children continued to have less access to antiretroviral therapy than adults (28% coverage of children, compared with 37% coverage of adults). An estimated 90% of the world’s children living with HIV reside in sub-Saharan Africa. Antiretroviral therapy coverage of children in the region is slightly below the global average, at just 26%. Among the 25 countries with the greatest number of people living with HIV, only Botswana reported antiretroviral therapy coverage of children of greater than 80% (Table 4.1). A number of countries report sharply lower antiretroviral therapy coverage for children than for adults. Adult coverage is higher in 12 of the 14 highburden countries for which coverage estimates for both adults and children are available. In six countries, antiretroviral therapy coverage of children is less than half that of adults, with particularly large differences in countries such as Cameroon (30% adults versus 11% children), Mozambique (32% versus 12%) and Uganda (43% versus 18%). By contrast, two of the 12 countries (South Africa and Botswana) report greater antiretroviral therapy coverage for children than for adults. Very few pregnant women living with HIV receive antiretroviral therapy for their own health Access to services for preventing mother-child-transmission of HIV increased between 2008 and 2009, but still few pregnant women living with HIV are screened for their own health. The proportion of pregnant women who tested positive for HIV and were assessed for their eligibility to receive antiretroviral therapy for their own health increased from 34% to 51%. Only 15% of pregnant women living with HIV whose HIV status is detected while accessing maternal and child health services were also provided antiretroviral therapy for their own health at the same time.
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%
15% of pregnant women living with HIV whose HIV status is detected while accessing maternal and child health services were also provided antiretroviral therapy for their own health at the same time.
In the 12 high-prevalence countries that reported on antiretroviral therapy access for pregnant women in both 2007 and 2009, the total number of women enrolled in treatment roughly doubled, from more than 18 000 to more than 37Â 000. In Swaziland, a major effort to provide antiretroviral therapy in maternal and child health settings increased the number of women beginning therapy from 259 in 2007 to 1844 in 2009. Access to antiretroviral therapy eludes marginalized populations Few data are available about access to antiretroviral therapy by sex workers, men who have sex with men and people who inject drugs. Most countries do not collect such data. For example, in Eastern Europe and Central Asia, only four of the 12 countries collect such data. Many countries in Asia, Central and South America and other regions report that negative attitudes on the part of health care workers often deter people at high risk of HIV infection from seeking treatment services (4). Further obstacles to antiretroviral therapy access include laws in a number of countries with sizeable populations of people born outside national borders that limit antiretroviral therapy access to citizens (5). Many prison systems limit access to antiretroviral therapy, according to country reports to UNAIDS (6). Chapter 4: HIV treatment | 2010 GLOBAL REPORT
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