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HIV treatment will boost prevention and strengthen health systems, says The world health report 2004

By using HIV treatment programmes to bolster existing prevention efforts and improve overall health systems in the developing world, the international community has a unique opportunity to change the course of history, says The world health report 2004 — changing history, launched by WHO in Geneva on 11 May.

AIDS-related illnesses are the leading cause of death among people between 15 and 59 years of age, with 34 and 46 million HIV-positive people worldwide and 5 million new infections every year, says the 170-page report. Tackling the disease, which has already killed more than 20 million people and has led some countries in Africa to the brink of economic collapse is described by the report as "the world's most urgent public health challenge."

Over US$ 20 billion has already been pledged for the global strategy to combat HIV/AIDS from donor countries, multilateral funding agencies such as the Global Fund to Fight Aids, Tuberculosis and Malaria, the US President's Emergency Plan for HIV/AIDS, and the World Bank.

"At long last, global investment in health — and particularly in the fight against HIV/AIDS — is on the rise," said WHO Director-General, Dr LEE Jong-wook. "The challenge now is to coordinate all our efforts and to ensure that this money benefits the people who need it most."

According to Richard Feachem, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, finance and the cost of drugs — which can now be purchased for as little as US$ 150 per person per year — were no longer the binding constraints they once were. The Global Fund hopes to raise "the lion's share" — about 60% — of the US$ 5.5 billion which WHO says is needed over the next two years to finance the initiative.

The report focuses on the urgent need for treatment and in particular the global initiative to provide three million people in developing countries with antiretroviral therapy by the end of 2005 – the "3 by 5" initiative. It points out that treatment has been the most neglected aspect of the fight against HIV/AIDS to date in most developing countries: less than 7% of the six million HIV-positive people in the developing world who need treatment actually have access to it.

"Scaling-up effective HIV treatment and prevention programmes is the best strategy to save lives and keep future generations HIV-free," said UNAIDS Executive Director, Dr Peter Piot.

Treatment is also crucial in preventing economic collapse faced by several countries in sub-Saharan Africa as a result of the heavy toll taken by the disease, says the report. It says that the long-term economic and social costs of the disease have been seriously underestimated in many countries.

"HIV/AIDS is crippling the most important portion of the population — young adults in their prime. It is depriving communities of doctors, teachers and lawyers, as well as farmers, miners and police officers and it is depriving children of their parents," said Dr Jim Yong Kim, Director of WHO's HIV Department. "By bringing people back from the brink of death to lead normal and productive lives, antiretroviral treatment can help prevent an economic and social catastrophe."

The report highlights the role of the "3 by 5" initiative as a catalyst for the strengthening of health systems by attracting resources in addition to those for HIV/AIDS, stimulating investment in physical infrastructure, developing procurement and distribution systems which can benefit other diseases and fostering interaction with communities.

"By tackling [HIV/AIDS] decisively, we will also be building health systems that can meet the needs of today and tomorrow," said Dr LEE.

The report also says that scaling-up treatment supports and strengthens prevention programmes. It cites examples of places where treatment has been made available stimulating an "overwhelming demand" for HIV testing and counselling services. "Knowledge of HIV status is the single most important factor contributing to behaviour change," said Dr Kim who explained that people who know they are HIV-positive are less likely to pass on the virus to others.

Richard Feachem said that the overwhelming constraint to achieving "3 by 5" was the capacity of countries to deliver drugs to those who need them. By March 2004, 48 of the countries with the highest burden of HIV/AIDS had requested technical assistance and guidelines for the development and implementation of treatment programmes from WHO.

Coinciding with the launch of the report, the Canadian Government announced a contribution of CAD 100 million over two years to assist WHO in its contribution to achieving the "3 by 5" target. According to Dr Kim, the majority of this will be used to assist countries in scaling-up treatment by training personnel and setting up diagnostic facilities.

For a perspective on The world health report, see the related editorial in this month's issue of the Bulletin (p. 400).

The world health report is available at: http://www.who.int/whr/2004/en/