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[英汉]世卫组织报告说撒哈拉以南非洲100多万人已获得对艾滋病毒

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世卫组织艾滋病毒/艾滋病司司长Kevin De Cock博士概述实现全面普及艾滋病治疗方面的进展和障碍

2006年8月16日 | 多伦多 -- 世卫组织艾滋病毒/艾滋病司司长Kevin De Cock博士今天在第十六届国际艾滋病会议第一届全会上讲话时报告说，撒哈拉以南非洲获得艾滋病毒抗逆转录病毒治疗的人数首次超过100万，致使自2003年12月以来该区域治疗的获得增加了10倍。

在低等和中等收入国家，2006年6月底接受抗逆转录病毒治疗的人数刚刚超过160万，比2005年12月获得该药物的130万人增加了24%，是2003年12月这些国家中接受治疗的40万人的4倍。艾滋病毒/艾滋病患者的95%目前生活在发展中世界。

尽管世卫组织和联合国艾滋病规划署报告全世界若干地区在获得治疗方面有了显著进展，但是De Cock博士强调说，为实现八国集团和联合国通过的到2010年尽可能全面普及艾滋病毒预防规划、治疗、护理和支持的目标尚需做大量工作。De Cock博士在今天的讲话中阐述了世卫组织继续扩大艾滋病毒治疗的抱负，要求采取新行动克服障碍，如果不解决这些障碍，将放慢今后扩大艾滋病毒治疗的速度。

De Cock博士评论说：“捐助者、受影响国家、联合国机构和公共卫生当局正在共同努力，大幅度和不断地增加提供拯救生命的艾滋病毒治疗。然而，在很多方面我们仍处于这项努力的初始阶段。我们只向低等和中等收入国家四分之一的有所需求者提供了治疗，而需要获得治疗的人数将不断增长。我们必须加快努力，克服在提供治疗方面的障碍。”

在全球总计为3860万艾滋病患者中，大约有680万生活在低等和中等收入国家，他们当前就需要抗逆转录病毒治疗。这意味着到2006年6月底时，全球有所需求者中的大约24%正在接受抗逆转录病毒治疗。这一覆盖率根据区域有所差异，从北非和中东的5%，东欧和中亚的13%直至拉丁美洲和加勒比的75%。

如今在低等和中等收入国家中接受抗逆转录病毒治疗的患者中有63%是非洲人，而2003年末时这一比例为25%。尽管撒哈拉以南非洲获得治疗的人数最多，而且占需要治疗者治疗覆盖率的第二位，但该区域仍占全球未满足治疗需求率的70%。

除了各国自己的开支之外，通过美国总统防治艾滋病紧急救援计划、抗艾滋病、结核和疟疾全球基金、世界银行、其它双边捐助机构以及通过制药公司诸如加快介入倡议等捐助对治疗的强化工作进行资助。一般来说，从这些行动中获得特殊援助的国家在这方面取得了最大的进展。

加强公平获得
谈到努力确保所有需求者公平获得治疗的问题，De Cock博士报告说，目前没有数据表明在治疗获得方面对妇女有任何系统的偏见，妇女接受抗逆转录病毒治疗的比例几乎相当于，在一些情况下超过受染病人的比例。

De Cock博士说，然而，其它方面的不公平现象很明显。尽管估计有80万15岁以下的儿童需要获得抗逆转录病毒治疗，但是获得治疗的儿童估计仅为6万至10万。全球死于与艾滋病毒相关疾病的7个人中有一个是15岁以下的儿童，这主要是由于不能强化预防母婴传播艾滋病毒规划以及预防少女感染艾滋病毒所致。

尽管诸如巴西、泰国和博茨瓦纳本国在这方面取得了进展，但是全球艾滋病毒阳性孕妇中目前仅约6%为预防出生婴儿被染艾滋病毒而受益于抗逆转录病毒预防措施。与此形成鲜明对照的是，工业化国家已完全消灭了儿科艾滋病毒疾病。

