Today Latin America and the Caribbean lead the developing world in providing HIV/AIDS treatment, accounting for more than half of all people on antiretrovirals in developing countries, according to the Pan American Health Organization (PAHO).
These life-saving drugs have changed the face of AIDS, and the region is striving to provide universal access to them, according to "Casting the AIDS Lifeline," an article in the latest issue of PAHO's magazine, Perspectives in Health.
In Latin America and the Caribbean there are an estimated 210,000 HIV/AIDS patients receiving antiretroviral treatment, 55 percent of the total number of people believed to be in need of treatment in the region. In Africa, by comparison, only 100,000 or 2 percent of some 4.4 million people who need them are receiving these drugs.
Public health advocates acknowledge that there remain frustrating delays in getting treatment to those who need it, but they say the achievements so far reflect a growing commitment to providing universal access to antiretroviral therapy.
"Today every country in our region has HIV/AIDS patients on antiretroviral treatment," says Carol Vlassoff, head of the HIV/AIDS program at the Pan American Health Organization. "There's a new consensus that everyone in our region who needs AIDS therapy should have access."
To support this process, PAHO is spearheading a regional initiative over the next year and a half to increase the number of people receiving AIDS therapy in Latin America and the Caribbean by 174,000—the number currently believed to need treatment but who still lack access. The effort falls within the framework of the "3 by 5" initiative, launched by the World Health Organization (WHO) in late 2003 with the goal of providing antiretroviral treatment to 3 million people in the developing world by the end of 2005. It also supports the Millennium Development Goals and answers the call by heads of state at the recent Summit of the Americas to treat 600,000 HIV/AIDS patients throughout the Americas by 2005.
Since combination antiretroviral therapy became available in the mid-1990s, death rates from AIDS have declined 90 percent in the United States and Europe. Middle income countries including Argentina, the Bahamas, and Brazil have seen as much as a 50 percent drop in death rates from AIDS after only a few years of treatment. But in the world's poorest countries, especially in Africa, AIDS deaths have continued to climb along with new infections.
Most Latin American and Caribbean countries focused their early anti-AIDS efforts on prevention, viewing antiretrovirals as largely out of reach.
A notable exception to this rule was Brazil, which responded to its spreading AIDS epidemic with a comprehensive strategy that incorporated both prevention and treatment, including universal access to free antiretroviral treatment.
To lower drug costs, Brazil began producing generic versions of antiretrovirals in 1993 and has also negotiated lower prices with brand-name manufacturers. While Brazil is one of the few countries in the region with the technical and manufacturing base necessary to produce its own drugs, other countries have followed its lead in negotiating with drug makers to lower antiretroviral prices with support from PAHO/WHO and the Joint United Nations Program on HIV/AIDS (UNAIDS).
Still the estimated cost per year of treating HIV/AIDS patients can be staggering. A number of countries have been absorbing these costs through their national health budgets and World Bank loans, but smaller and lower-income countries have had to seek other external sources of funding.
One of the most important of these is the $4.7 billion Global Fund for Aids, Tuberculosis and Malaria, launched in 2002 to channel public and private donations to combat these diseases. The United States'$15 billion President's Emergency Plan for AIDS Relief (PEPFAR), has also financed AIDS treatment in Haiti and Guyana and pledged $1 billion in general funds to the Global Fund for Aids, Tuberculosis and Malaria.
Despite these positive developments, activists complain that the process of expanding treatment has moved too slowly. Carol Vlassoff, head of PAHO's AIDS program, observes that, following the success of drug price negotiations, technical, bureaucratic and medical hurdles still need to be overcome and are top priorities for PAHO.
Vlassoff and others involved in the "3 by 5" initiative acknowledge that universal access to antiretrovirals is an ambitious goal. "But this is a goal we have to strive for," says Vlassoff. "Of all the developing regions, the Americas have real potential to achieve universal access. It is a challenge, but it needs to be done."
Other articles in this issue of Perspectives in Health include: "Latino Health in the USA," "Aging in the Americas," and "A Question of Human Rights," on rights violations of the mentally ill in the Americas.
The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It also serves as the regional office of the World Health Organization.