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The World Health Report 2004: Changing History
2004 states that, This is a critical moment in
the history of HIV/AIDS. There is more money,
more political will and more attention being
paid to this killer disease than ever before.
And yet, more people than ever are dying of AIDS
and becoming infected with HIV.
The report highlights that tackling HIV/AIDS is
the world's most urgent public health challenge.
AIDS has killed more than 20 million people and
is now the leading cause of death and lost years
of productive life for adults worldwide. It is
estimated that 34-46 million people are infected
with HIV around the world, and 30 million of
them live in Africa. UNAIDS estimates that as of
December 2003,
2,5 million children and 37
million adults were living with HIV/AIDS, while
2,5 million adults and 500 000 children died of
AIDS in the same year. In sub-Saharan Africa,
three million children under 15 are living with
HIV/AIDS.
HIV transmission from mothers to their
babies is the most common mode of transmission
in sub-Saharan Africa where one third of babies
born to mothers with HIV are likely to acquire
the virus before or during pregnancy, or through
breast-feeding. According to the United Nations
AIDS Programme (UNAIDS), of the 5,2 million new
HIV/AIDS infections recorded in 2003, 700 000
were children below 15 years.
In the developing world, 6 million people need
access to antiretroviral therapy (ART) to
survive. In 2003,
three million people died
without receiving treatment. Today, only 400 000
people in the developing world have access to
treatment. The situation is even more acute in
the poorest countries, which are also those
hardest hit by HIV/AIDS. Only 100 000 Africans
just 2% of those in the advanced stages of the
disease receive the correct treatment
according to the World Health report. Treatment
is the difference between life and death for the
millions of people who are HIV-positive but are
being denied access to antiretroviral
medication. Long-term care is also essential if
they are to derive the maximum benefit from
treatment.
Just 34 countries account for more than 90% of
the adults in advanced stages of the deadly
immuno-deficiency disease, according to the WHO.
Some countries are still in the process of
overcoming suspicion of the costly and complex
antiretroviral drugs, and the stigma surrounding
HIV/AIDS. In addition, many countries have
seriously underestimated the long-term economic
and social costs of HIV/AIDS the 2004 World
Health report states. Projections now suggest
that some countries in sub-Saharan Africa will
face economic collapse unless they bring their
epidemics under control. This will be mainly
because HIV/AIDS weakens and kills adults in
their prime, depriving communities of doctors,
teachers, lawyers, farmers, miners and police
officers, and depriving children of their
parents.
Good nutrition is essential.
In the United States experts told the Senate
Foreign Relations Committee that hunger and AIDS
have trapped millions of Africans in a spiral of
sickness and death.
AIDS and hunger interact. The Executive Director of the United
Nations World Food Program (WFP) points out
that, "AIDS dramatically undermines food
production. Malnourished bodies are more
receptive to HIV, and more receptive to the
opportunistic diseases that follow." Based on
United Nations' estimates, the disease has
killed
7 million African farmers, hindering food
production across the continent. Good nutrition
should be part of the treatment, the Administrator of the United States Agency for
International Development (USAID) stated. He
went on to say that antiretroviral drugs often
need to be taken with food, and the UN World
Health Organization believes that better
nutrition improves survival rates by
strengthening the immune system. A full package
of assistance is required including, food,
water, medicine and shelter, along with support
for extending school feeding programmes to all
schools in communities affected by the epidemic
he noted.
The Clinton HIV/AIDS Initiative (CHAI) and the
WFP have signed a landmark agreement to provide
food to
AIDS patients undergoing antiretroviral
(ARV) drug treatment in developing countries.
Too often, food has been missing from the
treatment regimen because, among other things,
patients become too weak and impoverished to
feed themselves and their families. "One of the
key challenges we face in tackling the HIV/AIDS
crisis is that if
a patient is malnourished, the ARVs often do not take full effect," said former
President Bill Clinton. "Furthermore,
malnourished patients are frequently susceptible
to other opportunistic infections and illnesses.
This agreement aims to ensure a more effective
response in dealing with a crisis where the poor
are disproportionately affected, and I look
forward to working with the WFP to ensure that
food support becomes an integral part in the
delivery of comprehensive care and treatment to
those suffering from HIV/AIDS."
In addition to the adverse impact poor nutrition
has on the health of AIDS patients, HIV/AIDS
also dramatically deepens food crises in poor
countries. Families are often less able to earn
a living, while at the same time their ability
to produce food to feed themselves is
undermined. Research has also shown that hunger
can cause previously HIV negative people to
engage in high-risk survival strategies, such as
sex work, that increase their chances of
becoming infected with the virus. The overall
result is that poverty and hunger significantly
escalate the intensity of the crisis and the
number of people infected.
Supplying antiretroviral therapy.
AIDS treatment is part of a comprehensive AIDS
strategy, linking prevention, treatment, care
and support. In 2003, WHO, UNAIDS and the Global
Fund to Fight AIDS, Tuberculosis and Malaria
declared lack of access to treatment with
antiretroviral medicines a global health
emergency. In response, these organizations and
their partners launched an effort to provide
three million people in developing countries
with antiretroviral therapy by the end of 2005
the 3 by 5 initiative. Until now, treatment
has been the most neglected element in most
developing countries. Vital resources have been
pledged, including more than US$ 20 billion from
donor countries and through multilateral funding
agencies including the Global Fund to fight
AIDS, Tuberculosis and Malaria, the United
States President's Emergency Plan for HIV/AIDS
Relief and the World Bank.
The Executive Director of UNAIDS explains
that, "For the first time in the history of this
epidemic, there is serious money on the table.
We've moved from $200m going to AIDS in
developing countries when UNAIDS was founded
about seven years ago to $4.5bn dollars in
2003..." The WHO and UNAIDS say treatment is
what the money must be spent on. In the United
States and Europe, people with AIDS are leading
normal productive lives, thanks to
antiretroviral drugs. "Scaling up effective HIV
treatment and prevention programmes is the best
strategy to save lives and keep future
generations HIV free," he said.
The report emphases that the delivery of AIDS
treatment and prevention offers a chance to
build up health systems in the poorest countries
providing health benefits for all. "Future
generations will judge our era in large part by
our response to the AIDS pandemic," the Director-General of WHO commented.
WHO is working closely with all partners,
including national health officials, treatment
providers, community organisations, people
living with HIV/AIDS and other stakeholders to
design national treatment scale-up plans and
begin their implementation. Political commitment
and national ownership of programmes are
essential. The streamlined funding mechanisms
developed by the
Global Fund are enabling many
countries to access funding and expand AIDS
treatment and prevention programmes faster than
ever before.
WHO has also extended its gratitude to the
Canadian government for the Prime Minister's
announcement of a contribution of CAD $ 100
million over two years for the WHO target of
treating three million people living with AIDS
by the end of 2005. Canada has demonstrated
vision and leadership in supporting a new
initiative. This contribution to '3 by 5' will
make it possible for WHO to help catalyse
efforts at the country level to urgently treat
three million people living with AIDS"
The British government also plans to spend £1
billion
a year on poverty alleviation in Africa
by 2006,
a minister stated. The British
Under-Secretary of State
for International
Development noted that a significant proportion
of that money will be used to fight HIV/AIDS.
He
affirmed that there was a very real need to
focus on medium- and long-term strategies to
combat the
epidemic. He explained that because
of the virus,
"the development that took place
[in less well-off countries] is being reversed".
The British government funds work
in Africa
through the Department for International
Development (DFID).
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