通过注射毒品感染艾滋病毒的患者也不能公平获得治疗。在东欧和中亚，注射吸毒者（大多数为男性）占艾滋病毒受染人群的70%以上，但是仅有四分之一的人获得治疗。

De Cock博士敦促与会代表在评估治疗工作时不仅要依据接受治疗护理的病人数字，而且要以治疗结果的质量为基础。提到发展中国家的大多数病人在患病晚期参与治疗规划的问题时，他强调改进治疗结果既需要对艾滋病毒的诊断也需要及早开始治疗。

De Cock博士说：“与欧洲人和北美人相比，资源匮乏国家的艾滋病毒感染国民在治疗一年之后的死亡率要高出三倍半的这一事实是不容接受的，我们必须承诺改变这一状况。这些重点并不是全新的内容，但是为拯救人类生命，它们确实需要改变承担的任务。”

为实现全面普及治疗而努力
展望未来，De Cock博士概述了五项战略方向，每一方向均代表着如果各国要在实现全面普及方面取得进展，其卫生部门则必须加以领导的重点领域，而世卫组织也将根据这些重点提供技术援助。五个方向如下：

扩大艾滋病毒的检测和咨询；
在卫生保健机构中尽量扩大预防机会；
增加对治疗和护理的获得；
加强卫生系统；以及
对战略信息进行投资。
在强调预防、治疗和护理息息相关的同时，De Cock博士呼吁在艾滋病毒传播最严重的地区应着力强调预防工作。他还强调在确定预防干预措施的有效性时必须以科学为指导。

回顾在迅速加强获得艾滋病毒治疗的“三五”工作方面取得的经验教训时，De Cock博士提及卫生系统的脆弱性 - 包括人力资源、基础结构、实验室能力、采购和供应系统以及财政管理方面，它们是广泛提供艾滋病毒服务的主要障碍，并呼吁在全球政治重点中提高加强卫生系统的地位。De Cock也提到战略信息的可靠性和可得性，包括流行病学和监测、检查与评价以及业务研究，它们是监测实现全面普及方面进展的基础。

提到撒哈拉以南非洲仅约有10%的艾滋病毒携带者了解他们的艾滋病毒状况时，De Cock博士补充说，世卫组织正与联合国艾滋病规划署合作，评估各国如何能够实施艾滋病毒检测和咨询。正在开展一项磋商以制定业务指南，帮助各国在卫生保健机构中扩大获得由提供者发起的检测和咨询，目的是增加治疗和预防，特别是在此病高度流行的国家中。这些指南将于今年晚些时候发表。

如欲获取更多信息，请联系：

多伦多：
Anne Winter
世卫组织
电话： +41 79 440 6011
电子邮件：wintera@who.int

Cathy Bartley
世卫组织
电话： +44 7958 561 671
电子邮件：cathy.bartley@ukonline.co.uk

日内瓦：
Iqbal Nandra
世卫组织
电话： +41 22 791 5589
手机： +41 79 509 062
电子邮件： wintera@who.int

Tunga Namjilsuren
世卫组织
电话： +44 22 791 1073
电子邮件：namjilsurent@who.int

英文版：
WHO HIV/AIDS Director Dr Kevin De Cock Outlines Progress and Obstacles to Achieving Universal Access to AIDS Treatment

16 AUGUST 2006 | TORONTO -- Addressing a plenary session of the XVI International AIDS Conference here today, WHO HIV/AIDS Director Dr Kevin De Cock reported that the number of people receiving HIV antiretroviral therapy in sub-Saharan Africa has surpassed 1 million for the first time, a ten-fold increase in treatment access in the region since December 2003.

In low- and middle-income countries, just over 1.6 million persons were receiving antiretroviral therapy at the end of June 2006, a 24 percent increase over the 1.3 million who had access to the drugs in December 2005, and four times the 400,000 people receiving treatment in these countries in December 2003. Ninety-five percent of people living with HIV/AIDS today live in the developing world.

