COUNTRIES MOST IN NEED OF SCALING UP ARV PROVISION

GFO Issue 94, Article Number: 2

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Article Type: Analysis Author: Bernard Rivers Date: 2008-09-17

ABSTRACT

ABSTRACT An analysis conducted by GFO shows that half of all countries that are eligible to receive Global Fund grants currently provide ARV treatment to less than 25% of those that need it, and/or have at least 25,000 people who need ARV treatment but are not receiving it.

An analysis by GFO of data newly provided at www.GlobalHealthFacts.org (see previous article) shows that 62 of the 126 countries that are eligible to apply to the Global Fund (i.e. 48% of these countries) currently provide ARV treatment to less than 25% of those that need it, and/or have at least 25,000 people who need ARV treatment but are not receiving it.

This suggests that all of these countries, and probably many others, are urgently in need of scaling up treatment through support from the Global Fund or others.

The countries in question are those shown in bold in the following table. Further explanations are provided at the end of the table.

Country (showing all countries eligible for Global Fund HIV grants)	People Living with HIV/AIDS	HIV Prevalence	People needing ARV treatment	People receiving ARV treatment	Of which:		People "needing" treatment minus people "receiving" treatment	Coverage (equals "Receiving" as % of "Needing")
	People Living with HIV/AIDS	HIV Prevalence	People needing ARV treatment	People receiving ARV treatment	People receiving ARV treatment with GF support	People receiving ARV treatment with Pepfar support		Coverage (equals "Receiving" as % of "Needing")

