives are at stake.