- The Washington Times - Sunday, April 16, 2006

GENEVA — Lack of access to lifesaving anti-retroviral drugs and a chronic shortage of medical personnel impede efforts to improve treatment for millions of AIDS patients in sub-Saharan Africa, global studies show.

Unless strong efforts are made to secure funds and resources to expand prevention and treatment, officials fear, the gap may widen in many poor countries.

An ambitious global effort, “3 by 5,” begun in December 2003 was intended to treat 3 million patients by the end of 2005, or at least half of the people afflicted with HIV/AIDS in poor countries. An assessment shows that the effort was insufficient.

By the end of last year, 1.3 million people in developing countries worldwide were receiving anti-retroviral treatment, according to a progress report of the first two years of the “3 by 5” program prepared by the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS). That number represented 20 percent of those infected, an increase from the estimated 400,000, or 7 percent, two years earlier.

The most dramatic improvement came in sub-Saharan Africa, where the number of people receiving anti-retroviral treatment at the end of last year was more than 810,000, or 17 percent of those in need, compared with about 100,000, or 2 percent of those in need, two years earlier.

The increase in treatment helped avert more than a quarter-million deaths, the report said, though sub-Saharan Africa still lags behind Asia and Latin America. In Latin America, 68 percent of those needing treatment received it.

The improvement in sub-Saharan Africa was concentrated in three countries : Botswana, Uganda and Zambia. At the end of December, 85 percent of those needing AIDS therapy in Botswana were receiving it. In Namibia, 71 percent of those needing treatment obtained it, and in Uganda, the proportion being treated was 51 percent. Elsewhere, the percentages were lower: Swaziland, 31 percent; Mali, 31 percent; and Zambia, 27 percent.

For South Africa, which has the continent’s most advanced economy, the level of treatment was a disappointing 21 percent of the 983,000 in need of treatment. The numbers were bleaker in many other African countries, where fewer than 10 percent were treated.

In Nigeria, the continent’s most populous country, the coverage was estimated at 7 percent of the 636,000 people in need of treatment, and the level was also 7 percent in Ethiopia, Tanzania and Ghana. Treatment was even harder to obtain in Niger, reaching 5 percent of those in need; the Democratic Republic of the Congo, 4 percent, and war-ravaged Somalia, 1 percent.

Drug costs a hurdle

The report said the cost of the drugs is one impediment to improving anti-retroviral therapy.

“The price of first-line anti-retroviral therapy regimens remains high, and the cost of second-line regimens is prohibitive for most countries,” it said.

Doctors Without Borders has voiced similar concerns.

“Growing numbers of people who have been on AIDS treatment for several years will increasingly need access to newer, second-generation medicines that remain priced out of reach or are not available at all,” the humanitarian group said. “Without a reliable supply of low-cost AIDS drugs, national governments and treatment providers will be faced with an uphill battle, and patients risk having vital treatment interrupted or priced out of their reach.”

The WHO and UNAIDS report said the average price paid for first-line treatment of HIV/AIDS in poor countries ranged from $148 for the fixed-dose combination of stavudine, lamivudine and nevirapine to $549 for the fixed-dose combination of zidovudine plus lamivudine and a single dose of efavirenz.

The average price of the two combinations was about $268 per person per year, the report said.

It also identifies constraints in procurement of drugs, diagnostics and weaknesses in health care systems as factors holding back the expansion of treatment.

The WHO annual report for 2006, issued on April 7, said the chronic shortage of health care workers in 57 poor nations, including 36 in sub-Saharan Africa, is affecting the delivery of lifesaving medical interventions.

“The number of health workers is stagnating or even falling in many places where they are needed” said Dr. Lee Jong-wook, director-general of WHO.

The WHO report said Africa has 24 percent of the global disease burden but only 3 percent of the health workers and less than 1 percent of global health expenditure.

Medical ‘brain drain’

The shortage is aggravated by the migration of doctors and nurses to better-paid jobs in rich countries such as the United States, Canada, Britain and Australia.

Close to a quarter of doctors trained in sub-Saharan Africa are working in rich countries, and for some countries such as Ghana and South Africa, the percentages are higher, at 29 percent and 37 percent, respectively.

To address the shortage, the WHO said more should be spent on training health care workers, and rich countries should adopt “responsible [medical] recruitment policies.” Its report noted that Africa has only 66 of the world’s 1,691 medical schools and 288 of the world’s 5,492 nursing and midwifery schools.

The report noted an urgent need to prevent mother-to-child HIV transmission. It said that during 2003 and 2005, “fewer than 10 percent of HIV-positive pregnant women received anti-retroviral prophylaxis before or during childbirth. As a result, 1,800 infants were born with HIV every day.”

The shortfall of money is a serious obstacle to global efforts to fight HIV/AIDS in poor nations, the report said. From 2003 to 2005, global outlays increased from $4.7 billion to 8.3 billion. Between 2005 and 2007, the report reckons a funding gap of $18 billion.

“The response of international donors and national funders, while ever more robust, has not been sufficient to meet this effort,” said Dr. Lee and UNAIDS Chief Dr. Peter Piot.

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