Progress towards universal access
In 2006, governments made a historic pledge at the United Nations to dramatically scale up the AIDS response. In the Political Declaration on HIV/AIDS (2006), countries committed to provide universal access to HIV prevention, treatment, care and support services to all those in need by 2010. This commitment has as its foundation the Declaration of Commitment on HIV/AIDS (2001), in which governments made a series of time-bound commitments to expand their efforts to address HIV. Both of these declarations support and generate momentum towards universal access and achieving the Millennium Development Goals (MDGs), particularly MDG 6, which seeks to halt and reverse the spread of HIV by 2015.
Throughout 2010 and in early 2011, UNAIDS supported countries to review progress towards universal access. A total of 117 country reviews were carried out and aide-memoires and condensed analyses of these templates were used to capture the recommendations for scaling up the response. The aims of the reviews include providing an opportunity for stakeholders and constituencies to take stock of progress made, identifying obstacles and deciding what needs to be done in order to achieve universal access and ultimately the MDGs.
UNAIDS also supported regional consultations on universal access with an emphasis on regional political bodies – social and economic mechanisms – to boost political commitment to address HIV.
In East and Southern Africa, key meetings have been held with National AIDS Commission chairs and ministers of health in the Southern African Development Community (SADC) region. A special sub-regional consultation was convened in March 2011 in Johannesburg, South Africa.
Accounting for Universal access globally: the role of the High Level Meeting on AIDS (June 2011)
The synthesis and analysis of the country reviews and regional consultations, backed by the most recent data from various sources, culminated in the Secretary General’s report titled Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths.
The report recorded the progress made, noted the challenges faced by countries and regions and supported the renewal of commitment toward universal access. Key findings include:
- HIV prevention. The number of people newly infected with HIV declined by 19 per cent in the decade before December 2009, with at least 33 countries experiencing a decline in HIV incidence of at least 25 per cent and 10 high-prevalence countries achieving the global goal of reducing HIV prevalence among young people by at least 25 per cent. Nevertheless, the epidemic continues to outpace the response, underscoring the need to revolutionise efforts to prevent new infections.
- Antiretroviral therapy (ART). As of December 2010, more than six million people were estimated to be receiving antiretroviral therapy in low- and middle-income countries. Yet the majority of people in need still lack access.
- Towards an HIV-free generation. Global coverage for antiretroviral prophylaxis to prevent the vertical transmission of HIV has exceeded 50 per cent. However, more than 10 years after interventions were validated to prevent vertical transmission in resource-limited settings, the world remains far from protecting newborns from becoming infected.
- Human rights. About three in 10 countries worldwide still lack laws prohibiting HIV-related discrimination. More than half of countries reported having laws or policies that indirectly or inadvertently reduce service access for vulnerable populations. Many of the countries with anti-discrimination laws do not rigorously enforce them.
- Financing the response. Funding for HIV programmes has dramatically increased, helping drive an overall surge in global health financing. Although in 2009, international HIV assistance declined for the first time, mirroring reductions in other forms of development aid.
The report highlights five recommendations made by the UN Secretary-General to strengthen the AIDS response:
- Harness the energy of young people for an HIV prevention revolution;
- Revitalise the push towards achieving universal access to HIV prevention, treatment, care and support by 2015;
- Work with countries to make HIV programmes more cost effective, efficient and sustainable;
- Promote the health, human rights and dignity of women and girls; and
- Ensure mutual accountability in the AIDS response to translate commitments into action.
The report, together with the consultations held during the 2011 High Level Meeting on AIDS culminated in a new declaration aimed at recommitting the global community to achieve universal access by 2015.
The declaration also articulates a number of global targets, transforming the principle of universal access from a vague aspirational goal into concrete and measurable objectives:
- Fifty per cent reduction in sexual transmission of HIV
- Fifty per cent reduction of HIV among people who inject drugs
- Fifty per cent reduction of tuberculosis deaths in people living with HIV
- Ensure no children are born with HIV and reduction of AIDS-related maternal deaths
- 15x15 (15 million people on ART by 2015)
- Mobilise funding (US$22–24 billion per year)
- Fifty-five Operative Paragraphs in the Political Declaration