Global	32,900,000	0.8%	9,700,000	2,990,000	1,447,976	1,641,000	6,710,000	31%

Afghanistan	NA	NA	NA	0	0	0	NA	NA
Albania	<1000	<0.2%	NA	<100	0	0	NA	NA
Algeria	21,000	0.1%	4,900	1,000	850	0	3,900	20%
Angola	190,000	2.1%	47,000	12,000	9,263	0	35,000	25%
Argentina	120,000	0.5%	53,000	38,000	0	0	15,000	73%
Armenia	2,400	0.1%	660	<100	59	0	c. 610	12%
Azerbaijan	7,800	0.2%	580	<100	24	0	c. 530	14%
Bangladesh	12,000	<0.1%	2,400	<200	0	0	c. 2,300	7%
Belarus	13,000	0.2%	4,300	900	643	0	3,400	20%
Belize	3,600	2.1%	1,100	600	494	0	500	49%
Benin	64,000	1.2%	20,000	9,800	8,633	0	10,200	49%
Bhutan	<500	0.1%	<100	<100	0	0	<100	NA
Bolivia	8,100	0.2%	2,300	<500	416	0	c. 2,050	22%
Bosnia and Herzegovina	<500	<0.1%	NA	<100	0	0	NA	NA
Botswana	300,000	23.9%	120,000	93,000	0	94,900	27,000	79%
Brazil	730,000	0.6%	230,000	181,000	0	0	49,000	80%
Bulgaria	NA	NA	NA	<500	210	0	NA	NA
Burkina Faso	130,000	1.6%	48,000	17,000	5,237	0	31,000	35%
Burundi	110,000	2.0%	47,000	11,000	8,935	0	36,000	23%
Cambodia	75,000	0.8%	40,000	27,000	23,587	0	13,000	67%
Cameroon	540,000	5.1%	180,000	46,000	28,773	0	134,000	25%
Cape Verde	NA	NA	NA	<500	0	0	NA	NA
Central African Republic	160,000	6.3%	45,000	9,600	4,801	0	35,400	21%
Chad	200,000	3.5%	55,000	7,400	1,430	0	47,600	13%
China	700,000	0.1%	190,000	35,000	28,884	0	155,000	19%
Colombia	170,000	0.6%	54,000	21,000	78	0	33,000	38%
Comoros	<200	<0.1%	<100	<100	5	0	<100	NA
Congo	79,000	3.5%	29,000	5,000	4,066	0	24,000	17%
Congo (DRC)	400,000- 500,000	1.2-1.5%	120,000	29,000	13,064	0	91,000	24%
Cote d'Ivoire	480,000	3.9%	190,000	52,000	46,007	39,700	138,000	28%
Cuba	6,200	0.1%	1,400	3,100	2,581	0	-1,700	>95%
Djibouti	16,000	3.1%	4,500	700	725	0	3,800	16%
Dominica	NA	NA	NA	<100	0	0	NA	NA
Dominican Rep.	62,000	1.1%	22,000	8,200	7,768	0	13,800	38%
Ecuador	26,000	0.3%	7,600	3,200	2,317	0	4,400	42%
Egypt	9,200	<0.1%	2,200	<500	0	0	c. 1,950	9%
El Salvador	35,000	0.8%	11,000	5,800	4,708	0	5,200	51%
Eritrea	38,000	1.3%	10,000	1,300	1,890	0	8,700	13%
Ethiopia	980,000	2.1%	310,000	90,000	81,819	97,100	220,000	29%
Fiji	<500	0.1%	<200	<100	0	0	c. 50	NA
Gabon	49,000	5.9%	15,000	6,400	3,306	0	8,600	42%
Gambia	8,200	0.9%	2,300	<500	385	0	c. 2,050	18%
Georgia	2,700	0.1%	<500	<500	271	0	<500	NA
Ghana	260,000	1.9%	87,000	13,000	10,275	0	74,000	15%
Grenada	NA	NA	NA	<100	0	0	NA	NA
Guatemala	59,000	0.8%	21,000	7,800	2,937	0	13,200	37%
Guinea	87,000	1.6%	21,000	5,700	1,411	0	15,300	27%
Guinea-Bissau	16,000	1.8%	4,400	900	517	0	3,500	20%
Guyana	13,000	2.5%	4,300	2,000	2,054	2,000	2,300	45%
Haiti	120,000	2.2%	36,000	15,000	12,921	15,100	21,000	41%
Honduras	28,000	0.7%	12,000	5,600	5,006	0	6,400	47%
India	2,400,000	0.3%	NA	158,000	100,897	0	NA	NA
Indonesia	270,000	0.2%	43,000	6,600	6,647	0	36,400	15%
Iran	86,000	0.2%	19,000	900	47	0	18,100	5%
Iraq	NA	<0.2%	NA	0	0	0	NA	NA
Jamaica	27,000	1.6%	8,500	3,600	4,000	0	4,900	43%
Jordan	<1000	<0.2%	NA	<100	45	0	NA	NA
Kazakhstan	12,000	0.1%	1,900	<500	342	0	c. 1,650	23%
Kenya	1,500,000- 2,000,000	7.1-8.5	470,000	177,000	166,379	192,100	293,000	38%
Kiribati	NA	NA	NA	<100	0	0	NA	NA
Korea (North)	<100	<0.1%	2,900	NA	0	0	<=2,900	0%
Kyrgyzstan	4,200	0.1%	610	<100	62	0	c. 560	14%
Lao PDR	5,500	0.2%	690	700	0	0	-10	>95%
Lesotho	270,000	23.2%	85,000	22,000	17,728	0	63,000	26%
Liberia	35,000	1.7%	8,500	1,400	1,157	0	7,100	17%
Macedonia	<500	<0.1%	NA	<100	20	0	NA	NA
Madagascar	14,000	0.1%	3,200	<200	163	0	c. 3,100	4%
Malawi	930,000	11.9%	290,000	101,000	79,398	0	189,000	35%
Malaysia	80,000	0.5%	20,000	6,800	0	0	13,200	35%
Maldives	<100	<0.1%	<100	<100	0	0	<100	NA
Mali	100,000	1.5%	30,000	12,000	12,814	0	18,000	41%
Marshall Islands	NA	NA	NA	<100	0	0	NA	NA
Mauritania	14,000	0.8%	3,600	800	531	0	2,800	23%
Mauritius	13,000	1.7%	1,500	<500	0	0	c. 1,250	22%
Mexico	200,000	0.3%	76,000	43,000	0	0	33,000	57%
Micronesia	NA	NA	NA	<100	0	0	NA	NA
Moldova	8,900	0.4%	800	<500	451	0	c. 550	58%
Mongolia	<1000	0.1%	<100	<100	2	0	<100	NA
Morocco	21,000	0.1%	5,300	1,600	1,400	0	3,700	31%
Mozambique	1,500,000	12.5%	370,000	90,000	78,236	88,200	280,000	24%
Myanmar	240,000	0.7%	76,000	11,000	0	0	65,000	15%
Namibia	200,000	15.3%	59,000	52,000	43,694	52,800	7,000	88%
Nepal	70,000	0.5%	20,000	1,400	1,240	0	18,600	7%
Nicaragua	7,700	0.2%	1,700	500	531	0	1,200	30%
Niger	60,000	0.8%	16,000	1,500	1,907	0	14,500	10%
Nigeria	2,600,000	3.1%	750,000	198,000	4,832	162,500	552,000	26%
Pakistan	96,000	0.1%	20,000	600	361	0	19,400	3%
Panama	20,000	1.0%	7,200	4,000	0	0	3,200	56%
Papua New Guinea	54,000	1.5%	5,900	2,300	1,546	0	3,600	38%
Paraguay	21,000	0.6%	4,800	1,100	0	0	3,700	22%
Peru	76,000	0.5%	23,000	11,000	10,610	0	12,000	48%
Philippines	8,300	<0.1%	1,100	<500	170	0	c. 850	31%
Rwanda	150,000	2.8%	68,000	49,000	44,395	52,400	19,000	71%
Saint Lucia	NA	NA	NA	<100	0	0	NA	NA
St. Vincent & Grenadines	NA	NA	NA	<100	0	0	NA	NA
Samoa	NA	NA	NA	<100	0	0	NA	NA
Sao Tome & Principe	NA	NA	NA	<100	0	0	NA	NA
Senegal	67,000	1.0%	12,000	6,700	2,270	0	5,300	56%
Serbia and Montenegro	6,400	0.1%	NA	NA	481	0	NA	NA
Sierra Leone	55,000	1.7%	13,000	2,600	1,623	0	10,400	20%
Solomon Islands	NA	NA	NA	<100	0	0	NA	NA
Somalia	24,000	0.5%	6,300	<500	201	0	c. 6,050	NA
South Africa	5,700,000	18.1%	1,700,000	460,000	115,142	435,100	1,240,000	28%
Sri Lanka	3,800	<0.1%	780	<200	0	0	c. 680	14%
Sudan	320,000	1.4%	87,000	1,200	1,480	0	85,800	1%
Suriname	6,800	2.4%	1,600	700	656	0	900	45%
Swaziland	190,000	26.1%	59,000	25,000	21,670	0	34,000	42%
Syria	NA	<0.2%	NA	<100	0	0	NA	NA
Tajikistan	10,000	0.3%	1,300	<100	94	0	c. 1,250	6%
Tanzania	1,400,000	6.2%	440,000	136,000	96,936	114,200	304,000	31%
Thailand	610,000	1.4%	250,000	153,000	93,839	0	97,000	61%
Timor Leste	NA	NA	NA	0	0	0	NA	NA
Togo	130,000	3.3%	41,000	8,000	3,389	0	33,000	19%
Tonga	NA	NA	NA	NA	0	0	NA	NA
Tunisia	3,700	0.1%	1,000	<500	0	0	c. 750	29%
Turkmenistan	<500	<0.1%	NA	0	0	0	NA	NA
Uganda	940,000	5.4%	350,000	115,000	46,642	131,200	235,000	33%
Ukraine	440,000	1.6%	91,000	7,700	4,060	0	83,300	8%
Uruguay	10,000	0.6%	3,100	1,800	0	0	1,300	56%
Uzbekistan	16,000	0.1%	1,400	<500	277	0	c. 1,150	24%
Vanuatu	NA	NA	NA	<100	0	0	NA	NA
Viet Nam	290,000	0.5%	67,000	17,000	2,927	11,800	50,000	26%
W. Bank & Gaza	NA	NA	NA	NA	0	0	NA	NA
Yemen	NA	<0.2%	NA	<200	0	0	NA	NA
Zambia	1,100,000	15.2%	330,000	151,000	122,684	151,900	179,000	46%
Zimbabwe	1,300,000	15.3%	570,000	98,000	8,634	0	472,000	17%