While WHO and UNAIDS reported significant increases in treatment access in several regions of the world, Dr De Cock emphasized that there is considerable work ahead to reach the G-8 and UN-endorsed goal of providing as close as possible to universal access to HIV prevention programmes, treatment, care and support by 2010. In his remarks today, Dr De Cock also laid out WHO’s vision for continuing to expand HIV treatment access, calling for new action to overcome barriers that, if unaddressed, will slow the rate of expansion in access to HIV treatment in the future.

“The combined efforts of donors, affected nations, UN agencies and public health authorities are providing substantial, ongoing increases in access to lifesaving HIV treatment,” commented Dr De Cock. “Yet, in many ways we are still at the beginning of this effort. We have reached just one-quarter of the people in need in low and middle-income countries, and the number of those who need treatment will continue to grow. Our efforts to overcome the obstacles to treatment access must grow even faster.”

Of the 38.6 million persons living with HIV globally, approximately 6.8 million people living in low- and middle-income countries require antiretroviral therapy now. This means that about 24 percent of people in need worldwide were receiving antiretroviral therapy by end-June 2006. Coverage by region varied, from five percent in North Africa and the Middle East and 13 percent in Eastern Europe and Central Asia to 75 per cent in Latin America and the Caribbean.

Sixty-three percent of persons on antiretroviral therapy in low- and middle-income countries today are African, compared with 25 percent in late 2003. Although sub-Saharan Africa has the greatest number of people on treatment, and the second-highest rate of treatment coverage among those who need it, the region still accounts for 70 percent of the global unmet treatment need.

In addition to expenditures by countries themselves, treatment scale-up has been funded through the U.S. President's Emergency Plan for AIDS Relief; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the World Bank; other bilateral donors, and pharmaceutical companies through contributions such as the Accelerating Access Initiative. In general, progress has been greatest in countries receiving specific assistance from these initiatives.

Increasing Equitable Access
Speaking on efforts to ensure equitable access to treatment among all people who need it, Dr De Cock reported that current data do not indicate any systematic bias against women in treatment access, with the proportion of female ART recipients corresponding closely to, and in some cases exceeding, the proportion of people infected.

However, other inequities are clear. While an estimated 800,000 children below the age of 15 require antiretroviral therapy, only about 60,000 to 100,000 are estimated to be receiving it. One in 7 people dying of HIV-related illness worldwide is a child under 15 years of age, a fact that is largely due to the failure to scale up programmes for the prevention of mother-to-child transmission of HIV and to prevent HIV infection in young women, noted Dr De Cock.

Despite the successes of such countries as Brazil, Thailand, and Botswana, only about six percent of HIV-positive pregnant women globally are currently benefiting from antiretroviral prophylaxis to help prevent HIV transmission in childbirth. In contrast, pediatric HIV disease has been virtually eliminated in the industrialized world.

People who contracted HIV through injecting drug use are also not receiving equitable access to treatment. In Eastern Europe and Central Asia, injecting drug users, a majority of them men, account for over 70 per cent of HIV-infected persons, but only about a quarter of treatment recipients.

Dr De Cock encouraged delegates at the meeting to evaluate treatment efforts not only based on the number of patients receiving care, but on the quality of treatment outcomes as well. Noting that most patients in developing country treatment programmes present with late-stage disease, he emphasized that improving treatment outcomes will require both diagnosing HIV and starting treatment earlier.

“A three-and-a half times higher death rate after one year of therapy in HIV-infected citizens of resource-poor countries compared with Europeans and North Americans should not be viewed as acceptable, and we must commit to change it,” said Dr De Cock. “These priorities are not radical new insights but they do require altered commitment to saving human life.”

Moving Towards Universal Access
Looking forward, Dr De Cock outlined five strategic directions, each of which represents a critical area where the health sector must lead if countries are to make progress towards achieving universal access, and on which WHO will focus its technical assistance. These include:

expanding HIV testing and counselling;
maximizing prevention opportunities in health care settings;
increasing access to treatment and care;
strengthening health systems; and
investing in strategic information.
While stressing that prevention, treatment and care are inextricably linked, De Cock called for an increased emphasis on prevention efforts where HIV transmission is most intense. He also emphasized the need to be guided by science

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