The goal of universal access to HIV treatment by 2010 is in danger of being missed, according to a report issued by the International Treatment Preparedness Coalition (ITPC), a coalition of HIV activists from more than 125 countries. The report, titled Missing the Target, said that plans to rapidly expand access to treatment to 10 million people by 2010 would not be successful unless efforts were drastically increased.

Despite evidence to show that HIV treatments prolong life, many people around the world continue to die of the disease. In 2006 alone, three million people succumbed to AIDS. Many of these lives could have been saved by greater access to treatment and health-care services.Although some progress has been made towards improving access to treatment, many people continue to be denied access to essential, life-saving drugs. In developing countries, just 28% of the 7.1 million people who need HIV treatment are receiving it. According to ITPC, which has conducted an analysis of HIV treatment in 17 countries, only 700,000 more people received treatment in 2006 than in the previous year.

The group said that if the rates of treatment expansion were not tripled, the goal of universal access by 2010 would not be realised. "The slow progress has already cost thousands of lives, and is destined to cost millions more. This is particularly tragic because evidence shows that AIDS treatment delivery is working," the ITPC report said. Poverty remains a key factor impeding access to antiretroviral drugs (ARVs).

Many people who do have access to the treatment do not have the money to feed themselves or access other vital health care services. What is often called 'free treatment' remains out of reach for the vast majority of people in need, with transport and diagnostic testing costs often proving prohibitive, the report said. "While timely and expanded distribution of ARVs remains the core objective, much greater attention is now needed on emerging challenges such as reaching marginalized groups, children, and people in rural areas, and providing vital support services such as transportation and nutritional assistance," ITPC's report said.

The collapse of health systems in many of the countries with high HIV prevalence rates is also a significant contributing factor to the failure to reach many people affected. Even where the drugs are available, if there are no health care workers to administer them, access to treatment will not improve. The worsening shortage of doctors, nurses, and community health workers who can provide HIV care needs to be tackled with increased financial investments and policy reforms, according to ITPC.

"Developing country governments must take on greater leadership on HIV/AIDS. People living with HIV and civil society must engage with their governments and insist they do more. In advocating for change, [people living with HIV] and civil society often face serious challenges and risk," said the report.

It also accused donors of failing to establish a successful formula for securing the regular and reliable funding essential to universal access efforts. ITPC said that funding agencies needed to make more visible efforts towards increasing access to treatment among poorer communities and integrating tuberculosis (TB) and other treatments into health services.

"UNAIDS and WHO provide important assistance on global treatment scale up through policy development and, in some cases, through efforts that facilitate the inclusion of civil society," the report said.

"But these agencies must be more outspoken when national programmes are mismanaged, targets are not met, or vulnerable populations are neglected; it is part of UN's moral responsibility to speak out when countries fail their people."