June 2006 marks the 25th anniversary of a report of five cases of Pneumocystis carinii (now jirovecii) pneumonia in men who have sex with men, heralding the acquired immunodeficiency syndrome (AIDS). (1) Over 65 million infections with the causative agent, human immunodeficiency virus (HIV), have now caused at least 25 million deaths.
Following recognition at the XI International Conference on AIDS in 1996, that combination antiretroviral therapy (ART) dramatically improves survival, various initiatives have helped to bring treatment to people with HIV/AIDS in developing countries. Although the target of treating 3 m people by the end of 2005 (WHO's "3 by 5" initiative) was not reached, about 1.3 m people now receive ART in low- and middle-income countries. Major lessons from the initiative include the utility of country-owned targets in mobilizing efforts and promoting accountability, the need for extensive partnerships to scale up activities, the importance of identifying and resolving health systems constraints, the challenges of ensuring equity, and the synergy between treatment initiatives and a simultaneous scaling-up of HIV prevention. (2)
In 2005, G8 leaders made a commitment to "working with WHO, UNAIDS and other international bodies to develop and implement a package of HIV prevention, treatment and care, with the aim of coming as close as possible to universal access to treatment for all those who need it by 2010". (3) As the lead agency for the health sector response to HIV/AIDS, WHO has consulted widely with others to define its contribution, drawing on the "3 by 5" experience and the UNAIDS technical support division of labour. (4) The following five strategic priorities will require a refocusing of WHO's efforts and the mobilization of new resources.
The first strategic direction recognizes that wider access to HIV testing and counselling is essential: data from recent surveys in heavily affected countries show that fewer than 10% of HIV-infected persons know whether or not they are infected. (5) There has been a move towards offering HIV testing more routinely in health care settings, as well as a re-evaluation of the intensity of pre-test counselling. WHO will be consulting with partners to develop guidance on HIV testing in clinical settings. Particularly lacking at the moment is guidance on the testing of children.
The second major priority is the delivery of prevention in health care settings. In particular, the requirements of people living with HIV and their families for prevention services have gone largely unaddressed. Also, the prevention of HIV transmission from HIV-infected mothers to their children requires more attention. …