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From April to May 2009, SAFAIDS moderated an e-forum discussion on Universal Access. This e-forum functioned as a public platform to solicit the opinions of HIV programme practitioners, People Living with HIV, academics, civil society and a broader public on universal access to HIV prevention, treatment, care and support.

The discussion aimed at bringinging sharper focus on identifying and proposing solutions for the challenges and obstacles that prevent the attainment of Universal Access.

Find below a summary of the forum's discussions as well as the resulting recommendations

Key questions asked during the discussion

1. Universal access is a Human Rights Issue. Can both governments and CSOs claim to have done enough?

2. The barriers and challenges to achieving UA are well-known, what are the solutions? What can we learn from countries like Botswana and Namibia that have achieved 80% and 70% UA respectively?

3. So the race is on: how do we accelerate to make Universal Access a reality? What can governments and CSOs do to accelerate the final push/progress in the remaining period?

4. Is moving the target date of 2010 even an option?

The discussions that ensued were exciting and enlightening.

Key issues emerging from the discussion

1. The Universal Access Pipe Dream

Achieving universal access, when we are less than a year to the target set, was a mere 'pipe dream'. Universal access was equated to utopia, "...an imaginary place or situation in which everything in society is perfect". Members reached a consensus that universal access was a noble concept which however could not be easily achieved due to a number of factors such as socio-political and economic challenges. An Anonymous member argued that, "But while universal access remains a noble concept, the multiplicity of challenges it entails, means that it stands far more than the numerical ideal of 100% coverage of services to all people." "

2. Community Voices: Understanding Universal Access

There was consensus among Community Based Organisations throughout the region that good governance and good economic management, will facilitate the availability and easy access to health and social services, jobs and hope. There is need to increase advocacy efforts on UA so the voices of CBOs are heard.

3. Let Africans come up with home grown solutions

UNAIDS was challenged to let Africans (or any other district, country or region) come up with their own strategies and implement them according to their settings - (an African solution to fighting HIV and AIDs in order to achieve universal access). An anonymous member argued that, "Unfortunately UNAIDS has missed the point. In Africa, we have for many years lacked strategies that are able to term the HIV spread. All we are using today are imported strategies from the west. The behaviour and life style of the people in the west is different from the Africans."

Members of the eForum then questioned what the African solution that was being referred to is. It emerged that each village, city, country or region should not attempt to just adopt or replicate 'good practices' successful elsewhere without adapting them to the local needs. Dr Rajesh Gopal, a prominent key discussant in the discussion argued that, "...having clarity on the cultural dimensions of transmission is just as important as understanding the microbiology of the virus when designing prevention strategies."

4. Barriers to Invigorating Universal Access

Lack of financial resources was noted as a barrier to achieving UA, with the Global recession being singled out. One member stated, "The success or failure of achieving universal access is entirely dependent upon the national and international financial commitments. Now that global recession has come into place, what does it mean for local, national and international universal access targets?"

Other barriers to achieving universal access included: the lack of political commitments at national levels as well other socio-economic factors such as poverty especially in the sub-Saharan region - which is the most affected by the HIV pandemic.

Conclusions and Recommendations for policy and programming

It is important to ensure strategies to the achievement of UA have a bottom-up approach, with home-grown solutions being prioritised.

The success or failure of achieving universal access is entirely dependent upon the national and international financial commitments. According to UNAIDS, "Governments and international donors should increase funding for networks and organisations for people living with HIV to provide HIV prevention and treatment literacy campaigns in local languages aimed at increasing awareness and improving the delivery of HIV prevention and treatment.

It was also concluded that many countries will not achieve the set targets by 2010. However, UNAIDS has recommended that in order to achieve universal access targets, countries must focus on the following priority areas in the health sector:
- Strengthening the role of the health sector in HIV prevention
- Overcoming obstacles to increase knowledge of HIV status
- Strengthening and sustaining efforts to scale up HIV treatment and care
- Accelerating access to HIV prevention, treatment and care for women and children

All postings and reference documents can be viewed in the Archives, also located on the Accelerating-prevention eForum website: http://www.healthdev.org/eforums/accelerating-prevention

The 4^th South Africa AIDS Conference took place in Durban, South Africa from 31 March to 3 April 2009. With the theme "Scaling up for Success", the conference shared best practices in HIV prevention, treatment and care and will identify barriers to scaling up responses to the HIV epidemic in Southern Africa.

At the conference, UNAIDS brought together experts such as Mrs Elizabeth Mataka, UN Special Envoy on AIDS in Africa, Ms Vuyiseka Dubula from the Treatment Action Campaign, Dr Khumo Siepone, Director of Botswana's HIV/AIDS Department, Dr Fareed Abdullah from the Global Fund and Dr Brian Brink from Anglo-America at a satellite session, with the title 'Universal Access - where do we go from here?'. The session discussed what needs to be done to sustain and accelerate progress in achieving Universal Access in the region.

> Read the summary of the satellite session

UNAIDS Regional Support Team for Eastern and Southern Africa RST convened a "think tank" meeting of regional partners representing UN agency representatives, senior policy makers, academics, civil society and People Living with HIV to engage in deepened reflection of trajectories for dynamizing action for Universal Access.

> Read a summary of the key issues emerging from this consultation