Publications
HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

Executive Summary

Since late 2003, when WHO and UNAIDS launched a strategy for ensuring treatment for 3 million people living with HIV/AIDS in low- and middle-income countries by the end of 2005 (the 3 by 5 target), coverage of antiretroviral therapy (ART) in these countries has more than doubled increasing from 400 000 to approximately 1 million people receiving treatment at the end of June 2005. To date, 14 of these countries are providing ART to at least 50 per cent of those who need it, consistent with the 3 by 5 target.

The current momentum in expanding treatment access in sub-Saharan Africa, where the burden of disease is greatest, is especially encouraging. Approximately 500 000 people in the region are receiving treatment, a three-fold increase in the last 12 months. Overall, scale-up appears to be accelerating, with about 150 000 and then about 200 000 more people on treatment in successive six-month periods. Most African countries report that demand for treatment is outstripping their capacity to supply it, and stress their urgent need for increased resources and technical support in order to maintain their momentum in scaling up.

Progress in Asia, the region with the second highest need for treatment, has also been signifi cant, with the number of people receiving treatment increasing nearly three-fold from 55 000 to 155 000 in the last 12 months.

In eastern Europe and central Asia, the number of people on treatment has almost doubled in the last 12 months, from 11 000 to 20 000 people. The majority of countries in this region aim to be providing universal access by the end of 2005, but this does not include the two countries with the largest unmet treatment need, the Russian Federation and Ukraine.

In Latin America and the Caribbean, WHO estimates that the total number of people on treatment grew from 275 000 to 290 000 in low- and middle-income countries during the fi rst half of 2005, which indicates that about two out of three people who need treatment in this region are receiving it. The most populous countries in the region - including Argentina, Brazil and Mexico - already have relatively high coverage, but several other countries are lagging behind. In north Africa and the Middle East, coverage remains low at about 5 per cent with little change in the number of people on treatment, currently estimated at about 4 000.

The momentum achieved to date in scaling up HIV treatment access has been the result of a broad range of local, national, regional and international efforts, including, fi rst and foremost, those of many of the most highly affected countries. These efforts have been supported by resources from the Global Fund to Fight AIDS, TB and Malaria (the Global Fund), the United States Presidents Emergency Plan for AIDS Relief and other bilateral donors, the World Bank, international non-governmental organizations (NGOs) and the private sector, with technical support from United Nations agencies and many other organizations.

The estimate of approximately 1 million people now on treatment falls short of the milestone of 1.6 million set in the WHO/UNAIDS 3 by 5 strategy for June 2005. Current data and trends indicate that providing ART to 3 million people by the end of 2005 will be unlikely. However, there is reason to be hopeful that growth rates will continue to increase in the remainder of 2005 and beyond. Although less than what is needed, an estimated US27 billion are available or have been pledged for HIV/AIDS globally from all sources for the three-year period 2005-2007. At the same time, substantial political commitment to moving forward is evident in the many countries that have translated the global 3 by 5 target into ambitious but feasible national treatment targets.

This interim report on global efforts to increase access to ART focuses primarily on understanding the reasons for the successes and failures of scaling up HIV/AIDS interventions in different settings. The report also makes recommendations concerning the approaches needed to overcome major bottlenecks, as well as the need for sustainable fi nancing mechanisms and greater harmonization of effort by technical and financing partners at country level. A comprehensive report and country-specifi c analysis of access efforts and obstacles that remain will be released at the end of 2005.