Technical notes:

Further details regarding the columns are:
- Country: All countries that were eligible to apply for Global Fund HIV grants in Round 8.
- People Living with HIV/AIDS:Adults and children living with HIV/AIDS, 2007.
- HIV Prevalence: Percentage of adults who had HIV/AIDS in 2007.
- People needing ARV Treatment: Estimated number of people needing ARV treatment, 2007. (Note: ARV treatment is usually not needed until several years after infection with HIV.)
- People receiving ARV Treatment:Estimated number of people receiving ARV treatment, December 2007.
- People receiving ARV treatment with GF support: People receiving ARV treatment from programmes supported by the Global Fund, as of 1 Dec. 2007. (Original source: www.theglobalfund.org/en/files/publications/factsheets/aids/ARV_Factsheet_2007.pdf.)
- People receiving ARV treatment with Pepfar support: Number of people receiving ARV treatment from programmes supported by Pepfar, as of 31 March 2008.
- People "needing" treatment minus people "receiving" treatment: The difference between "people needing ARV Treatment" and "people receiving ARV Treatment".
- Coverage: Those "receiving" as a percentage of those "needing", December 2007.
- The number in the GF column or in the Pepfar column sometimes exceeds the total number shown for people nationwide treatment, because of data being gathered at different points during 2007.
Countries are shown in bold in cases where Coverage is less than 25%, and/or where people "needing" treatment minus people "receiving" treatment is greater than 25,000 people.
It should be noted that the people shown as needing but not yet receiving treatment will not be known to themselves or to anyone else if they have not been tested and are not yet symptomatic. And even if such people are known, the country may need to invest in health systems before such treatment can be provided.
All data were obtained in August 2008 from www.GlobalHealthFacts.org, a website created by the Kaiser Family Foundation. Data provided at this site are primarily obtained from the Global Fund, UN agencies, Pepfar and other international entities, rather than from individual implementing countries, and therefore do not always represent the most recent data available at the country level.
A more detailed spreadsheet-based version of this analysis, compiled by Aidspan in the course of writing this article, is available at www.aidspan.org/documents/other/Aidspan-ARV-numbers-analysis.xls.
In countries where the Global Fund (or Pepfar) provides substantial support on a national scale for things like clinics, testing facilities, and distribution and logistics systems, the Fund (or Pepfar, as the case may be) sometimes publishes numbers (reproduced in the relevant columns of the above table) stating that all people in the country who are receiving treatment are doing so with GF/Pepfar support. Thus, for most countries, the numbers in these two columns overlap substantially if not entirely. (This point is discussed further in the Commentary, below.)

Publication Date: 2008-09-17

COUNTRIES MOST IN NEED OF SCALING UP ARV PROVISION

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