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全球爱滋病病毒应对工作取得空前进展 持续投放资源仍至关重要

2011-11-30

globalhivaidsresponse2011
日内瓦/香港,2011年11月30日——在预防和治疗爱滋病病毒方面取得的全球进展,凸显了在爱滋病病毒/爱滋病领域长期持续投放资源的好处。世界衞生组织、联合国儿童基金会和联合国爱滋病规划署最新发表的《全球爱滋病病毒/爱滋病应对报告》表明,扩大爱滋病病毒服务,令过去10年间的新增感染病例下降了15%,而过去5年间的爱滋病相关死亡亦下降了22%。

世衞组织爱滋病病毒/爱滋病司司长Gottfried Hirnschall说:「全世界用了10年时间才实现这项进展。现在人类真正有可能减慢疾病发展趋势,但要做到这一点,就必须在今后10年及以后,保持並加快应对工作。」
去年爱滋病病毒科学和规划创新方面的进展,给未来的进步增加了希望。在经济紧缩的年代,各国迅速应用提高爱滋病病毒规划效率和有效性的新科技和新方法至关重要。

报告提出了正在发挥作用的措施重点:

[RELEASE OBTAINED] Natasha Chisenga Simpasa, holding her six-week-old daughter, Mutale, listens as a health worker explains proper dosing of Mutales prophylactic antibiotics during a consultation at the Chelstone Clinic in Lusaka, the capital. Ms. Simpasa is HIV-positive. She participated in the clinics PMTCT programme for her sons, 20-month-old Fanwick and four-year-old Masonda, both of whom are HIV-negative. She is now participating in PMTCT for Mutale. Mutale has just received her first HIV test, but the results will not be known for several weeks. [#8 IN SEQUENCE OF NINE] In October 2010 in Zambia, the Chelstone Clinic in Lusaka continues to provide vital programmes to treat HIV-positive pregnant women and to prevent mother-to-child transmission of HIV (PMTCT). Some 95,000 Zambian children under age five are infected with HIV; the vast majority contracted the illness from an HIV-positive mother during pregnancy, delivery or eastfeeding. PMTCT programmes include HIV testing during pregnancy, antiretroviral (ARV) regimens for sick HIV-positive pregnant women, and early diagnosis and treatment for infants exposed to HIV in utero. Participating infants receive prophylactic antibiotics and ARVs in the weeks after they are born, and are administered HIV tests at six weeks. If eastfed by an HIV-positive mother, infants continue to receive prophylactics and are tested again at 12 months and 18 months (and three months after eastfeeding ceases or at any age if they fall ill). HIV-positive infants diagnosed and treated within the first 12 weeks of life are 75 per cent less likely to die from the disease. Zambia has recently made great strides in expanding PMTCT programmes. In the second quarter of 2009, ARVs were administered to approximately half of all children in need and to some 57 per cent of HIV-positive pregnant women. However, many infants still do not receive PMTCT services because their caretakers lack access to properly equipped facilities, or fear the stigma associated with HIV, or find it difficult to adhere to the structured course of required tests and services.

• 改进爱滋病病毒检测服务,东部和南部非洲孕妇接受爱滋病病毒检测和谘询的比率,由2005年的14%大大提高至61%。

• 2010年,近一半(48%)有需要的孕妇得到预防爱滋病病毒母婴传播的有效药物。

• 抗逆转录病毒治疗不仅能够改善被感染者的健康和福祉,而且能够阻断爱滋病病毒的进一步传播。现在低收入和中等收入国家有665万人能够获得抗逆转录病毒治疗,佔符合接受治疗条件的1,420万人的47%。

报告指出,到2020年,在爱滋病病毒服务方面的投资可能带来高达港币2,652亿元(约340亿美元)的经济活动和生产率增量,大大超过抗逆转录病毒治疗规划的费用。

联合国爱滋病规划署副执行主任保罗•德莱表示:「2011年是形势逆转的一年。有了新的科学、前所未有的政治领导力和在爱滋病应对方面取得的持续进展,各国有机会抓住当前的进展,将他们的应对工作提高到新水准。各国可以通过明智投资提高效率、降低成本並改进结果。但是,若减少投放资源于爱滋病工作,迄今为止所取得的成就,仍有可能丧失。」

