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In the Declaration of Commitment on HIV/AIDS, adopted at an historic special session of the UN General Assembly in 2001, leaders from 189 Member States committed to comprehensive, time-bound targets for the delivery of the effective HIV prevention, treatment, care and support needed to halt and begin to reverse the global epidemic by 2015.
Accountability and transparency are central to achieving these goals. The Declaration of Commitment on HIV/AIDS provides for regular reporting to the General Assembly on global progress, using indicators developed by UNAIDS, individual nations and a diverse range of partners. To inform the five-year assessment of progress by the UN General Assembly in 2006, UNAIDS reviewed country progress reports on core AIDS indicators, with particular attention to quantifiable targets that were to be reached by December 2005.
The 2006 Report on the global AIDS epidemic contains the most comprehensive set of data on the country response to the AIDS epidemic ever compiled. Not only did 126 countries submit full reports, but, for the first time, civil society was actively engaged in the collection, review and analysis of these country data. In addition, UNAIDS received more than 30 separate reports from civil society, allowing for a more comprehensive assessment of political commitment, quality and equity of service coverage, and the effectiveness of efforts to address stigma and discrimination.
Among the key findings of this comprehensive global review are the following:
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Important progress has been made since the 2001 Special Session, yet there is extraordinary diversity in the response to HIV between countries and regions.
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While select countries have reached key targets and milestones for 2005, many countries have failed to fulfil the pledges specified in the Declaration.
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Some countries have made great strides in expanding access to treatment, but have made little progress in bringing HIV prevention programmes to scale, while other countries that are now experiencing a reduction in national HIV prevalence are making only slow progress to ensure that treatment is available to those who need it.
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In most countries, a strong foundation now exists on which to build an effective HIV response, with increasing political commitment and partner coordination at country level.
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The rate of increase in HIV resources has accelerated since the 2001 Special Session, with an annual average increase of US$ 1.7 billion between 2001–2004, compared with an average annual increase of US$ 266 million between 1996 and 2001. Available funding in 2005 reached US$ 8.3 billion.
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Domestic public expenditure from governments has also significantly increased in low-income sub-Saharan African countries, and more moderately in middle-income countries. In 2005, domestic resources reached US$ 2.5 billion.
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Treatment access has dramatically expanded. From 240 000 people in 2001, 1.3 million people in low- and middle-income countries received antiretroviral therapy in 2005, and 21 countries met or exceeded targets under the “3 by 5” initiative to provide treatment to at least 50% of those who need it.
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The number of people using HIV testing and counselling services quadrupled in the past five years in more than 70 countries surveyed, from roughly four million persons in 2001 to 16.5 million in 2005.
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In 58 countries reporting data, 74% of primary schools and 81% of secondary schools now provide HIV and AIDS education.
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In eight of 11 sub-Saharan countries studied, the percentage of young people having sex before age 15 declined and condom use increased.
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Six of 11 African countries heavily affected by HIV reported a decline of 25% or more in HIV prevalence among 15–24-year-olds in capital cities.
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Some countries have achieved nearly 60% coverage of HIV-positive pregnant women receiving antiretroviral prophylaxis to prevent mother-to-child transmission.
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Blood for use in transfusions is now routinely screened for HIV in most countries.
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However, there are still significant weaknesses in the response to HIV.
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HIV prevention programmes are failing to reach those at greatest risk. Efforts to increase HIV knowledge among young people remain inadequate.
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Although the Declaration of Commitment on HIV/AIDS aimed for 90% of young people to be knowledgeable about HIV by 2005, surveys indicate that fewer than 50% of young people achieved comprehensive knowledge levels.
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Only 9% of men who have sex with men received any type of HIV prevention service in 2005; fewer than 20% of injecting drug users received HIV prevention services.
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Services to prevent HIV infections in infants have not scaled up as rapidly as programmes to provide antiretroviral therapy, with just 9% of pregnant women being covered.
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Civil society reports from over 30 countries indicate that stigma and discrimination against people living with HIV remains pervasive.
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The HIV response is insufficiently grounded in the promotion, protection and fulfilment of human rights. Half of the countries submitting reports to UNAIDS acknowledged the existence of policies that interfere with the accessibility and effectiveness of HIV-related measures for prevention and care.
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National governments, international partners and communities are failing to provide adequate care and support for the 15 million children orphaned by AIDS, and for millions of other children made vulnerable by the epidemic.
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A quarter century into the epidemic, the global AIDS response stands at a crossroads. The AIDS response must become substantially stronger, more strategic and better coordinated if the world is to achieve the 2010 Declaration of Commitment targets. The countries most affected by HIV and AIDS will fail to achieve Millennium Development Goals to reduce poverty, hunger and childhood mortality, and countries whose development is already flagging because of HIV and AIDS will continue to weaken, potentially threatening social stability and national security, if the response does not increase significantly.
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