'3by5' disappointment stresses for more comprehensive services

The two UN agencies, who share responsibility for tackling the global pandemic, have highlighted progress during the past 18 months towards greater ARV access, and report that one million people living with HIV/AIDS (PWHA) in developing nations are now taking life-saving ARV drugs. They had hoped three million people would have access to the medicines by the end of 2005, but that now looks out of reach.

What the report fails to adequately address is the plight of the five million people who already require ARV drugs but cannot access them. In Bangladesh, it is estimated that roughly 12,000 people are living with HIV/AIDS and an estimated 1,000 are in need of ARV treatment. However, only a fraction (one fifth) of the people in need are actually receiving the life-saving drugs.

"Current progress in scaling up of ARV provision in my local context is totally disappointing. ARVs are not available." States K. Zaman of AAAD, an organisation working on HIV/AIDS in Dhaka.

The 3by5 disappointment indicates that where large unmet ARV needs persist, a broad package of other readily-available treatment and care options should be urgently provided to keep PWHAs alive while they wait for ARV programmes to deliver on their promise.

"Should we forget the unfortunate PLWHA, not covered by ARVS" asks S.M Rafiqul Islam of HIV/AIDS Cell, a local NGO. "What sort of ethics it is? What about the other components of the package for PWHA in general" he continues.

Given that Bangladesh is one of 22 countries home to over 80 per cent of the global tuberculosis (TB) cases, one much needed care component crucial to extending lives is the prevention and treatment of the HIV-associated opportunistic infections (OIs), such as TB.

Reducing HIV related stigma is also vital in the fight against HIV/AIDS. "Those who are suffering from AIDS do not want to come forward for identification of their suffering and HIV disease. So initiative should be taken so that the AIDS patients can be identified through encouraging them or by giving them facilities that are safe and empowering. And this operation should be implemented at the grassroots level. Then we will all benefit" states Zaman.

Finally acknowledging the 3by5 delay has also prompted speculation globally on the nature of such international initiatives, and about what might now replace the 3by5 target as a goal to maintain the momentum that the drive for ARVs has generated.

"WHO launched 3by5 with a loud voice but without having a clear plan at the national level for urgent treatment scale-up. Because of this, the 3by5 goal will not be met and the small confidence we have in multilateral institutions is further destroyed. We need a global plan that builds upon specific national plans." said Marcel van Soest, Executive Director of the World AIDS Campaign. "For example, how can we move towards universal drug access in countries like Sudan, Zimbabwe, and Afghanistan? Unless we draw on the real lessons of the past 18 months, how can we build confidence in WHO, UNAIDS and in this whole endeavour?"

Earlier this month, G8 finance ministers referred to the need to mobilise sufficient money to achieve 'universal access' to ARVs by 2010. This even larger ARV treatment target is now being put forward by some organisations as the way forward, and they hope that the full G8 meeting in Scotland next month will fully embrace such a goal.

"The failure of 3by5 to reach its target is not just another missed opportunity. It is an indictment of leaders in rich and poor countries that failed to back it and save the lives that needed saving," said Leonard Okello, International HIV Coordinator at ActionAid International in response to the WHO/UNAIDS report. "The G8 meeting next month has the chance to make amends. They now need to commit themselves to a target that all who need treatment will be receiving it by 2010 and make sure this happens," he added.

Others are more skeptical of a new target being set on the heels of the known 3by5 failure. "What about the people dying now? Why are we talking about universal access by 2010 when we could not even reach the goal of 3by5?" van Soest asked. "There are many simple, concrete care and treatment options available to keep people alive now, we need to provide people with a comprehensive health programme, only focusing on ARVs is too narrow."

Dr Alice Welbourn of the International Community of Women Living with HIV/AIDS added: "This year alone there will be over 10 times the number of Indian Ocean Tsunami deaths caused by AIDS-related illnesses. World leaders have shown that they can respond to one horrendous crisis when pressurised by their citizens to do so. When are they going to start to respond meaningfully, with real resources and real commitment to the global crisis of HIV/AIDS?"

"We HIV-positive people are their early warning system. We have been warning the world for over 20 years now what AIDS means to our lives, our families, our communities. How many more of us will have died before we hear an answer?"

In 2005 alone, an estimated three million people will lose their lives as a result of HIV/AIDS -- or over 8,000 every single day. There are currently around 40 million people living with the virus.

Bobby Ramakant is Campaign Coordinator (South Asia), Email: bobby@hdnet.org