报告还指出了需要继续进行的工作:

[RELEASE OBTAINED] Patients wait outside the Samfya Stage 2 Clinic, in the rural town of Samfya, in Samfya District. The clinic provides PMTCT services as well as other child and maternal health services. In October 2010 in Zambia, clinics in both urban and rural areas are providing vital programmes to treat HIV-positive pregnant women and to prevent mother-to-child transmission of HIV (PMTCT). PMTCT programmes include HIV testing during pregnancy, antiretroviral (ARV) regimens for sick HIV-positive pregnant women, and early diagnosis and treatment for infants exposed to HIV in utero. These infants receive prophylactic antibiotics and ARVs in the weeks after they are born and are administered HIV tests at six weeks. If eastfed by an HIV-positive mother, infants continue to receive prophylactics and are tested again at 12 months and 18 months (and three months after eastfeeding ceases or at any age if they fall ill). HIV-positive infants diagnosed and treated within the first 12 weeks of life are 75 per cent less likely to die from the disease. However, many infants do not receive PMTCT services because their caregivers lack access to properly equipped facilities or fear the stigma associated with HIV. Zambia has recently made great strides in expanding PMTCT programmes. In the second quarter of 2009, ARVs were administered to approximately half of all children in need and to some 57 per cent of HIV-positive pregnant women. But for PMTCT measures to be effective, infants must adhere to a long-term, structured course of tests and services. Access to PMTCT services is particularly difficult in rural areas, where poverty rates are higher and many remote communities have limited access to health clinics. UNICEF supports the expansion of these services into rural areas, including Samfya District in Luapula Province. The province has the highest child-mortality rates in the country, and Samfyas clinics face critical staff and supply shortages. However, rural areas also tend to have lower HIV infection rates, as well as greater willingness on the part of fathers to participate in PMTCT services.
• 低收入和中等收入国家仍有超过一半需要抗逆转录病毒治疗的人无法获得治疗。当中许多人甚至还不知道自己感染了爱滋病病毒。

• 虽然有越来越多的证据表明各国应该关注哪些领域才能产生实效,但仍有一些国家的相关工作未能针对风险最大、最有需要的人群。在很多情况下,少女、注射吸毒者、男男性行为者、跨性別人群、性工作者、囚犯和流动人口等群体,仍无法获得爱滋病病毒预防和治疗服务。

现时,全世界15至24岁爱滋病病毒感染者大部分(64%)是女性。这一比例在撒哈拉以南非洲还更高,当地少女和年轻妇女佔所有爱滋病病毒感染年轻人的71%,主要是由于预防措施还沒有延伸到他们。

关键人群继续被边缘化。在东欧和中亚,60%以上爱滋病病毒感染者是注射吸毒者。但注射吸毒者仅佔接受抗逆转录病毒治疗者的22%。

虽然在阻止爱滋病病毒母婴传播方面,更好的服务已经成功地避免了35万例新增儿童感染,但仍有340万儿童感染爱滋病病毒,其中许多人缺乏爱滋病病毒治疗。2010年,在低收入和中等收入国家,每4名需要爱滋病病毒治疗的儿童中,只有1人获得治疗。与此相比,每2名需要治疗的成人就有1名得到治疗。

联合国儿童基金会驻日内瓦办事处主任莱拉.帕卡拉说:「虽然在成人可获得的治疗、保健和支持方面取得了进展,我们注意到在儿童方面进展缓慢。儿童爱滋病病毒干预措施的覆盖率仍然非常低。我们必须通过共同行动和公平的战略,确保全球努力不仅考虑到成人,也考虑到儿童。」

