WHO Not Likely To Achieve 3 by 5 Goal; 1M HIV-Positive People Receiving AIDS Drugs in Developing Countries, Report Says

About one million HIV-positive people in developing countries are receiving antiretroviral drugs, meaning the World Health Organization likely will not meet its 3 by 5 Initiative goal of delivering antiretrovirals to three million people by the end of this year, according to a progress report released on Wednesday, BBC News reports (Allen, BBC News, 6/29). However, WHO HIV/AIDS Programme Director Jim Kim said the ambitious goal has driven the global community to make significant progress in HIV/AIDS treatment (Boseley, Guardian, 6/30). The main reasons for not achieving the target include problems with safeguarding and delivering the drugs and a shortage of health professionals trained to deliver HIV/AIDS care, according to Kim (Brown, Washington Post, 6/30). At the end of the year, WHO will release an estimated date when the three million target will be achieved, but the organization will not set future treatment targets, Kim said (Russell, San Francisco Chronicle, 6/30). Kim said he is optimistic that the three million goal will be met but that it might take an additional 18 months (Higgins, AP/Yahoo! News, 6/29). Currently, about 6.5 million HIV-positive people worldwide need antiretroviral drugs but do not have access to them, according to the Wall Street Journal. About 40 million people worldwide are living with HIV/AIDS (Naik, Wall Street Journal, 6/30).

Successes
Despite not achieving its goal, WHO's program has doubled the number of HIV-positive people in developing countries who are receiving antiretrovirals over the past 18 months, the Los Angeles Times reports. The increase has been greatest in sub-Saharan African countries, where treatment coverage has expanded more than 60% over the last six months to reach approximately 500,000 people, according to the report (Wible, Los Angeles Times, 6/30). In Asia, the number of people accessing antiretrovirals has tripled since June 2004 to about 155,000 people. The pace of starting people on antiretroviral drugs is accelerating everywhere and the "momentum is unstoppable," Kim said (Nolen, Globe and Mail, 6/30).

Failures, Problems
The report cited extremely high prices for second-line antiretrovirals that are used when patients fail to respond to the less-expensive and more common first-line treatments because of side effects or drug resistance. Kim called on drug manufacturers to increase production of generic versions of second-line antiretrovirals to reduce the prices. The report also warns that a lack of drugs formulated for children could contribute to an increased number of deaths among HIV-positive infants (Agence France-Presse, 6/29). For the first time, the report listed the number of severely ill children in need of antiretrovirals. Approximately 660,000 children need immediate treatment, about 10% of the total number of people in need (Altman/McNeil, New York Times, 6/30). In addition, a lack of health care workers to administer and monitor patients' drug regimens has hindered treatment progress, the report says (Agence France-Presse, 6/29).

Recommendations
The report recommends that developing countries and organizations do the following to increase the pace of antiretroviral access:

• Establish national targets for treatment access and implement concrete plans to achieve the goals;
  
  
• Standardize procedures to avoid delays in receiving and distributing drugs;
  
  
• Train more health care workers to administer antiretrovirals;
  
  
• Increase technical assistance to countries to scale up overall health infrastructures (WHO/UNAIDS release, 6/29);
  
  
• Focus on prevention -- especially among high-risk populations, such as commercial sex workers, injection drug users and prison inmates -- to reduce the spread of the virus (Agence France-Presse, 6/29); and
  
  
• Accelerate the distribution of pledged funds to developing countries and increase funding commitments (WHO/UNAIDS release, 6/29).

Reaction
"The truth is that the 3 by 5 Initiative -- which, I predict, will be seen one day as one of the U.N.'s finest hours -- has unleashed an irreversible momentum for treatment," U.N. Special Envoy for HIV/AIDS in Africa Stephen Lewis said, adding, "I see it everywhere as I travel through Africa. Governments are moving heaven and earth to keep their people alive, and nothing will stop that driving impulse" (Palmer, Toronto Star, 6/30). Medecins Sans Frontieres on Wednesday urged leaders of the Group of Eight industrialized nations -- who are scheduled to meet next week in Gleneagles, Scotland -- to support compulsory licensing and encourage governments in developing nations to break patents held by large pharmaceutical companies (Evans, Reuters, 6/29). "It is imperative that we continue to speed up access to lifesaving HIV treatment, not only as a means of treating the millions in need today but also as a tool to help prevent millions of additional infections," UNAIDS Executive Director Peter Piot said, adding, "One of the key findings of the new report is that the availability of treatment increases the number of people who access key prevention services, such as testing and counseling." WHO Director-General Jong-Wook Lee said, "The challenges in providing sustainable care in resource-poor settings are enormous, as we expected them to be, but every day demonstrates that this type of care can and must be provided" (Xinhua/People's Daily, 6/30).

NPR's "Morning Edition" on Thursday included an interview with Kim about the goal and the lessons learned from the organization's efforts (Inskeep, "Morning Edition," NPR, 6/30). The complete segment is available online in RealPlayer.