The World
Health Organization on Monday as part of its World
AIDS Day activities announced details of its "three by five" HIV/AIDS
plan, which aims to treat three million HIV-positive people with antiretroviral
drugs by 2005, the Washington
Post reports (Brown, Washington Post, 12/1). WHO Director-General
Jong-Wook Lee on Sept. 22 during a U.N.
General Assembly special session on HIV/AIDS in New York City announced
WHO's commitment to the "three by five" plan and declared the lack of access
to antiretroviral drugs a global health emergency (Kaiser
Daily HIV/AIDS Report, 11/26). WHO's plan, which "lays out a timetable
and roadmap" for treating three million people with antiretroviral drugs
in the next two years but does not provide or subsidize the drugs, calls
for training 100,000 health care workers, "redirecting the focus" of 10,000
clinics in poor countries to treat HIV/AIDS, and using some "one size fits
most" antiretroviral drug combinations, the Post reports. Thus far,
20 countries have sought WHO assistance in establishing HIV/AIDS treatment
programs and WHO estimates that 20 more will ask for help by June 2004,
the Post reports. WHO has already sent consultation teams to Kenya,
Burkina Faso, Malawi and Zambia (Washington Post, 12/1).
Details
The $5.5 billion plan recommends four
"simplified" combination antiretroviral treatments, including stavudine,
lamivudine and nevirapine; zidovudine, lamivudine and nevirapine; stavudine,
lamivudine and efavirenz; and zidovudine, lamivudine and efavirenz; the
combinations do not include protease inhibitors. Each country participating
in the plan will be able to choose the treatment based on the patient's
needs and the availability of certain regimens, the New
York Times reports. The plan also recommends using "quality-assured
'fixed-dose combinations'" or "blister packs" if available, according to
the Times (Altman, New York Times, 12/1). In addition, poor
patients will not be required to make a copayment in order to receive antiretrovirals.
Under the new plan, WHO expects the cost of antiretroviral therapy per
person per year to fall from $450 to $250, the Wall Street Journal
reports (Naik, Wall Street Journal, 12/1). The plan calls for "rapidly
expanding programs to train workers and improve services," but does not
call for the creation of new programs, the Times reports. Dr. Charles
Gilks, head of the "three by five" plan, said, "We cannot in a two-year
period build new health systems," adding, "Clear decisions will have to
be made where programs will be started, and that will involve winners and
losers" (New York Times, 12/1).
Plan 'Hurdles'
The plan will face some "significant
... hurdles," including funding and securing antiretrovirals for distribution,
the Wall Street Journal reports. WHO officials say that "a good
chunk" of the needed funding has been pledged "in one form or another,"
but WHO needs to raise another $350 million from member states to fund
its own "three by five" activities and to "make the plan work," according
to the Journal. In addition, it remains unclear how the agency's
plan will "mesh" with other efforts to fight the pandemic, including President
Bush's global AIDS initiative. Also, drug manufacturers will have to increase
production of antiretrovirals' active ingredients before the drug treatments
could be distributed, the
Journal reports. Also, deciding which
patients should receive treatment likely will prove to be a "politically
and socially tricky decision that health agencies of individual countries
will have to make," according to the Journal. Gilks said, "It's
sometimes been an obstacle. It's a divisive issue," adding, "The question
of who shall receive [antiretroviral treatment] is a question of who will
live" (Wall Street Journal, 12/1).
Reaction
WHO experts wrote in a 55-page document
detailing the plan, "This may be the toughest health assignment the world
has ever faced, but it is also the most urgent. The lives of millions of
people are at stake. Everyone involved must find new ways of working together
and new ways of learning from what they do" (Washington Post, 12/1).
UNAIDS Executive Director
Peter Piot said, "The lack of HIV treatment is without a doubt a global
emergency," adding, "We firmly believe that we stand no chance of halting
this epidemic unless we dramatically scale up access to HIV care. Treatment
and prevention are the two pillars of a truly effective, comprehensive
AIDS strategy" (New York Times, 12/1). Gilks said, "It is unacceptable
to let 8,000 people die every day from a treatable and preventable disease.
We hope this will be a universal framework" for treating HIV patients in
poorer countries with antiretrovirals (Wall Street Journal, 12/1).
Lee said, "The lives of millions of people are at stake. This strategy
demands massive and unconventional efforts to make sure they stay alive,"
adding, "This is a global health crisis." Richard Feachem, executive director
of the Global Fund to Fight
AIDS, Tuberculosis and Malaria, said, "HIV/AIDS is the greatest disease
recorded in human history. We have made a good start in prevention, particularly
in some countries. But in treatment we have hardly started and we must
rapidly accelerate effective treatment of HIV and people all over the world"
(BBC News, 12/1). He added, "The 'three by five' campaign is the
kick-start to that effort. It is the engine that will drive us forward
and expand access to treatment very rapidly. The world desperately needs
this." U.N. Secretary General Kofi Annan said, "The epidemic continues
its lethal march around the world, with few signs of slowing down," adding,
"We must work even harder to match our commitment with the necessary resources
and action" (BBC
News, 12/1).
UNAIDS Executive Director Peter Piot
in an interview with Jackie Judd, Kaiser Family Foundation Senior Visiting
Fellow and former correspondent with ABC News, said that he believes "success
is possible" in the fight against the HIV/AIDS epidemic. Piot discusses
prevention efforts, the campaign against stigma and discrimination, expansion
of access to treatment, including WHO's "three by five" plan, and what
he hopes will be accomplished by World AIDS Day next year. The interview
is available online.
Additional information on World AIDS
Day -- including webcasts; access to studies and key facts; and links to
resources and organizations around the world -- can be found online
on kaisernetwork.org.
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