The Progress report 2011: Global HIV/AIDS response reviews progress made until the end of 2010 in scaling up access to health sector interventions for HIV prevention, treatment, care and support in low–and middle-income countries.

It is the fifth in a series of annual progress reports published since 2006 by WHO, UNICEF and UNAIDS, in collaboration with national and international partners, to monitor key components of the health sector response to the HIV epidemic.

The key findings of the report: update on the HIV epidemic; selected health sector interventions for HIV prevention; knowledge of HIV status, scaling up treatment and care for people living with HIV; scaling up services for key populations at higher risk of HIV infection; scaling up HIV services for women and children; towards elimination of mother to child transmission and improving maternal and child health in the context of HIV.

Introduction
This documents the extraordinary progress achieved over the past decade in the health sector response to HIV. Access to evidence-informed HIV prevention, testing and counselling, treatment and care services in low- and middle-income countries has expanded dramatically. This progress demonstrates how countries can surmount seemingly intractable health and development challenges through commitment, investment and collective action.

The global incidence of HIV infection has stabilized and begun to decline in many countries with generalized epidemics. The number of people receiving antiretroviral therapy continues to increase, with 6.65 million people getting treatment at the end of 2010. Almost 50% of pregnant women living with HIV received effective antiretroviral regimens to prevent mother-to-child transmission, spurring the international community to launch the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. What would have been viewed as wildly unrealistic only a few years ago is now a very real possibility.

Recent published evidence from clinical trials has confirmed the powerful impact antiretroviral drugs have on the epidemic as part of an effective package of options for HIV prevention. For the first time, the prospect of a microbicide that contains antiretroviral medicine is providing additional hope to the women in sub-Saharan Africa who continue to bear a disproportionate burden of the HIV epidemic in this region.

Despite these advances, still too many people are acquiring HIV infection, too many people are getting sick and too many people are dying. Of particular concerns are trends affecting Eastern Europe and Central Asia, where the numbers of people acquiring HIV infection and dying from HIV-related causes continue to increase.

New surveillance data confirm that the epidemic disproportionately affects sex workers, men who have sex with men, transgender people, people who inject drugs, prisoners and migrants in both concentrated and generalized epidemics. Too often national AIDS plans omit these people, who face formidable legal and other structural barriers to accessing HIV services. Globally, more than 50% of the people eligible for treatment do not have access to antiretroviral therapy, including many people living with HIV who are unaware of their HIV status.

Children have much poorer access to antiretroviral therapy than do adults, and attrition at each stage in the cascade of care has highlighted the need to strengthen links within HIV services and with other areas of health and community systems. Nevertheless, several critical developments over the past year have highlighted the capacity of the global response to innovate and learn from scientific and programmatic evidence. The Political Declaration on HIV/AIDS, adopted in June 2011 by the United Nations General Assembly, set ambitious targets aimed at achieving universal access and the health-related Millennium Development Goals by 2015. The WHO Global Health Sector Strategy on HIV/AIDS, 2011–2015, the UNAIDS 2011–2015 Strategy: Getting to Zero, and the UNICEF’s strategic and programmatic focus on equity will help to guide national and global efforts to respond to the epidemic and move from an emergency response to a long-term, sustainable model of delivering HIV services. These strategies emphasize the need to better tailor national HIV responses to the local epidemics, to decentralize programmes to bring them closer to people in need and to integrate with other health and community services to achieve the greatest impact. These are important developments aimed at consolidating gains to date and improving the quality, coverage and efficiency of HIV services.

The past decade has seen a historically unprecedented global response to the unique threat the HIV epidemic poses to human development. Networks of people living with and affected by HIV, as well as civil society organizations, have continued to work with other partners, to demand and mobilize political leadership. This has led to increased funding, technical innovation and international collaboration that has saved millions of people’s lives and changed the trajectory of the epidemic. As capacity at all levels increases, programmes are becoming more effective and efficient.

Nevertheless, financial pressures on both domestic and foreign assistance budgets are threatening the impressive progress to date. Recent data indicating that HIV funding is declining is a deeply troubling trend that must be reversed for the international community to meet its commitments on HIV. HIV has proven to be a formidable challenge, but the tide is turning. The tools to achieve an AIDS-free generation are in our hands. Let us move forward together on the ambitious goals set for 2015 and bring us closer to realizing our collective vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.