Page last updated at 13:55 GMT, Monday, 2 June 2008 14:55 UK

HIV/AIDS progress painfully slow

Jill McGivering
BBC News

Aids baby
Drugs can prevent mothers from passing HIV to their unborn babies

A new international report into the battle to stem HIV/Aids and treat sufferers around the world has found both progress and deeply-rooted problems.

The report, released jointly by the World Health Organization, UNAids and Unicef, offers a bleak numbers game showing that the gap between the supply of antiretroviral treatment and the demand continues to grow steadily.

While the report tracks some progress in the fight against HIV/Aids, it highlights the need for more treatment for pregnant women with HIV in order to prevent their children being infected.

The positive news is that the number of people with HIV who are now getting antiretroviral treatment has increased dramatically in the last three years.

Prevention, treatment, care

The treatment is now reaching nearly 3 million people worldwide, almost a third of those who are thought to need it.

Although there is an increase each year in the number of people receiving treatment, the number of new identified cases each year is rising at an even faster rate.

Dr Kevin de Cock, the director of the HIV/Aids programme at the World Health Organization, told the BBC that the rate of new infections likely peaked nine or 10 years ago but there are still 2.5 million new infections each year, while only about one million new people are receiving treatment.

"So the message is you cannot separate prevention, treatment and care. We need all of them," Dr de Cock said.

He highlighted the continuing weakness of health systems in middle and low income countries, especially those in sub-Saharan Africa where new cases are concentrated.

Health systems that suffer from a lack of skilled workers, infrastructure, lab capacity and availability of drugs are a main obstacle both to improving prevention and delivering treatment more comprehensively.

Pregnancy treatment

This also points to a more general debate raging about whether the focus is now too much on individual health threats - malaria and HIV for example - and not enough on overall health systems.

There's no question we're having an impact on mortality with 3 million people on antiretroviral therapy. But the only solution in the long term is to stop new infections. Clearly we need to do better with prevention
Dr Kevin de Cock, World Health Organization

Dr de Cock says the two have to be viewed in tandem.

"We must not return to a situation where there are very academic, very theoretical discussions about health systems. We need stronger health systems."

The report also looks at the treatment of pregnant women with HIV.

Intervention with antiretrovirals can prevent a baby being born HIV positive.

Mother to child transmission has been almost eliminated in the developed world, with 90% of current cases in sub-Saharan Africa where access to treatment is limited.

Worldwide, about a third of pregnant women with HIV now get this preventative treatment. That is up from 10% a few years ago but, experts say, it is still far too low.

Future impact

One of the fears for those battling HIV/Aids is the long term need for treatment and the impact that will have on resources.

At the moment about 33 million people globally are known to have HIV. As well as new cases each year, millions of these people will need access to antiretrovirals in the future if they become ill.

Tackling that demand will require sustained political will and further dramatic increases in access to treatment.

AIDS/HIV drugs
Demand for the anti-retroviral drugs continues to grow steadily

Health experts warn that the only real answer to tackling HIV/Aids is stopping people becoming infected in the first place.

"A prime function of medicine and public health is to stop people from dying," said Dr de Cock.

"There is no question we're having an impact on mortality with 3 million people on antiretroviral therapy.

"But the only solution in the long term is to stop new infections. Clearly we need to do better with prevention."

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