02 June 2008

UN hits Aids target 2 years late

Despite missing their deadline, the WHO's 2003 ambitious initiative to treat Aids by putting 3 million infected people worldwide on ARV drugs within two years, succeeded last year.

In 2003, the World Health Organization began its ambitious "3 by 5" initiative to treat Aids, promising to put 3 million infected people worldwide on antiretroviral drugs within two years.

According to a report issued this week, they finally succeeded last year. Despite missing their deadline, officials were upbeat.

"If every UN health target was met just two years late, the world would be a much better place," said Dr Kevin De Cock, director of WHO's Aids department.

In the last four years, the number of people on anti-Aids drugs has increased by seven and a half times, WHO, UNICEF and UNAIDS said. In Africa, the region hardest hit by Aids, more than two million people are now receiving the lifesaving antiretrovirals. About 100 000 were on the drugs in 2003.

Only 31% worldwide who need ARV's are on them
"A lot of people said we would never get to three million," said Paul Zeitz, executive director of the Global Aids Alliance, an advocacy group in Washington DC. "This proves that it is possible to get treatment out, even in the hardest to reach places."

Still, only 31 percent of people worldwide who need antiretrovirals receive them. And more people get infected every year than are put on treatment.

The UN estimates that there are about 33 million people living with HIV and that there were roughly 2.5 million new infections last year.

"There are millions of people still standing in line waiting to get therapy," De Cock said. One of the biggest obstacles is that many people with HIV aren't aware of their status. Diagnosing HIV and treating patients remains a problem even in rich countries. In the United States, only 55 percent of people who require Aids drugs get them.

WHO considers giving ARV's earlier
The numbers of people needing antiretrovirals may change if WHO's treatment guidelines change, or if there are new estimates of the numbers of people infected.

De Cock said WHO may consider recommending that people with HIV receive antiretrovirals earlier. That would mean an instant jump in the numbers of people needing the drugs, as more people would automatically qualify.

The numbers might also fluctuate if there are new estimates of how many people have HIV. Last year, the estimated number of infected people was slashed from nearly 40 million to 33 million.

"These numbers are the best we've got, but they're not necessarily that good because they may have to be revised depending on newer data," said James Chin, a clinical professor of epidemiology at the University of California at Berkeley.

WHO's report is based largely on self-reported information from 143 governments. Now that WHO's treatment target has been met, some experts worry that the interest in fighting Aids will evaporate.

More preventative measures called for
In 2005, leaders of the Group of Eight industrialised nations vowed to invest more in Aids treatment. "Wealthy nations like the UK, Japan and France have all backed off and have not shown any interest in reaffirming the goal of universal access," Zeitz said.

However, Britain has announced it intends to spend nearly US$12 billion over the next seven years on responding to Aids in poor countries.

WHO has no plans to launch any future Aids treatment initiatives like "3 by 5", according to De Cock. To curb the epidemic, WHO and partners are calling for preventive measures including more HIV testing and male circumcision, which can cut men's chances of catching HIV by up 60 percent.

Because anti-Aids drugs must be taken for life, the price of fighting Aids will almost certainly rise in the future, as the emergence of drug resistant strains will require more expensive drugs.

WHO estimates that to meet treatment needs, funding will have to more than quadruple to US$35 billion in 2010. "We are on a treadmill now," said David Ross, a professor of epidemiology and public health at London's School of Hygiene and Tropical Medicine.

"It would be a major disaster and totally irresponsible if the funds dried up and we abandoned those people now dependent on antiretrovirals." – (Sapa, June 2008)

Read more:
Circumcision no shield from HIV
US gives $50 billion to HIV fight


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Dr Sindisiwe van Zyl qualified at the University of Pretoria in 2005. She is a patients' rights activist and loves using social media to teach about HIV. She is in private practice in Johannesburg.

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