The delegation welcomes the announcement of the new WHO guidelines.
Given the changing landscape of the response, and in a context of diminished funding, the delegation strongly recommends that an in-depth analysis of the potential implications of the guidelines is conducted – including recommendations to address them.
Whilst recognizing the progress made we should not however lose sight of the fact that the job is far from over. MDG6 has not been achieved universally, there are still huge numbers of people eligible for treatment who are not on ARV’s, even without taking into account the new WHO guidelines. Notwithstanding progress made in some countries there are still globally currently more new infections than new people on treatment. Affordable access to diagnostics and second and third line treatments remains problematic in many middle income and low-income countries. Uptake of voluntary testing is disappointingly low.
We fully agree that undetectable viral loads are a better quality indicator to measure progress in treating people living with HIV and strongly support the inclusion of this indicator. Such a move however, clearly highlights the urgent need to significantly scale up investment in HIV and AIDS responses.
We fully support the Executive Director’s endorsement of the shift from high cost medical service delivery to community-based primary care systems. We need to be vigilant however, that this drive for increased effectiveness and scale-up of prevention, treatment, care and support is not reduced as a simple measure to achieve cost-efficiencies and to maintain the ‘status quo’.
In recognizing the welcome increased domestic investment in the last reporting period the delegation also notes that 90% of resources for key affected populations are still from external sources.
This is exacerbated by many international donors exiting low prevalence especially middle income countries where epidemics are concentrated in most at risk populations: People who use drugs; men who have sex with men; sex workers; transgender people; migrants, and refugees. Consequently, as already mentioned by Germany, Switzerland and Australia, we see fast growing epidemics in Eastern Europe and Central Asia, and in North Africa and the Middle East. At the same time, in Latin America there are some cases where governments have not stepped up to fill the gap left by international donors.
Our celebration of progress made must be tempered by the enormity of the job still in front of us.