3 X 5 – Responding To A Global Crisis
Some 6 million people infected with HIV in the developing world need access to antiretroviral (ARV) therapy. Only 300,000 have this access. The failure to deliver ARVs to the millions of people who need them is a global health emergency. To address this emergency, WHO is fully committed to achieving the “3 by 5 ” target – getting 3 million people on ARVs by the end of 2005. This is a means to achieving the treatment goal: universal access to ARVS for all who need them. WHO will lead the effort, with UNAIDS and other partners, using its skills and experience in coordinating global responses to diseases such as the effective and rapid control of SARS.
To achieve the 3 by 5 target, WHO will:
- Provide Emergency Response Teams at the request of governments, with the support and involvement of partners including the UN system and NGOs. The priority will be teams for high burden countries where the treatment gap is most urgent. These teams will work with treatment implementers and will conduct a rapid assessment of the barriers and opportunities that exist in achieving the 3 by 5 target;
- Establish an AIDS Drugs and Diagnostics Facility to assist countries and implementers navigate in drug purchasing and financing, while considering best prices and quality. This is one of the most significant barriers faced by countries. Without effective systems to help purchasers, the time and effort needed to get drugs and diagnostics into countries will grow as the number of people on treatment grows.
- Publish simplified treatment guidelines by 1 December. These guidelines will make ARVs relatively simple to administer.
- Publish by 1 December uniform standards and simplified tools to track the progress and impact of ARV treatment programmes, including surveillance of drug resistance to capture the full impact of antiretroviral therapy.
- Start the emergency expansion of training and capacity development for health professionals for delivering simplified, standardized ARV treatment. WHO will support those partners already involved in training, and work with countries to help build a critical mass of highly competent and skilled trainers to expand national capacity for ARV delivery.
- Advocate for funding, together with UNAIDS and other partners. Achieving the 3 by 5 target will require not only funding for drugs but a massive investment in training and in strengthening health services in countries. Health systems strengthening will benefit ARV delivery, but
Why is 3 by 5 so urgently needed?
- More than 20 million people around the world have already died of AIDS, and at least 42 million more are infected. Sub-Saharan Africa is the hardest hit continent, with one out of 10 adults – more than 28.5 million – currently living with HIV/AIDS. Prevalence in southern Africa is particularly high. For example, Lesotho has HIV rates as high as 31% and Botswana as high as 38.8%.
- Of the estimated 6 million people in developing countries in immediate need of AIDS treatment, less than 300,000 now have access to ARVs. In Africa, just 1% of HIV positive people – 50,000 out of 4.1 million who need it – have access to treatment.
- At current rates of delivery, less than one million people in the developing world will have access to ARV treatment by the end of 2005.
- By robbing communities and nations of their greatest asset – their people – AIDS drains the human and institutional capacities that drive sustainable development. This, in turn, distorts labour markets, disrupts production and consumption, erodes productive and public sectors and ultimately diminishes national wealth. A World Bank report warns that HIV/AIDS causes far greater long-term damage to national economies than previously assumed.
- Prevention strategies will not solve the current health crisis in the most severely affected countries unless parallel treatment strategies are put in place to help people already living with HIV/AIDS.
- Delivering treatment for HIV/AIDS in the developing world is necessary if the international community is to live up to commitments on human rights, the Millennium Development Goals (MDGs) and the Declaration of the United Nations General Assembly on HIV/AIDS.
Who needs ARVs and how do they work?
- Without access to ARV drugs, the lives of infected people follow an inevitable course: progressive destruction of the immune system, increasing ill-health and episodes of life-threatening associated diseases, (e.g., tuberculosis or pneumonia), wasting, and ultimately death.
- When ARV drugs are given in combination (three drugs together), the rate at which the virus reproduces itself is reduced and the body’s immune system can partly regenerate itself, thereby restoring health and quality of life.
- WHO recommends that ARV therapy should be started when the damage caused by HIV to the immune system reaches a certain threshold, as indicated by clinical condition and/or laboratory tests, including CD4 cell count. When CD4 testing is not available, simpler laboratory tests can be used.
What are the benefits of access to ARV treatment?
- ARV medicines have dramatically reduced death rates, prolonged lives, improved quality of life, revitalized communities and, to a large extent, transformed HIV/AIDS from a fatal condition to a manageable illness.
- While there is still no cure for HIV/AIDS, ARV treatment can add many years of healthy life to an infected person. In high-income countries, an estimated 1.5 million people currently live with HIV/AIDS. Most of them lead productive lives, largely due to ARV therapy. In the US, for example, the introduction of triple combination ARV therapy in 1996 led to a 70% decline in deaths attributable to HIV/AIDS.
- Delivering ARV therapy has other returns. Millions of dollars spent now can save billions in the future. Data from Brazil indicate that the costs associated with providing universal access to ARV therapy from 1996 to 2002 amounted to US$1.8 billion, but the savings in hospital and ambulatory care services reached US$2.2 billion – not to mention the broader savings related to teachers who keep on teaching, parents who remain with their children, and farmers who continue to work on their land.
- Brazil has also proven that it is possible to contain HIV/AIDS in resource-poor environments with relatively weak health infrastructures. It has delivered free ARVs to virtually every AIDS patient in need – in spite of the size of the country and its large population. From 1996 to 2002, Brazil saw a decrease in mortality rates of 40%-70%, morbidity rates of 60%-80%, plus a seven-fold drop in hospitalization needs.
- The availability of ARV therapy makes it more likely that people will come forward for HIV testing, learn their status, receive counselling and care and become knowledgeable about preventing the spread of the virus. Access to treatment will reduce the fear, stigma and discrimination associated with HIV/AIDS, thereby enabling societies to discuss the epidemic more openly and to prevent new infections more effectively.
What progress has been made so far?
- There is awareness that prevention and treatment are both necessary for controlling the spread of HIV/AIDS and that these two approaches are mutually reinforcing elements of a comprehensive response to HIV/AIDS.
- There has been a significant reduction – more than 90% in some cases – in the price of ARV drugs offered to all sub-Saharan African countries, reducing costs from about $10,000 per year to as low as $300 for some combinations.
- Many developing countries, including several in Africa, have made a promising start by showing that ARV treatment is not only implementable, but also affordable and sustainable.
- A World Trade Organization decision in late August 2003, allowing poorer nations to import generic versions of patented antiretroviral drugs under certain circumstances, can facilitate the provision of low-cost drugs for people living with HIV/AIDS in developing countries.
- There are growing numbers of partners engaged in the response to the epidemic, and continuing forceful activism and advocacy by people living with HIV/AIDS and civil society.
- The increased availability of international financial resources, including the creation of the Global Fund to fight AIDS, Tuberculosis and Malaria, signals a renewed commitment by the international community to the global fight against AIDS.
The way forward
- At the UN General Assembly High-Level Meeting on HIV/AIDS on 22 September 2003, the World Health Organization declared the lack of access to HIV treatment a global health emergency.
- WHO is committed to lead the way towards the ambitious 3-by-5 target. Working with a wide range of partners, including UNAIDS, there will be urgent action to see that 3 million people are on ARVs by the end of 2005.
 CD4 (T4) or CD4+ cells are white blood cells killed or disabled during HIV infection. These cells normally orchestrate the immune response, signalling other cells in the immune system to perform their special functions.