WHO’s 3 by 5 Initiative Behind Schedule, Goal Can Still Be Met, Report Says

Although the objective of the World Health Organization's 3 by 5 Initiative -- treating three million people with antiretroviral drugs by 2005 -- is behind schedule, it is still possible, according to the first progress report for the initiative released on Saturday, the Boston Globe reports. The report -- released in advance of the XV International AIDS Conference in Bangkok, Thailand -- estimates that 440,000 people currently are receiving treatment under the program. Dr. Jim Kim, head of WHO's AIDS program, said that there are twice as many HIV-positive people currently receiving treatment as there were two years ago. However, the agency had hoped to have 500,000 HIV-positive people receiving treatment in that time, according to the Globe (Donnelly, Boston Globe, 7/11). Under current treatment availability, the three million-person target would not be reached until 2009, the Washington Post reports (Nakashima/Brown, Washington Post, 7/11). Officials said that the initiative's "slow progress" was due in part to the time needed to develop standard technical guidelines and training materials and certify health care workers, the New York Times reports (Altman, New York Times, 7/11). Another obstacle has been funding shortfalls, with a $62 million shortage in the $218 million needed to roll out the program, according to Agence France-Presse. WHO has estimated the total cost of the initiative at $5.5 billion, Agence France-Presse reports (Agence France-Presse, 7/10). In addition, WHO is facing a shortage of trained health care workers to administer drugs in developing countries, the Post reports. According to WHO, 15,000 health care workers in developing countries have been trained to provide antiretroviral treatment since 2001; the initiative calls for training 100,000 by 2005. According to the Wall Street Journal, Kim said he "couldn't care less" about prognosticators who say the program's goal is impossible, adding, "If we don't do something extraordinary in the next 18 months, we deserve to be slapped and told to go home" (Naik, Wall Street Journal, 7/12).

Goals, Progress
UNAIDS Executive Director Peter Piot said, "We have to be frank and admit that we have a long way to go" (New York Times, 7/11). U.N. and WHO officials say that some progress toward the initiative's goals has been made, including streamlining drug regimens and reducing prices, according to the Post. A year's supply of antiretroviral treatment in 1999 cost $10,000 per person, per year and patients were required to take more than 12 pills a day. Currently, combination drug regimens can be obtained for less than $200 per person, per year and are available in once- or twice-daily pills. In addition, programs in many countries are "on the verge" of enrolling large numbers of patients in the next few months, the Post reports (Washington Post, 7/11). U.N. Special Envoy for HIV/AIDS in Africa Stephen Lewis said that the target of three million patients treated by 2005 may not be met, according to Agence France-Presse. However, he added that the "momentum for treatment is overwhelming," saying, "I think it has been painfully slow but there is a sense of importance and urgency and determination to press forward" (Agence-France Presse, 7/10). Lewis added that "every country has enough in place" to begin expanding treatment into Africa, "If we can only break through the impasse of getting drugs into countries and getting work started, then I think we can reach this goal" (Boston Globe, 7/11).

Kaisernetwork.org on July 10 webcasted an interview with World Health Organization Assistant Director-General Jack Chow about progress in the 3 by 5 Initiative and the challenges the agency faces in providing access to antiretroviral drug treatment for people living with HIV in resource-poor settings. Kaisernetwork.org also webcasted the WHO conference session on the initiative. The webcasts and other coverage of the conference are available online at kaisernetwork.org/aids2004.