[RELEASE OBTAINED] Two-year-old Bright smiles at his aunt Leontina Chalikosa (formerly Mwewa), in Mulebambushi Village, Samfya District. Brights mother, Yvonne, died of AIDS the previous year, and Leontina is now his primary caretaker. PMTCT services were not available when Yvonne was pregnant with Bright, and she did not learn she was HIV-positive until after his birth. Bright became ill around the time his mother died; soon after, he tested positive for HIV. As part of paediatric services at the nearby Chimembe Clinic, Bright is receiving ARVs and his health has improved, though he is currently sick with malaria. [#1 IN SEQUENCE OF FIVE] In October 2010 in Zambia, clinics in both urban and rural areas are providing vital programmes to treat HIV-positive pregnant women and to prevent mother-to-child transmission of HIV (PMTCT). PMTCT programmes include HIV testing during pregnancy, antiretroviral (ARV) regimens for sick HIV-positive pregnant women, and early diagnosis and treatment for infants exposed to HIV in utero. These infants receive prophylactic antibiotics and ARVs in the weeks after they are born and are administered HIV tests at six weeks. If eastfed by an HIV-positive mother, infants continue to receive prophylactics and are tested again at 12 months and 18 months (and three months after eastfeeding ceases or at any age if they fall ill). HIV-positive infants diagnosed and treated within the first 12 weeks of life are 75 per cent less likely to die from the disease. However, many infants do not receive PMTCT services because their caregivers lack access to properly equipped facilities or fear the stigma associated with HIV. Zambia has recently made great strides in expanding PMTCT programmes. In the second quarter of 2009, ARVs were administered to approximately half of all children in need and to some 57 per cent of HIV-positive pregnant women. But for PMTCT measures to be effective, infants must adhere to a long-term, structured course of tests and services. Access to PMTCT services is particularly difficult in rural areas, where poverty rates are higher and many remote communities have limited access to health clinics. UNICEF supports the expansion of these services into rural areas, including Samfya District in Luapula Province. The province has the highest child-mortality rates in the country, and Samfyas clinics face critical staff and supply shortages. However, rural areas also tend to have lower HIV infection rates, as well as greater willingness on the part of fathers to participate in PMTCT services.
On 1 December 2005 in southern Sudan, children wearing 'Unite for Children, Unite Against AIDS' T-shirts attend a local launching of the global campaign of the same name in Juba, the capital of Bahr el Jebel State. The global campaign launch was held at United Nations Headquarters and in several world capitals on 25 October. Worldwide, 15 million children have lost one or both parents to AIDS. Every day, nearly 1,800 children under 15 become HIV-positive and 1,400 die from AIDS-related illness. More than 6,000 young people aged 15-24 acquire the virus daily. Yet children are missing from the global HIV/AIDS agenda.
各区域和国家的爱滋病病毒情况

2010年,世界各地爱滋病病毒流行情况和地区上的应对工作各有不同,相关趋势、进展率和结果也发生了变化。

撒哈拉以南非洲地区获得抗逆转录病毒治疗的人数增加30%,是增幅最多的一年。博茨瓦纳、纳米比亚和卢旺达3国已经实现爱滋病病毒预防、治疗和保健服务的普遍覆盖(80%)。2010年底,该地区抗逆转录病毒治疗覆盖率达39%。近半感染爱滋病病毒的孕妇接受预防病毒母婴传播的治疗。21%有需要的儿童能够获得儿科爱滋病病毒治疗。该地区新增感染病例为190万,感染者人数为2,290万。该地区不同地方的进展情况差別巨大。在抗逆转录病毒治疗和预防母婴传播覆盖率方面,东部(56%)和南部(64%)非洲国家显着高于西部(30%)和中部(18%)非洲国家。

亚洲总体流行情况趋于稳定,但有些社区新增感染数量很高。亚洲480万爱滋病病毒感染者中,接近一半(49%)生活在印度。抗逆转录病毒治疗覆盖率正在增加,需要爱滋病病毒治疗的成人和儿童有39%获得了治疗。预防母婴传播服务的覆盖率相对较低(16%)。

东欧和中亚爱滋病病毒急剧增长,过去10年间新增感染增加了25%。新增感染90%以上发生在俄罗斯和乌克兰两国。该地区预防母婴传播和儿科爱滋病病毒治疗覆盖率高(分別是78%和65%)。但是,抗逆转录病毒治疗覆盖率只有23%,特別是最受影响的人群——注射吸毒者——的治疗覆盖率很低。

中东和北非地区2010年爱滋病病毒感染者人数达到最高(59,000人),比前1年增加了36%。爱滋病病毒服务覆盖率非常低:抗逆转录病毒治疗覆盖率为10%,儿科治疗覆盖率为5%,预防母婴传播覆盖率为4%。

