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Treatments Targets & Results
World overview
Who sets the targets?
What are the targets?
What progress has been made?
So is the 3 by 5 inititative a
failure?
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UNAIDS/WHO estimates that nearly 40 million people
were living with HIV at the end of 2004. A person who is HIV
positive is likely to ultimately become sick with an AIDS-related
condition, but if treated with antiretroviral (ARV) medication,
their life can be prolonged, often for many years.
At the end of June 2005, UNAIDS/WHO estimated that
6.5 million people in developing and transitional countries urgently
needed this life-saving ARV medication. Of these only 970,000 - 15%
- were accessing ARV drugs. In sub-Saharan Africa, only 11% of those
who needed treatment were receiving it. These numbers - still
shockingly small - are a great improvement on figures from two years
earlier. At the UN General Assembly Meeting on HIV/AIDS on September
22nd 2003, the WHO, UNAIDS and the Global Fund declared the lack of
access to HIV treatment a global health emergency.
The percentages of HIV+ people accessing ARV
treatment in richer countries make much better reading. In
high-income areas, such as Western Europe, treatment is available to
almost everybody who needs it. However, even in the USA, the richest
country in the world, some of the poorest people who do not have
health insurance are missing out on treatment. The cost of the drugs
in high-income countries is now much higher than the prices being
offered to developing countries, and there have been concerns that
public healthcare services will not be able to shoulder the burden
of paying for new expensive drugs.
There are some notable exceptions in the developing
world, where people are receiving sustainable and free/cheap
treatment. Brazil has been providing its citizens with ARV drugs for
many years, and African countries such as Uganda and Botswana are in
the process of expanding ambitious ARV distribution programmes.
Other countries have made commitments to start providing free
treatment, such as India. As well as countrywide initiatives, global
organisations and funding bodies are rolling-out plans to increase
ARV coverage.
Never before in the history of the epidemic has so
much money been available to finance treatment and care for HIV+
people, and never before have antiretroviral medicines been made so
cheaply and plentifully available. But still, every day, 8,000
people are dying from a disease which can be treated, but which all
too often isn't.
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In December 2003, the World Health Organisation
(WHO) announced a strategy aiming to bring ARV treatment to 3
million people living with HIV in developing and transitional
countries by 2005. Calling this strategy the "3 by 5" initiative (3
million people by 2005), the WHO said it hoped to see 700,000 people
on ARV therapy by December 2004, 1.6 million people by June 2005 and
3 million by December 2005. This 3 million represented 50% of the
number of people expected to be in need of treatment at the end of
2005.
The WHO is not actually purchasing and supplying the
ARVs themselves. They are working in partnership with global
organisations such as UNAIDS; The Global Fund to Fight AIDS,
Tuberculosis and Malaria; the US Presidential Emergency Plan for
AIDS Relief; and The World Bank, as well as national governments and
Non-Governmental Organisations (NGOs) already working in developing
countries, to implement the new guidelines and targets, and to
provide support and expertise.
Essentially, whilst they won't actually be buying
drugs, they will help governments in badly-affected countries to set
up a comprehensive national response to HIV and AIDS. As regards
treatment, they will advise on issues such as:
The WHO 3 by 5 logo
• How to go about applying for funding to buy drugs
• How to actually purchase a regular supply of
high-quality, affordable medicines
• How to train medical staff
• How to get drugs to the people who need them.
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By June 2004 there should be
• 20 countries using the AIDS Medicines and
Diagnostics Service (AMDS) service
• 25 countries with national implementation plans
• 35 countries establishing ARV therapy targets
• 200 additional WHO staff deployed to country
offices
• 1,500 partnerships between ARV therapy outlets and
community-groups
• 10,000 health providers trained to provide ARV
therapy
• 500,000 people receiving ARVs in developing
countries.
