HIV Treatment Programs Can Boost Prevention, Improve Overall Health Systems, WHO Report Says
The international community has an opportunity to change the course of history by using HIV treatment programs to bolster prevention efforts and improve overall health systems in the developing world, according to the "World Health Report 2004 - Changing History," which was released on Tuesday by the World Health Organization, the AP/Seattle Post-Intelligencer reports (Fowler, AP/Seattle Post-Intelligencer, 5/11). The 170-page report, which is scheduled to be presented at WHO's annual assembly next week, says that AIDS-related illnesses are the leading cause of death among people ages 15 to 59 worldwide (Evans, Reuters, 5/11). There are about 34 to 46 million HIV-positive people in the world, and five million more people become HIV-positive each year, according to the report (Martin, VOANews, 5/11). Some African countries could face economic collapse if the epidemic is not controlled, the report says (Foulkes, BBC News, 5/11).
The report recommends a rapid scale-up of small HIV/AIDS treatment programs (Reuters, 5/11). Treatment has been the most neglected aspect of the fight against HIV/AIDS to date in most developing countries, according to the report (WHO release, 5/11). Less than 7% of the six million HIV-positive people in the developing world who need treatment are thought to have access to it, the report says (Fleck, New York Times, 5/12). In addition, only 100,000 HIV-positive people in Africa -- 2% of those in an advanced stage of the disease -- are given the correct treatment, if any, according to the report (Agence France-Presse , 5/11). Scaling up treatment programs can support and strengthen prevention programs and overall health infrastructure, making it the most promising of all possible HIV-related interventions, according to the report (WHO release, 5/11). For example, in places where treatment is made available, there is an "overwhelming deman[d]" for HIV testing and counseling services, which can lead to improved prevention among HIV-negative people and a decreased likelihood that HIV-positive people will pass the virus on to others. In addition, because such programs require investments in broader health services, they boost the fight against other diseases, the report says, adding, "The outcome can be better health for generations to come" (AP/Seattle Post-Intelligencer, 5/11). Therefore, the world community must use the more than $20 billion pledged to the fight against HIV/AIDS to implement treatment programs "swiftly and in a coordinated way" and mobilize technical support for HIV/AIDS programs, according to a WHO release (WHO release, 5/11).
3 by 5 Initiative
The report also highlights WHO's efforts to increase access to antiretroviral treatment through its 3 by 5 Initiative (WHO release, 5/11). The 3 by 5 Initiative aims to provide antiretroviral drugs to three million HIV-positive people worldwide by 2005. The plan also calls for training 100,000 health care workers, refocusing 10,000 clinics in developing countries to treat HIV/AIDS and using common antiretroviral drug combinations to treat people. However, the plan does not provide the drugs or subsidize their cost (Kaiser Daily HIV/AIDS Report, 5/11). WHO is providing technical assistance in implementing country-wide treatment programs and has developed simplified treatment, testing and health care worker training guidelines, according to the release. In addition, WHO in coordination with UNICEF and the World Bank has developed the AIDS Medicines and Diagnostics Service to ensure that countries obtain the best prices on antiretroviral drugs and diagnostic tools, according to the report. The service will help countries purchase, predict demand for and manage the supply and delivery of the drugs, the report says (WHO release, 5/11). If the initial two-year plan is successful, WHO hopes to expand the effort to provide and sustain treatment for an additional three million people and use the AIDS drug program as a basis for strengthening overall health systems (Naik, Wall Street Journal, 5/12).
As the 2005 target date for the 3 by 5 Initiative approaches, WHO must "ratchet up" support from wealthy donors to match the political commitments of the countries in Africa, Asia and Latin America, according to WHO spokesperson Samantha Bolton (Agence France-Presse , 5/11). "Future generations will judge our era in large part by our response to the AIDS pandemic," WHO Director-General Dr. Jong-Wook Lee said, adding, "By tackling it decisively, we will also be building health systems that can meet the health needs of today and tomorrow, and continue the advance to health for all" (Xinhua News Agency , 5/11). "We must invest these additional resources in strengthening comprehensive prevention and care strategies that build on 20 years experience of what we know works," UNAIDS Executive Director Peter Piot said, adding, "Scaling up effective HIV treatment and prevention programs is the best strategy to save lives and keep future generations HIV-free" (WHO release, 5/11).
The course of the HIV/AIDS epidemic in China and India will have "a decisive influence on the global pandemic," according to the report. India, along with six African countries, accounts for half of the six million HIV-positive people in need of treatment and may have surpassed South Africa as having the largest number of HIV-positive people in the world. "The Indian epidemic is rapidly becoming the largest epidemic in the world," Global Fund to Fight AIDS, Tuberculosis and Malaria Executive Director Richard Feachem said, adding, "There is nothing in place in India today which is of a scale or of a seriousness which will prevent a catastrophic epidemic unfolding" (Agence France-Presse , 5/11). The report estimates that there are 4.5 million HIV-positive people in India, compared with five million HIV-positive people in South Africa. However, the statistics may be underestimates, and the country may have "considerably more infected people than South Africa," Feachem said. Piot said that in China, the data on HIV/AIDS are "quite good for some provinces but not so reliable for others," adding that the country's estimate of 840,000 HIV-positive people seems to be nearly accurate. "I would say it is safe to assume it is around one million," Piot said. In addition, the country "appear[s] determined to confront AIDS," according to Lee (Nebehay, Reuters, 5/11). China has "embraced" the 3 by 5 Initiative and plans to treat 100,000 people by 2005, according to the report (Xinhua News Agency , 5/11).