拉丁美洲和加勒比地区总体流行情况趋于稳定,拉美有150万爱滋病病毒感染者,加勒比地区是20万。在拉丁美洲,爱滋病病毒主要存在于男男性行为者中。但在加勒比地区,妇女是最受影响的人群,佔爱滋病病毒感染者的53%。该地区成人抗逆转录病毒治疗覆盖率是63%,儿童覆盖率是39%。有效预防母婴传播治疗方案的覆盖率较高,为74%。

A doctor takes a blood sample from a patient at a UNICEF-supported detoxification centre in the city of Sfax, capital of Sfax Governorate. In March-April 2011 in Tunisia, children and adolescents continue to be affected by the political changes in several countries in the Middle East and North Africa Region. Protests began in Tunisia in December 2010, leading to a change in government one month later. Political reforms are underway, though changes to address persistent hardships such as unemployment will take many months. Populist demonstrations have also affected nearby countries, with civilians protesting high food prices and unemployment rates, and demanding political change. Adolescents are participating in many of these protests, demanding that their views be considered as well. In neighbouring Libya, protests have resulted in armed conflict, and by early April, some 228,000 people had fled from Libya to Tunisia to escape the violence. Tunisian children and adolescents continue to be affected by both the revolution in their own country and by the displacement crisis on the Libyan border. Lingering insecurity is also affecting Tunisian schools, with schools reporting looting, vandalism or armed attacks in seven out of 23 regions.
On 24 May, schoolchildren sing a song during the visit of UNICEF Executive Director Ann M. Veneman to Dvumbe Primary School, in a rural area south-east of Mbabane, capital of Swaziland. Some 30 per cent of children at the school have lost either one or both of their parents to AIDS. To help encourage orphaned and other vulnerable children to stay in school, UNICEF supported the creation of a vegetable garden at the school as well as a programme providing two nutritious meals a day. The meal programme is now being provided by the World Food Programme. From 22 to 28 May 2005, UNICEF Executive Director Ann M. Veneman travelled to South Africa, Swaziland and Malawi to review the impact of HIV/AIDS on children, as well as UNICEF programmes. All three countries are highly affected by the pandemic, in a region that has the largest number of children in the world affected by HIV/AIDS and the highest percentage of children orphaned by AIDS. Swaziland and Malawi face the 'triple threat' of food insecurity, weakened governance and HIV/AIDS. During her trip, Ms. Veneman met with government officials, donor agencies and other UNICEF partners and visited hospitals and other health facilities, including sites providing services to prevent mother-to-child transmission of HIV; community outreach centres; schools; nutrition programmes; and a child-headed household. She also joined United Nations Special Envoy for Humanitarian Needs in Southern Africa James Morris (who is also World Food Programme Executive Director) and UNAIDS Executive Director Dr. Peter Piot to review joint UN programmes and resource needs to address these issues. This was Ms. Veneman's first official field visit as UNICEF Executive Director.
今后10年继续坚持应对爱滋病病毒
• 各国爱滋病病毒规划带来的效益优势已十分明显:南非实施了一项新的采购招标策略,在两年之内将爱滋病病毒药物费用减少了一半以上。乌干达转向使用更简单的儿科治疗方案,节省了港币1,560万元(约200万美元)。实现这些效益是因为2010年世衞组织和联合国爱滋病规划署推出了「治疗2.0」倡议,促进更简单、更便宜、更易于提供的爱滋病病毒治疗和诊断工具,同时由社区对分散的服务提供支援。

• 世衞组织、联合国爱滋病规划署和联合国儿童基金会提出「消除倡议」,旨在到2015年消除新增儿童爱滋病病毒感染並确保其母亲的生存。

• 世衞组织正在就战略性使用抗逆转录病毒药物预防和治疗爱滋病制定新的指导档。

• 世衞组织「2011至2015年全球衞生部门爱滋病病毒/爱滋病战略」2011年5月获得世界衞生大会支持,该战略强调继续努力优化爱滋病病毒治疗和联合预防——使用各种不同方法降低人们感染风险——的重要性。

2011年《全球爱滋病病毒/爱滋病应对报告》全面报告了全球、各地区和国家的流行病学情况和获得爱滋病病毒服务方面的进展情况。该报告由世衞组织、联合国儿童基金会和联合国爱滋病规划署经与各国和国际伙伴合作共同撰写。