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3 by 5: Sparking Hope in HIV/AIDS Treatment and
Prevention
Dr LEE Jong-wook Director General,
World Health Organization on the Occasion of World AIDS Day, 1 December 2004
For almost a decade, we
have known how to treat AIDS. Administered through sound public health
programmes, anti-retroviral therapy (ART) can almost literally bring people
back from the dead.
But in poor countries of
Africa, Asia and Latin America, the hope of treatment has been deferred.
Three million people annually still die as a result of AIDS - 8,000 every
day. In Botswana, steady economic and social development raised life
expectancy above 60 years in the mid 1980s. Now a baby born in Botswana is
likely to die before his or her 31st birthday. An entire generation of
parents, workers, and citizens is vanishing. The hard-won gains from half a
century of development and economic growth are dissipating.
In recent months, though,
we have sown the seeds of a remarkable transformation. Since the last World
AIDS Day, a broad-based global coalition has embraced the “3 by 5” target of
making ART available to three million people sick with HIV/AIDS in poor
countries. The call to treat “3 by 5” is driving a comprehensive public health
effort, including scaling-up access to treatment and prevention,
expanded HIV testing and counseling, mass education, care and support,
and prevention of mother-to-child transmission.
The ambitious “3 by 5”
target draws energy from a growing sense of urgency at the national and the
international level. It builds on the vast new resources available through
the Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2002,
and the Global AIDS Act signed into law by President Bush of the United States
one year later. These monies, along with contributions from other bilateral
donors, amount to nearly $20 billion in new pledges over the coming years for
integrated HIV/AIDS treatment, care, and prevention. Meanwhile, through
teamwork by health workers, activists, government officials, non-governmental
organizations, and the pharmaceutical industry, the overall cost of our
struggle with the epidemic has fallen dramatically.
Encouraged by a new sense
of possibility, governments are moving into action. Since last December, 73
countries have appealed to the World Health Organization for technical
assistance in preparing a national “HIV treatment and prevention scale-up”
programme. In May, all 192 members of the World Health Organization endorsed
the “3 by 5” target.
To support countries'
efforts, WHO is dispatching “3 by 5” country officers to give technical
assistance where it's most needed. They are helping to implement new
guidelines that can be used to treat people even in areas with limited medical
infrastructure. A multi-agency “AIDS Medicines and Diagnostics Service” has
been launched by WHO to facilitate the purchase and distribution of drugs,
tests, and other important technologies. With the agency’s assistance, tens
of thousands of new health workers are being trained and certified in the
communities where need is greatest.
Another key to the “3 by 5”
effort is WHO’s prequalification programme. Since its establishment in 2001
the programme has improved access to safe, effective medicines for HIV/AIDS,
tuberculosis and malaria, coordinating quality assurance of products. Over
the last few months, several generic antiretroviral medicines have been
removed from the list and are awaiting additional review. While this has
caused some difficulties in countries and programmes relying on these
medicines, it also demonstrates that WHO will accept only the highest
standards. In the longer-term, these actions will ensure that safe,
effective and affordable medicines are made available to people who might
otherwise have access only to sub-standard products, or no access at all.
On both moral and
scientific grounds, treatment of the millions who are sick as a result of HIV
is fundamental. Together, scaling-up treatment and prevention form the
backbone of any response. People must have access to evidence-based
information and support, as well as to condoms and other methods of
protecting themselves against the virus. Outreach to vulnerable populations,
including women, girls, sex workers, intravenous drug users and prisoners,
will help stem the epidemic.
There is growing evidence
that treatment increases the effectiveness of prevention. The HIV treatment
programme established by Médecins sans Frontières in Khayelitsha, near Cape
Town, has shown that the availability of treatment increases community
awareness about HIV/AIDS, promotes uptake of HIV testing and reduces the
level of stigma and discrimination associated with the disease, factors which
all contribute to an environment in which both preventive and therapeutic
interventions can be implemented much more effectively.
The challenges continue to
be enormous. The health system infrastructure in many high-burden countries
is weak; and “3 by 5” must help to build it up. Meanwhile, as described in
the latest UNAIDS/WHO Epidemic Update, there have been sharp recent increases
in the virus’s spread among women. This necessitates a fundamental
reorientation of treatment and prevention programs, and will require a shift
in social norms to protect women's health.
But the bottom line is that
countries, UN agencies, donors, and other stakeholders must move more quickly
to scale-up prevention and treatment services. By June 2004, just
440,000 of the people in need were receiving treatment. We hope to have better
news for the next "3 by 5" progress report in early 2005. But at
current rates it will be difficult to meet this ambitious target. We must
push ourselves harder to make it happen.
The World Health
Organization remains steadfastly committed to the principles and vision of “3
by 5.” We are encouraged that so many highly-affected countries have
enthusiastically embraced the target. On this 17th World AIDS Day, the
possibility of treatment is now in sight for millions of people around the
world. At a time when hope and fear stand opposed as never before, we must
not let them down.
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