RESPONSE TO HIV/AIDS

STOP AIDS: KEEP THE PROMISE

Universal access to health care and HIV/AIDS

The World Health Organization has been committed to the goal of universal access to health care for many years beginning with a resolution adopted at the Thirtieth Health Assembly (1977) when countries committed themselves to the attainment by the year 2000 of a level of health that would permit all peoples of the world to lead socially and economically productive lives.

1. The primary health care strategy, formulated a year later at the 1978 International Conference on Primary Health Care, recognized that primary health care is based on practical, scientifically sound and socially accepted methods and technology made universally accessible to individuals and families in the community.
2. The Declaration of Commitment at the 2001 United Nations General Assembly Special Session on HIV/ AIDS has led to increased international commitment and considerable success in some countries in ensuring access to HIV /AIDS services. However, reaching the Millennium Development Goals related to HIV/AIDS requires that HIV prevention, treatment, care and support interventions be scaled up much further.
3. In 2003, WHO declared the lack of access to antiretroviral treatment (ART) a global health emergency. Subsequently, WHO and the UNAIDS Secretariat announced a global initiative to support countries in delivering ART to 3 million people living with HIV/AIDS in low- and middle-income countries by the end of 2005. In May 2004 the “3 by 5” target was unanimously endorsed by all 192 WHO Member States at the Fifty-seventh World Health Assembly.

“3 by 5” Initiative: Lessons Learnt

The “3 by 5” target has had an important catalyzing effect at the global level, and has been acknowledged as an important step in a longer-term global effort to realize the objectives set out in the Millennium Development Goals. It has demonstrated that providing treatment is possible in even the most resource-challenged settings, but that sound planning and well-supported infrastructures are both essential. Perhaps most importantly, “3 by 5” illustrates that expanded international financial support, improved international coordination and communication, clear milestones, robust monitoring and evaluation, enhanced partnership structures, improved implementation of lessons learnt and an intensified focus on strengthening health systems are all essential elements to achieving universal access by 2010. The “3 by 5” initiative has highlighted the importance of using existing opportunities and health infrastructure to deliver ART and scale-up HIV prevention in resource-limited settings, notably in the areas of tuberculosis, sexual and reproductive health, prevention of mother-to-child transmission of HIV and management of substance dependence.

Moving Towards Universal Access

1. To maintain momentum and build upon the progress made so far, in July 2005 leaders of the G8 group of industrialized countries announced their intention to “work .... with WHO, UNAIDS and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010”. This goal was subsequently endorsed by all UN Member States at the High Level Plenary Meeting of the Sixtieth Session of the UN General Assembly in September 2005.
2. The World Health Organization takes the lead within the UN system in the global health sector response to HIV/AIDS. WHO provides technical, evidence-based support to Member States for a comprehensive and sustainable response to HIV/AIDS treatment, care, and prevention through the health sector. In 2003, the Fifty-sixth World Health Assembly endorsed the Global Health Sector Strategy for HIV/AIDS, 2003-2007, and requested WHO to support Member States in implementing the strategy. The Strategy defines the “Core Components of a Health-Sector Response to HIV/AIDS”.
3. WHO’s global plan on the Contribution to Scaling Up towards Universal Access to HIV/AIDS Prevention, Treatment and Care 2006-2010, was released in 2006.
4. A regional strategic plan was developed to guide the WHO South-East Asia Region’s contribution to scaling-up HIV/AIDS prevention, care and treatment responses in Member countries in order to achieve the targets by 2015. It provides direction to the Organization at regional and country levels to work together and in cooperation with partners to achieve the goal. It relates particularly to the assistance that WHO will provide to ensure that the health sector in each country makes an effective and sustainable contribution to HIV prevention, treatment and care. It acknowledges the crucial need for increased cooperation and coordination between global partners.
5. Scaling-up of the HIV/AIDS strategy in the Region involves developing a comprehensive response to HIV/AIDS that includes prevention, treatment and care as well as addressing the need to expand coverage geographically, to reach more people. It also focuses on increasing coverage to different population types, improving the quality and scope of services, and ensuring that the involved systems are accountable. The ultimate goal is to guarantee the delivery of a comprehensive range of interventions and programmes to reduce the transmission of HIV/AIDS and lessen its impact on individuals and societies.

WHO - Leading the Health Sector Response to HIV/AIDS

Goals

The regional strategy is to strengthen health system capacities in all countries to effectively scale up interventions for the prevention, care and treatment of HIV/AIDS and sexually transmitted infections (STIs).

The objectives are:

1. To prevent HIV transmission
2. To improve the quality of life of those living with and affected by HIV/AIDS, and
3. To alleviate the impact of HIV/AIDS on individuals, households and local communities.

Regional Strategic Plan for HIV/AIDS, 2007-2015

Strategic Directions:

Strategic Direction 1: Maximizing the health sector’s contribution to HIV prevention

Priority interventions:

1. Prevention of sexual transmission
2. Prevention of HIV transmission through injecting drug use
3. Prevention of parent-to-child transmission (PPTCT)
4. Prevention of HIV through the healthcare setting

Strategic Direction 2: Enabling people with HIV to know their status through HIV testing and counselling

Priority interventions:

1. Voluntary testing and counselling
2. Provider-initiated testing and counselling

Strategic Direction 3: Accelerating the scale-up of HIV/AIDS treatment and care

Priority interventions:

1. Antiretroviral therapy
2. Prevention and management of opportunistic infections
3. Care, including nutrition, palliative care and end-of-life care
4. Prevention for people living with HIV
5. Linking HIV and TB services

Strategic Direction 4: Investing in strategic information to guide a more effective response

Priority interventions:

1. Epidemiology and surveillance of HIV and STIs
2. HIV drug resistance transmission surveillance and monitoring as part of ART programmes
3. Monitoring and evaluation of the health sector’s progress towards universal access
4. Operational research

Strategic Direction 5: Strengthening and expanding health systems

Priority interventions:

1. Advocacy, leadership and stewardship
2. National strategic planning and management
3. Procurement and supply management
4. Laboratory strengthening
5. Human resource management
6. Strategies for sustainable financing