(September 2006) Beginning with the Declaration of Commitment on HIV/AIDS issued by the United Nations General Assembly in 2001—the first worldwide pledge to address the epidemic—international commitment to the fight against AIDS has been growing.

In June of this year, the General Assembly made a new commitment to scale up toward the goal of universal access for HIV prevention, treatment, care, and support by 2010. The 2006 declaration commits UN member states to scale up their national responses to HIV and AIDS, with the involvement of affected communities, vulnerable groups, the private sector, and people living with HIV.1

At the XVI International AIDS Conference in Toronto this past August, the need to scale up HIV programs received additional support and attention. Over 26,000 participants—scientists, clinicians, activists, caregivers, policymakers, community leaders, and people living with HIV—from more than 170 countries called for an accelerated response.

Twenty-five years into the epidemic, HIV prevention, treatment, and care are still inadequate, particularly in low- and middle-income countries:

  • Only 9 percent of HIV positive pregnant women receive antiretroviral drugs to prevent mother-to-child-transmission.
  • Less than 20 percent of injecting drug users received any type of HIV prevention services in 2005.
  • Only one in every five people living with HIV has access to antiretroviral drugs.
  • In sub-Saharan Africa, less than 10 percent of the 12 million children orphaned by AIDS receive basic support services.2

HIV services for those most in need are desperately lacking, and meeting the needs of affected communities will require a comprehensive response that addresses both prevention and treatment.

Scaling up for universal access by 2010 is an ambitious goal, one that requires AIDS programs to be equitable, accessible, affordable, comprehensive, and sustainable. In their efforts to achieve universal access, countries face a host of challenges. Given the uncertainty of funding, governments continue to encounter difficulties in sustaining programs—a problem further exacerbated by a deficit of health care staff. Stigma and discrimination continue to impede prevention and treatment efforts. Additionally, the epidemic has affected a wide swath of society in many countries, making this ambitious goal particularly difficult to meet because programs must be tailored to diverse local situations.3

To overcome these and many other challenges, the 2006 commitment calls for governments and civil society to work together at the country level to set measurable targets for 2010 as well as maintain monitoring and evaluation systems to help meet the new targets. The declaration provides the global framework and collective political will, but these commitments will need to be translated into action at the country level.4

Throughout the Toronto conference, the importance of prevention was emphasized: Universal access to treatment will only by possible if the rate of new infections is reduced dramatically. The arduous task of implementation lies ahead as conference participants return home hoping to help expand access to antiretroviral drugs and scale up prevention.

Marya Khan is a research associate at the Population Reference Bureau.


  1. UNAIDS, Scaling Up Access to HIV Prevention, Treatment, Care and Support: The Next Steps (Geneva: UNAIDS, 2006).
  2. UNAIDS, 2006 Report on the Global AIDS Epidemic (Geneva: UNAIDS, 2006).
  3. United Nations General Assembly, Scaling Up HIV Prevention, Treatment, Care and Support (Geneva: UNAIDS, 2006).
  4. UNAIDS, Scaling Up Access.