By December 2004 there should be
• 30 countries using the AMDS service
• 35 countries with national implementation plans
• 50 countries establishing ARV therapy targets
• 400 additional WHO staff deployed to country
offices
• 3,000 partnerships between ARV therapy outlets and
community-groups
• 30,000 health providers trained to provide ARV
therapy
• 700,000 people receiving ARVs in developing
countries.
By June 2005 there should be
• 40 countries using the AMDS service
• 60 countries with national implementation plans
• 60 countries establishing ARV therapy targets
• 440 additional WHO staff deployed to country
offices
• 9,000 partnerships between ARV therapy outlets and
community-groups
• 70,000 health providers trained to provide ARV
therapy
• 1,600,000 people receiving ARVs in developing
countries.
By December 2005 there should be
• 50 countries using the AMDS service
• 60 countries with national implementation plans
• 60 countries establishing ARV therapy targets
• 480 additional WHO staff deployed to country
offices
• 30,000 partnerships between ARV therapy outlets
and community-groups
• 100,000 health providers trained to provide ARV
therapy
• 3,000,000 people receiving ARVs in developing
countries.
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Estimated progress made towards treatment targets:
• 440,000 receiving treatment in June 2004
• 700,000 receiving treatment in December 2004
• 970,000 receiving treatment in June 2005.
Progress made towards other targets:
• 40 countries using the AMDS service (mid-2004)
• 40 countries with national implementation plans
(December 2004)
• More than 40 countries establishing ARV therapy
targets (June 2005)
• 112 additional WHO staff deployed to country
offices (December 2004).
Despite falling short of the June 2004 target, the
number of people on treatment was back on track at the end of 2004.
However, the estimated total for the end of June 2005 fell a long
way short of the 1.6 million target. The WHO have admitted that:
"Current data and trends indicate that providing ART to 3 million
people by the end of 2005 will be unlikely."
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The WHO has pointed out that, even if 3 by 5 doesn't
succeed within the intended timeframe, this doesn't mean that it
should be given up as a failure. Much of 3 by 5's work has been to
set up structures by which medication can be delivered to those who
most need it. Once the structures are in place, the delivery of
medication should begin to accelerate, and the project should
ultimately be able to help more than the three million people it was
originally intended to.
It should be remembered that treatment for these
970,000 people was not funded by the 3 by 5 initiative itself. The
drugs may be paid for by donors such as PEPFAR and the Global Fund;
by the affected countries; by employers; or by the recipients
themselves.
One of the main players in getting ARV medication to
people around the world is US President George Bush. The President's
Emergency Plan for AIDS Relief, (PEPFAR) proposed by President Bush
in early 2003 was to commit US$15 billion over a five-year period.
The money was to be spent on financing the fight against AIDS in
low- and middle-income countries. About US$9 billion of this is new
money, the remainder made up of money already allocated for overseas
aid. About US$1 billion of this money has been pledged to the Global
Fund.
Much of the PEPFAR funding is aimed at treating
people with free AIDS drugs. PEPFAR backs the use of the expensive
brand-name drugs from the big multinational pharmaceutical companies
which invented them - and which stand to make considerable profits
if they are bought in large quantities for developing countries. It
has therefore been accused of directing vast sums of money to these
American manufacturers at the cost of the health and lives of many
people in African countries. However, since January 2005 the US FDA
has approved a number of generic ARV drugs, which may now be bought
with PEPFAR funds.
PEPFAR has a goal of having 2 million people on ARVs
by 2008. It began spending the money in 2004 and allocated US$2.4
billion for the first year. By the end of March 2005, PEPFAR had
helped to provide ARV therapy for 155,000 people in its 15 focus
countries (63% of total provision in those countries) and 17,000
elsewhere.3 By the end of June 2005, the total for focus countries
had risen to 235,000 - already exceeding the target of 200,000 for
June 2005.4 Included in PEPFAR statistics are one third of all
people assisted by the Global Fund, since the US provides one third
of Global Fund money.
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