The global HIV/AIDS pandemic continues to demand urgent attention, despite significant progress in scaling up treatment over the last several years. An estimated 34 million people were living with HIV/AIDS at the end of 2010, and, of the approximately 14.2 million in need of antiretroviral treatment (ART), 6.6 million were receiving it. While this represents a ten-fold increase over the last six years, more than 7.6 million people are still in need of treatment. Meanwhile, the virus continues to take its toll, particularly in developing countries, where 95% of those infected live. An estimated 1.8 million people died of AIDS in 2010, including 250 000 children.

Access to appropriate and adapted paediatric antiretrovirals (ARVs), as well as to newer and more potent second-line ARVs, for people who have developed resistance, remains a major challenge, as does tackling transmission of the virus from expectant mothers to their babies – the primary cause of child infection.

UNITAID has made these challenges the focus of its HIV/AIDS effort, and together with its partners the Clinton Health Access Initiative (CHAI), UNICEF and the World Health Organization (WHO), UNITAID is helping address them in crucial ways, by:

• Increasing access to appropriate HIV treatment for children and ensuring drug prices come down;
• Expanding access to second-line treatment and helping bring prices down through increased market competition; and,
• Supporting the scale-up of prevention of mother-to-child transmission (PMTCT) programmes.

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UNITAID-CHAI partnership

In 2010, UNITAID allocated US$ 156 million to the Clinton Health Access Initiative (CHAI), formerly the Clinton HIV/AIDS Initiative, to supply enough second-line medicines (used when patients develop resistance to their first treatment) to treat 126 000 people, including antiretrovirals to improve first-line regimens, and enough AIDS treatments to treat 330 000 children in 40 developing countries. Of the full amount, approximately 1% (US$ 1.5 million) will cover administrative costs and staff salaries. CHAI raises an additional US$ 10–15 million to provide technical assistance and support to national AIDS programmes, in order to ensure that patients receive their treatments. The collaboration between UNITAID and CHAI began in November 2006 – 375 000 adults and children were being treated with UNITAID funds at the end of 2009. UNITAID allocated a ceiling budget of US$ 458 million for improved paediatric and second-line treatments through 2010.

Among the principal results the partnership has achieved are:

• eight out of ten children on AIDS treatment are being treated thanks to this partnership;
• a market has been created for child-friendly AIDS medicines where none existed before, achieving cumulative price reductions of up to 80% on leading paediatric HIV/AIDS medicines;
• a sharp reduction in the price of the antiretroviral treatments since 2006. The annual cost of a second-line regimen has been reduced from US$ 1500 in 2006 to US$ 450 in 2011, and for paediatric regimens, from US$ 200 to US$ 66 in 2009. UNITAID has made the money go further – more people are treated with the same funds;
• the introduction of improved antiretroviral formulations, such as fixed-dose combinations for children (three-in-one pills), which are easier to take and ensure better therapy;
• early infant diagnosis, which facilitates earlier access to treatment.