WHO hopes 3-by-5 plan will reverse Africa's HIV/AIDS epidemic



Fiona Fleck




WHO together with UNAIDS, unveiled plans on 1 December, World AIDS Day, to get urgently-needed treatment to millions of AIDS patients in developing countries, as the global HIV/AIDS pandemic hit grim new highs according to a recent UNAIDS/WHO report.

The AIDS Epidemic Update 2003, released on 25 November, said that 40 million people — 5 million of whom were infected in 2003 — were living with HIV/AIDS. It said that over two-thirds of the world's HIV/AIDS cases were in southern Africa but that now the virus was spreading fastest in eastern Europe and central Asia, where the number of cases tripled between 1999 and 2002.

WHO's plan to get antiretroviral (ARV) treatment to 3 million people by 2005, known as the 3-by-5 initiative, is seen as a vital step to providing universal treatment for AIDS patients across the world.

"Antiretroviral therapy was hailed in the 1990s as a triumph of modern science. Experts and the media proclaimed ... the defeat of AIDS ... . Sadly, that optimism was misplaced," WHO Director General, Dr LEE Jong-wook, told high-profile guests at the "3-by-5" launch in Livingstone, Zambia.

LEE said that WHO's 3-by-5 initiative had been made possible by the current political and financial attention being paid to AIDS by multilateral institutions such as the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria, coupled with US President George Bush's pledge to donate US$ 15 billion to AIDS treatment and other pledges from groups like the Bill and Melinda Gates Foundation. All of this has been further complemented by the efforts of pharmaceutical companies to reduce the prices of patented AIDS drugs.

LEE said the initiative had in part been inspired by groundbreaking work by nongovernmental organizations such as Medécins Sans Frontières and that its success would depend on national and international agencies and "critically, the courageous contributions of national governments, especially in Africa, to increasing their people's access to ARV-based AIDS care."

Under the new WHO plan, about 100 000 new paramedics and nurses in developing countries will be trained to provide simplified treatment and prescribe newly-WHO-approved fixed-dose combination drugs to AIDS patients.

The single pills — which have recently been added to the ""Prequalification" list of medicines meeting WHO standards — contain three drugs: lamivudine, stavudine and nevirapine which temporarily suppress viral replication and improve symptoms. Two of those fixed-dose triple combination drugs are produced by Indian generic drugs company Ranbaxy and the third, by India's Cipla.

Fixed-dose drugs have proved successful in treating malaria and tuberculosis. Whether in the form of a single pill or a "blister" pack containing three pills, such triple combinations are cheaper to deliver, provide medication that is easier for patients to follow than three separate pills and can be prescribed by medical staff who are not qualified doctors.

The WHO Prequalification Project — part of the 3-by-5 strategy — aims to assess the quality, safety and clinical efficacy of HIV medicines distributed in developing and transition countries. Currently the Prequalification list contains over 50 single-drug, two-drug and three-drug combinations, including the three newly-qualified products. The Prequalification Project is a core element of the new AIDS, Medicines and Diagnostics Service (AMDS), a new mechanism created to make sure that the supply of safe, effective and affordable medicines of good quality are more easily accessible.

UNAIDS Executive Director, Dr Peter Piot, said he hoped that once ARV treatment was widely available in the developing world more people would come forward to be tested and that this would help raise awareness of the disease and stem the spread of the deadly virus.

"Most people in Africa or outside Africa who are infected with HIV have no clue that they are [infected] because there is no access to testing facilities, but above all there is no incentive to know because there's no treatment at the end of the test — all there is is discrimination, rejection, losing your job," Piot told the BBC in a recent interview.

The 3-by-5 launch coincided with two reports highlighting the impact of the disease in developing countries. A report on the state of food insecurity in the world in 2003, published by the UN Food and Agriculture Organization concluded that AIDS has had a devastating effect on agriculture and food supply in poor countries by decimating adult populations, including one fifth of farm workers across southern Africa.





UNICEF also issued a report on the effects of HIV/AIDS predicting that the number of AIDS orphans (children who have lost either their mother or both parents) would nearly double to 20 million in sub-Saharan Africa — as many as 12% of all the region's children — in the next seven years.

In an attempt to reduce the economic impact of the disease, seven major international companies joined forces with the Global Fund to Fight AIDS, Tuberculosis and Malaria to boost prevention and treatment of HIV/AIDS for their employees and their families in Asia and Africa. The initiative, dubbed the Global Business Coalition, comes after years of seeing their workforces decimated by the killer disease and won praise from US Secretary of Health, Tommy Thompson, who was in Nairobi, Kenya, for its launch on 3 December.

South Africa's electrical utility Eskom and mining group AngloAmerican, US oil giant Chevron Texaco, US–German automobile group DaimlerChrysler, Dutch brewer Heineken, French construction firm Lafarge and India's Tata Steel said they would use company facilities to expand HIV/AIDS treatment and prevention in the workplace.

The International Federation of Red Cross and Red Crescent Societies said its ability to function was being threatened by the pandemic as it announced a new fund to provide antiretroviral treatment for some 200 000 workers and volunteers living with HIV/AIDS.

World Health Organization Genebra - Genebra - Switzerland
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