Access to HIV Treatment -- Raising the Bar

The global effort to ensure access to antiretroviral therapy for millions of people is one of the greatest success stories in the history of public health. In just a decade, access to life-saving HIV treatment in developing countries has increased more than forty-fold, with 9.7 million people in low- and middle-income countries accessing treatment in 2012, according to a new report from WHO, UNICEF, and UNAIDS.

Antiretroviral therapy saves lives, improves quality of life, and lifts communities and economies, enabling people to once again work, go to school, care for their families, and participate in society. Every day, treatment access and other investments are helping us get closer to an end of the AIDS epidemic.

Expanding access to treatment is also helping to slow the spread of the epidemic. In 2011, a landmark study demonstrated that a person who is living with HIV and who has access to antiretroviral therapy has much lower levels of the virus in their system, and as a result, is much less likely to transmit HIV. The reality that treatment also can prevent new HIV infections can be seen in countries such as South Africa, where new infections are declining as more people receive HIV treatment.

These successes are inspiring -- but the concluding chapters of this story have yet to be written. It's time to raise the bar.

We have set a new challenge with new antiretroviral therapy guidelines that reflect the latest scientific knowledge. These new guidelines recommend starting treatment earlier, when people are still strong and well (at a CD4 count of 500 cells/mm3, up from the previous threshold of 350 cells/mm3). This approach responds to research showing that treatment is most effective when started earlier in the course of HIV disease. The guidelines also recommend initiating treatment immediately for children under the age of five, pregnant women, people who are co-infected with tuberculosis or hepatitis B, and others who are particularly susceptible to more rapid progression of HIV disease.

The new guidelines also seek to increase the use of antiretroviral therapy by recommending simplified treatment regimens for people living with HIV. For people just beginning therapy, WHO now recommends a treatment regimen that is available as a single pill taken once daily. This simpler regimen makes it easier for people to take the medicine, which is critical for protecting their health, improving adherence and avoiding the emergence of drug resistance.

WHO's new guidelines are welcome news for people living with HIV, but implementing them presents challenges. The new guidelines mean that the number of people eligible for antiretroviral therapy today has increased to an estimated 26 million people worldwide. That means 16 million more than the number of people who have access today. For UNAIDS, the mandate is clear -- scale up to ensure that as many people as possible who are eligible for antiretroviral therapy have access to the lifesaving treatment.

The evidence of the benefits of providing HIV treatment to everyone eligible is irrefutable. That is why I am optimistic that national leaders, international donors, civil society and partners will seize this opportunity and work with us to expand access to treatment.

It is evident that expanded treatment programs must go hand-in-hand with other efforts to prevent and address the root causes of HIV infection. Recent scientific advances show that male circumcision and pre-exposure prophylaxis (the use of antiretroviral drugs by people who are HIV-negative to reduce their risk of infection) hold great promise for reducing new infections, but these tools remain out of reach of many people at high risk for HIV. And all countries must redouble efforts to eliminate the stigma and discrimination that put many vulnerable groups, such as men who have sex with men, sex workers and drug users, at a higher risk of becoming infected with HIV -- and that prevent people at higher risk from accessing antiretroviral therapy.

The path to zero -- zero new infections, zero discrimination, and zero AIDS-related deaths -- is clearer today than ever before. Universal access to antiretroviral therapy can help pave the way.

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