AFRO-NETS> 3 by 5 Initiative

[Claudio Schuftan <aviva@netnam.vn>]

3 by 5 Initiative
-----------------
 
Global AIDS treatment emergency
http://www.who.int/mediacentre/factsheets/2003/fs274/en/
 
Currently, five to six million people infected with HIV in the 
developing world need access to antiretroviral (ARV) therapy to 
survive. Only 300,000 have this access. The failure to deliver 
ARVs to the millions of people who need them is a global health 
emergency. To address this emergency, WHO is fully committed to 
achieving the "3 by 5" target - getting three million people on 
ARVs by the end of 2005. This is a means to achieving the treat-
ment goal: universal access to ARVS for all who need them. WHO 
will lead the effort, with UNAIDS and other partners, using its 
skills and experience in coordinating global responses to dis-
eases such as the effective and rapid control of SARS.
 
To achieve the 3 by 5 target, WHO will:
 
a. Provide Emergency Response Teams at the request of govern-
ments, with the support and involvement of partners including the 
UN system and NGOs. The priority will be teams for high burden 
countries where the treatment gap is most urgent. These teams 
will work with treatment implementers and will conduct a rapid 
assessment of the barriers and opportunities that exist in 
achieving the 3 by 5 target;
 
b. Establish an AIDS Drugs and Diagnostics Facility to assist 
countries and implementers navigate in medicine purchasing and 
financing, while considering best prices and quality. This is one 
of the most significant barriers faced by countries. Without ef-
fective systems to help purchasers, the time and effort needed to 
get drugs and diagnostics into countries will grow as the number 
of people on treatment grows;
 
c. Publish simplified treatment guidelines by 1 December. Achiev-
ing the 3 by 5 requires global standard first and second line 
treatment regimens. The guidelines would make ARVS relatively 
simple to administer;
 
d. Publish by 1 December uniform standards and simplified tools 
to track the progress and impact of ARV treatment programmes, in-
cluding surveillance of drug resistance to capture the full im-
pact of antiretroviral therapy;
 
e. Start the emergency expansion of training and capacity devel-
opment for health professionals for delivering simplified, stan-
dardized ARV treatment. WHO will support those partners already 
involved in training, and work with countries to help build a 
critical mass of highly competent and skilled trainers to expand 
national capacity for ARV delivery;
 
f. Advocate for funding, together with UNAIDS and other partners. 
Achieving the 3 by 5 target will require not only funding for 
drugs but a massive investment in training and for strengthening 
health services in countries. Health systems strengthening will 
benefit ARV delivery, but also delivery of other health services.
 
Why is 3 by 5 so urgently needed?
 
a. More than 20 million people have already died of AIDS and at 
least 42 million more are infected. Sub-Saharan Africa is the 
hardest hit continent, with one out of ten adults - more than 
28.5 million currently living with HIV/AIDS of a total adult 
population of 291 million. Prevalence in southern Africa is par-
ticularly high, for example, Lesotho has HIV rates as high as 31% 
and Botswana as high as 38.8%;
 
b. Of the estimated five to six million people in developing 
countries in immediate need of AIDS treatment, less than 300,000 
now have access to ARVs. In Africa, just 1% of HIV positive peo-
ple - 50,000 out of 4.1 million who need it - have access to 
treatment;
 
c. At current rates of delivery less than one million people in 
the developing world will have access to ARV treatment by the end 
of 2005;
 
d. By robbing communities and nations of their greatest asset - 
their people - AIDS drains the human and institutional capacities 
that drive sustainable development. This, in turn, distorts la-
bour markets, disrupts production and consumption, erodes produc-
tive and public sectors and ultimately diminishes national 
wealth. A World Bank report warns that HIV/AIDS causes far 
greater long-term damage to national economies than previously 
assumed; Prevention strategies will not solve the current health 
crisis in the most severely affected countries unless parallel 
treatment strategies are put in place to help people already liv-
ing with HIV/AIDS;
 
e. Delivering treatment for HIV/AIDS in the developing world is 
necessary if the international community is to live up to commit-
ments on human rights, the Millennium Development Goals (MDGs) 
and the Declaration of the United Nations General Assembly on 
HIV/AIDS.
 
