WHO’s goal to provide life-long antiretroviral therapy to 3 million people with HIV/AIDS at risk of failing

Lack of financial resources, staff, and commitment from key countries, may hamper WHO’s goal to provide life-long antiretroviral therapy to 3 million people with HIV/AIDS in developing countries by the end of 2005 (3 by 5), states an editorial in this week’s issue of The Lancet.

Though progress has been made with 720000 people in developing countries receiving antiretroviral treatment and three times the target number of outlets providing antiretrovirals, the financial resources allocated to 3 by 5 are below what are needed (US$ 163 million vs 174million), and the number of WHO staff deployed to the initiative is well below what it should be (112 vs400). Only 30 countries have established treatment goals instead of the December target of 50. Three countries in particular need to show their commitment—India, South Africa and Nigeria. Overall it is in Africa that the greatest barrier exists, states the editorial. Of the estimated 4 million in Africa who need antiretrovirals, only 325000 (8%) were on treatment by December. Despite huge successes in Uganda and Botswana, for example, with both countries already delivering antiretrovirals to half their affected populations, the burden of disease remains great and the distribution of antiretrovirals is poor in South Africa, Nigeria, Zimbabwe, Tanzania, and Ethiopia.

The Lancetcomments: “If the 3 by 5 programme had the political clout to influence South Africa alone to implement all its recommendations, where the necessary infrastructure largely exists, then the 3 million target would be more likely to be attained. Without South Africa on board, with its 837 000 people affected by HIV/AIDS and its leadership position within Africa, 3 by 5 is but a pipe dream.”