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[afro-nets] Accelerate expansion of antiretroviral therapy to all people living with HIV: WHO

WHO Statement

On World AIDS Day WHO emphasizes that expanding antiretroviral therapy to all 
people living with HIV is key to ending the AIDS epidemic within a generation.

"The Millennium Development Goal of reversing the HIV epidemic was reached 
ahead of the 2015 deadline - an incredible achievement that testifies to the 
power of national action and international solidarity," declared WHO 
Director-General, Margaret Chan. 

Expansion of antiretroviral therapy (ART) has resulted in a stark reduction of 
AIDS-related deaths. 
At the same time, increasingly effective prevention efforts have reduced 
numbers of new HIV infections. Since the epidemic's peak in 2004, the number of 
- deaths has fallen by 42% with some 7.8 million lives being saved over the 
last 15 years, according to a new WHO report. The number of new infections has 
fallen by 35% since the turn of the century. 

Over the last 15 years, scale-up of ART has been most dramatic in the WHO 
African Region where now more than 11 million people are receiving HIV 
treatment, up from 11 000 at the turn of the century. People living with HIV in 
Africa are now more likely to receive treatment than people living in most 
other parts of the world. Globally, in June 2015 close to 16 million people out 
of a total of 37 million people living with HIV were taking ART.

Doubling access to testing and antiretroviral therapy
At the UN General Assembly in September, world leaders endorsed a new set of 
Sustainable Development Goals and milestones, including a call for ending the 
AIDS epidemic by 2030. Reducing the number of new infections by 75% and 
doubling the number of people on ART by 2020 are the first milestones towards 
achieving this goal. 

Trial results published earlier this year have confirmed that people living 
with HIV who begin antiretroviral therapy soon after acquiring the virus - 
before the virus has weakened their immune systems - are more likely to stay 
healthy and less likely to transmit the virus to their partners. Those findings 
led WHO in September to recommend that everyone living with HIV be offered 

In the effort to help countries implement the "treat all" recommendation, WHO 
is now presenting an additional set of recommendations on how to expand ART to 
all - in a rapid, focused, and efficient manner. 
These recommendations include using innovative testing approaches such as 
community or self-testing to help increase the number of people who know their 
HIV status; starting treatment faster in those people who are diagnosed with 
HIV; bringing ART to the community; and allowing for greater intervals between 
clinic visits for people who have been stable on ART for some time. They also 
highlight the importance of improving access to viral load testing and new 
classes of antiretroviral drugs. 

"WHO applauds governments, civil society, and organizations that have made 
availability of life-saving antiretroviral therapy possible in the most trying 
circumstances. The new recommendation to expand ART to all people living with 
HIV is a call to further step up the pace," said Dr Winnie Mpanju-Shumbusho, 
Assistant Director General at WHO.

Preventing new infections 
Reducing the number of new HIV infections remains a major focus for the vision 
of ending AIDS. There is increasing concern about a slow down-or even reversal 
- in the decrease of new infections in some countries and among some of the 
most affected population groups. "We must deploy all means to strengthen the 
HIV prevention response. The health sector can and must play a central role," 
added Dr Mpanju -Shumbusho

Already, over the last 5 years in Africa some 10 million men have undergone 
voluntary medical circumcision, a procedure that reduces their risk of 
acquiring HIV by 60%. New approaches to prevention are also emerging, including 
the use of antiretroviral drugs to help people at substantial risk from 
acquiring HIV. WHO now recommends this practice, called "pre-exposure 
prophylaxis," or PrEP, as an additional option to augment comprehensive 
prevention for people at heightened risk of HIV infection. Other elements of 
this package include behaviour-change communication, the consistent use of male 
and female condoms and prevention programmes for key populations, including 
harm reduction for people who use drugs. 

The same drugs that keep people living with HIV from becoming sick also prevent 
transmission of the virus from pregnant women to their infants. Among the 22 
countries that account for 90% of new HIV infections, 8 have reduced new 
infections among children by more than 50% since 2009, based on 2013 data, and 
another 4 are close to that mark.

Ingredients of success
Some low- and middle-income countries have made remarkable progress towards 
universal access to HIV services: 12 countries have ensured that 60% or more of 
all people living with HIV are aware of their infection and receiving 
antiretroviral therapy. Key ingredients of the successful HIV response in these 
countries are national ownership, greater focus of HIV services to reach the 
most affected locations and populations based on good data, and simplification 
of prevention and treatment services. 

"The sense of urgency that was the norm during the disease's most-destructive 
years must not be allowed to abate," Dr Mpanju-Shumbusho said. "HIV remains a 
major health challenge - drawing sharp attention to health system weaknesses 
and gaps in universal health coverage. Addressing these issues will be critical 
to meeting the new global targets for AIDS."

Link to the WHO Consolidated guidelines on the use of antiretroviral drugs for 
treating and preventing HIV infection: what's new
Policy brief

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