Who needs ARVS and how do they work?
 
a. Without access to ARV drugs, the lives of infected people fol-
low an inevitable course: progressive destruction of the immune 
system, increasing ill-health and episodes of life-threatening 
associated diseases, (e.g. tuberculosis, or pneumonia), wasting, 
and ultimately death;
 
b. When ARV drugs are given in combination (three drugs to-
gether), the rate at which the virus reproduces itself is reduced 
and the body's immune system can partly regenerate itself, 
thereby restoring health and quality of life;
 
c. WHO recommends that ARV therapy should be started when the 
damage caused by HIV to the immune system reaches a certain 
threshold, as indicated by clinical condition and/or laboratory 
tests, including CD4 cell count. When CD4 testing is not avail-
able, simpler laboratory tests can be used. [1]
 
What are the benefits of access to ARV treatment?
 
a. ARV medicines have dramatically reduced death rates, prolonged 
lives, improved quality of life, revitalized communities and, to 
a large extent, transformed HIV/AIDS from a fatal condition to a 
manageable illness;
 
b. While there is still no cure for HIV/AIDS, ARV treatment can 
add many years of healthy life to an infected person. In high-
income countries, an estimated 1.5 million people currently live 
with HIV/AIDS. Most of them lead productive lives, largely due to 
ARV therapy. In the US, for example, the introduction of triple 
combination ARV therapy in 1996 led to a 70% decline in deaths 
attributable to HIV/AIDS;
 
c. Delivering ARV therapy has other returns. Millions of dollars 
spent now can save billions in the future. Data from Brazil indi-
cates that the costs associated with providing universal access 
to ARV therapy from 1996 to 2002 amounted to US$1.8 billion, but 
the savings in hospital and ambulatory care services reached 
US$2.2 billion - not to mention the broader savings related to 
teachers who keep on teaching, parents who remain with their 
children, and farmers who continue to work on their land;
 
d. Brazil has also proven that it is possible to contain HIV/AIDS 
in resource-poor environments with relatively weak health infra-
structure. It has delivered free ARVs to virtually every AIDS pa-
tient in need - in spite of the size of the country and its large 
population. From 1996 to 2002, Brazil saw a decrease in mortality 
rates of 40%-70%, morbidity rates of 60%-80%, plus a seven-fold 
drop in hospitalization needs;
 
e. The availability of ARV therapy makes it more likely that peo-
ple will come forward for HIV testing, learn their status, re-
ceive counselling and care and become knowledgeable about pre-
venting the spread of the virus. Access to treatment will reduce 
the fear, stigma and discrimination associated with HIV/AIDS, 
thereby enabling societies to discuss the epidemic more openly 
and to prevent new infections more effectively.
 
What progress has been made so far? A number of international de-
velopments enhance the possibility of treating more people living 
with AIDS in the developing world:
 
a. There is awareness that prevention and treatment are both nec-
essary for controlling the spread of HIV/AIDS and that these two 
approaches are mutually reinforcing elements of a comprehensive 
response to HIV/AIDS;
 
b. There has been a significant reduction - more than 90% in some 
cases - in the price of ARV drugs offered to all sub-Saharan Af-
rican countries; reducing costs from about US$ 10,000 per year to 
as low as US$ 300 for some combinations;
 
c. Many developing countries, including several in Africa, have 
made a promising start by showing that ARV treatment is not only 
implementable, but also affordable and sustainable;
 
d. The World Trade Organization decision in late August 2003 al-
lowing poorer nations to import generic versions of patented 
antiretroviral drugs under certain circumstances, can facilitate 
the provision of low cost drugs for people living with HIV/AIDS 
in developing countries;
 
e. There are growing numbers of partners engaged in the response 
to the epidemic, and continuing forceful activism and advocacy by 
people living with HIV/AIDS and civil society;
 
f. The increased availability of international financial re-
sources, including the creation of the Global Fund to fight AIDS, 
Tuberculosis and Malaria, signals a renewed commitment from the 
international community with the global fight against AIDS.
 
The way forward
 
a. At the UN General Assembly High-Level Meeting on HIV/AIDS on 
22 September 2003, the World Health Organization (WHO) declared 
the lack of access to HIV treatment a global health emergency.
 
b. WHO is committed to lead the way towards the ambitious "three-
by-five" target. Working with a wide range of partners including 
UNAIDS, there will be urgent action to see that three million 
people are on ARVs by the end of 2005.
 
c. To make this ambitious but necessary vision a reality, WHO 
will have a detailed strategy in place by World AIDS Day, 1 De-
cember 2003.
 
--
[1] CD4 (T4) or CD4+ cells are white blood cells killed or dis-
abled during HIV infection. These cells normally orchestrate the 
immune response, signalling other cells in the immune system to 
perform their special functions.
 
--
See also: Scaling up antiretroviral therapy in resource-limited 
settings: Treatment guidelines for a public health approach:
http://www.who.int/hiv/pub/prev_care/draft/en/

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