Slow progress in ARV rollout says new WHO, UNAIDS report

With just six months to go before the end of the year, it seems unlikely that the World Health Organisation's (WHO) campaign to put three million people in the developing world on anti-AIDS drugs by the end of 2005 will be met. An estimated 1 million people are currently receiving antiretroviral (ARV) treatment, according to the third progress report on the '3 by 5' initiative, released on Wednesday by the World Health Organisation (WHO) and UNAIDS. This figure fell short of the 1.6 million target set by WHO and UNAIDS for June 2005, the report noted. African governments have cranked up the rollout of anti-AIDS drugs to their HIV-positive citizens and about half a million people in sub-Saharan Africa are currently receiving the life-prolonging medication - a three-fold increase in the last 12 months. However, the demand for treatment was "outstripping" the capacity of most African countries to supply it. The report highlighted an "urgent need" for increased resources and technical support to maintain momentum in scaling up. Despite the progress that has been achieved, children were still neglected by most national treatment programmes, and WHO and UNAIDS estimated that 660,000 children globally needed access to ARVs. According to the report, "probably less that 5 percent" of the 1 million people on treatment in the developing world were children. Financial constraints remained a major obstacle to obtaining treatment for many HIV-positive people. "There is increasing evidence that charging fees for ART [antiretroviral therapy] at the point of service delivery presents a major barrier to access for poor people in many countries, and can depress rates of adherence to treatment as well as treatment uptake," the report warned. As access to treatment was expanding, new opportunities for prevention were also emerging. Kenya, for example, had reported a dramatic increase in the number of people tested and counselled between 2000 and 2004 as the result of a major expansion of testing sites in clinics and communities. The report stressed that the push to expand access to ARVs in poorer countries "did not begin, and will not end with 3 by 5". But for most of the countries hardest hit by the pandemic, wide distribution of the medication would only be sustainable with "substantial external resources". Admitting that "progress has been slower than expected", WHO and UNAIDS called for the target to be seen as "an important milestone", as the current momentum in expanding treatment access was encouraging. To access the report: www.who.int