- The Washington Times - Wednesday, February 2, 2005

GENEVA - Global efforts to extend drug treatment to millions of AIDS sufferers — nearly three-quarters of whom live in sub-Saharan Africa — picked up momentum in 2004, but major obstacles still need to be overcome, international health officials said last week.

“Many countries need to increase their efforts, money is short, and international organizations need to become much faster in assisting countries,” concluded the latest “3 by 5” progress report by the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS), published Jan. 26.

The “3 by 5” objective, announced in 2003, is to ensure that 3 million people living with AIDS receive treatment by the end of 2005. The goal is projected to cost as much as $3.8 billion to achieve.

The top leaders of WHO, Dr. Lee Jong-wook; the Global Fund to Fight AIDS, Tuberculosis and Malaria, Dr. Richard Feachem; UNAIDS, Dr. Peter Piot; and Randall Tobias, the U.S. global AIDS coordinator, praised the advances attained in AIDS treatment last year at a news briefing last week in Davos, Switzerland.

“We salute countries that have shown us treatment is possible and can be scaled up quickly, even in the poorest setting,” Dr. Lee said.

Said Mr. Tobias: “The heart and soul of President Bush’s emergency plan for AIDS relief is to work shoulder to shoulder with host governments and our other partners in those nations in support of the national strategy of each country.”

By the end of 2004, about 700,000 AIDS patients in poor countries were receiving antiretroviral (ARV) treatment, up 75 percent from a year earlier and from 440,000 last July.

Though a gain, the 700,000 figure is just 12 percent of the estimated 5.8 million adults in poor countries who need ARV therapy. Of the 5.1 million who still lack ARV treatment, said the “3 by 5” report, 72 percent live in sub-Saharan Africa and 22 percent in Asia.

In sub-Saharan Africa, the WHO and UNAIDS in their latest “3 by 5” progress report estimate that the number of people receiving ARV treatment “has doubled over six months from 150,000 to 310,000” — about 8 percent of adults who need such therapy.

The report highlights that progress varies among countries. Botswana, Namibia and Uganda showed the largest increases in ARV treatment among African countries.

In Botswana, the number of facilities offering ARV therapy nearly doubled from 12 in 2003 to 23 sites at the end of 2004, covering all but a few districts in the country.

By March 2004, Botswana also had trained 2,212 health workers, the report said, including physicians, nurses, pharmacists, counselors and other health workers. As a result, of the estimated 75,000 people ages 15 to 49 needing therapy, half were receiving treatment at the end of 2004.

Similarly, the percentage of adults with AIDS receiving treatment in Uganda at the end of December stood at 40 percent.

The number of AIDS patients receiving ARV treatment is very low in some African countries, however. In Nigeria, where an estimated 558,000 people 15 to 49 years old have AIDS, only 2 percent are receiving anti-retroviral treatment.

In the war-ravaged Democratic Republic of the Congo, which has 167,000 adult AIDS sufferers, only 2 percent have been introduced to ARV treatment, and in Mozambique, only 4 percent of the estimated 199,000 infected adults have received treatment.

Asked about the low treatment figures in Nigeria, the Democratic Republic of the Congo and Mozambique, Dr. Piot of UNAIDS told The Washington Times that the Democratic Republic of the Congo’s civil war was a major reason in that country, and he noted that Mozambique lacks clinics. As for Nigeria, Dr. Piot said: “It’s a huge country, and it takes more time to get things off the ground.”

Dr. Piot and other AIDS experts are nevertheless optimistic that if the momentum is continued, the target for 2005 will be met.

The “3 by 5” report noted that many African countries are putting in place the necessary medical infrastructure to deliver more solid results.

Cameroon — which has an estimated 560,000 people living with HIV or AIDS, of whom 95,000 need ARV treatment — had managed by the end of 2004 to put 14 percent on ARV treatment.

The report said Cameroon also has set up 14 counseling and prevention centers in provincial areas, and 160 sites for preventing mother-to-child HIV transmission, as well as 21 certified ARV treatment centers.

The report said treatment also “provides an opportunity to strengthen prevention,” but added: “Prevention is needed more than ever to turn around the epidemic.”

Experts suggest that integrating prevention and care might prevent more than 29 million infections and cause 10 million fewer deaths, it said.

Under new affordable-drug strategies, a year of ARV treatment can cost patients $300 to $400. In some countries — for example, Brazil and, recently, Zambia — such payments are waived. The treatment has been shown to improve the survival rate of AIDS patients.

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