Analysis: Worldwide AIDS goal out of reach

By ED SUSMAN and MICHAEL SMITH, United Press International

BANGKOK, July 11 (UPI) -- The ambitious worldwide goal of getting 3 million of the sickest AIDS victims treated with state-of-the-art, drugs by the end of the year apparently is out of reach -- beset by shortfalls in funding and in putting together the foundations to make the project work.

As the keynote speaker at the 15th International AIDS Conference Sunday, U.N. Secretary-General Kofi Anan admitted: "We are not doing nearly well enough. We are not on track to begin reducing the scale and impact of the epidemic by the year 2005, as we had promised."


The World Health Organization, buoyed by early success in the fund-raising ability of the Global Fund to Fight AIDS, Tuberculosis and Malaria, had declared in 2003 a goal of treating 3 million people with AIDS by the year 2005 -- called the "3 by 5" initiative.


That effort has been slow to move off of the starting blocks. With less than 18 months to go before the end of 2005, the cumulative world effort has:

-- Managed to put 440,000 people worldwide -- from non-wealthy countries -- under anti-retroviral treatment. That means more than 2,500,000 people must be added to the treatment rolls to complete the project successfully, although treating 3 million actually means 3 million other people will die of AIDS because 6 million people should be under treatment today, the WHO says.

The human immunodeficiency virus, which causes AIDS, is a retrovirus.

-- Trained 15,000 health care workers to deliver the anti-retroviral treatment -- but 85,000 more people need to be trained.

-- Identified 500 treatment centers to distribute the drugs -- about 5 percent of the total needed.

At a news briefing prior to the opening of the AIDS conference, officials of the World health Organization argued the efforts thus far to achieve the 3-by-5 goal appear to be struggling, but the organization and its worldwide partners still might be a position to make geometric leaps in treatment because of the foundations that have been laid.

"Important work has been done in just a few months to build the framework to guide countries in their efforts to get AIDS treatment to the people who need it," said Dr. Lee Jong-wook, director-general of the WHO in Geneva, Switzerland.


WHO officials struggled, however, to explain the figures in their own report.

For example, officials repeatedly said the number of patients on treatment had doubled, from around 200,000 at the end of 2002 to 440,000 today. Yet, they referred to that increase as a 50 percent change. A doubling of the numbers would be a 100 percent increase.

Nor were they able to explain where the 440,000 number came from. They noted that 187,000 patients were in the 49 countries considered target nations for treatment. Another 140,000 were under treatment in Brazil. That nation is delivering on its promise to treat everyone infected with HIV.

The total creates a shortfall of 113,000 people, however, who presumably live in non-targeted, non-poverty-stricken nations. More confusing was the report's notation that, in Costa Rica and Panama, more patients were being treated than that the original 3-by-5 goal had estimated.

Despite being unable to produce satisfying answers to reports' questions about the discrepancies, Dr. Jim Yong Kim, director of HIV/AIDS at WHO said: "We are moving in the right direction, but too slowly. We now have 18 months for governments, non-governmental organizations and other partners to rapidly increase the availability of prevention, treatment and care in developing countries."


The WHO figures controversy was not the only one that had arisen even before the conference opened Sunday.

Earlier, at a symposium on AIDS issues, the editor of the Journal of the American Medical Association accused the Bush administration of playing "petty politics" in limiting the size of the U.S. delegation to the International AIDS conference.

Dr. Catherine DeAngelis charged the administration was seeking payback against the conference because Tommy Thompson, the U.S. secretary of Health and Human Services had been shouted down by angry AIDS activists in 2002 in Barcelona. Instead of a corps of several hundred people, as in previous years, just 50 individuals were sent from the Centers for Disease Control and Prevention.

DeAngelis said one of the people not making the trip was the author of a paper describing the successful use of a rapid test to identify women in labor who were infected with the virus. Knowing if a woman is HIV-infected can allow medical interventions that can prevent transmission of the virus to the child.

Dr. Marc Bulterys, a CDC physician based in Malawi, in Africa, was the lead author of the paper and was invited by JAMA to present his findings at the special news briefing Sunday. He was not allowed to attend by the CDC, even though the journal had offered to pay his expenses.


In response to questions, Dr. Ron Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention, said: "Dr. Bulterys was not included in the delegation to Bangkok for the meeting. The CDC offered to have a member of the delegation fill in for Bulterys, but JAMA refused."

Dr. Marge Cohen, of Cook County Hospital in Chicago and a co-author of the paper, presented the findings.

Dr. Joep Lange, president of the International AIDS Society, said the cutback in the U.S. presence at the meeting was "shameful -- and that is a conservative term."

In the opening ceremony of the conference, Anan warned unless efforts were made to control the epidemic in Asia, the region is in danger of following Africa into a horrendous death spiral that will not only take a huge toll of human life, but also will dramatically disrupt economic development.

One in four new HIV infections occurred in Asia last year, Anan said, and the virus is "spreading at an alarming rate. There is no time to lose if we are to prevent the epidemic in Asia from spinning out of control."

Other speakers, including Thai Prime Minister Thaksin Shinawatra, said there are signs of hope, however.


Shinawatra said Thailand has been successful so far in resisting the epidemic, and is expanding its program of providing anti-HIV drugs free to pregnant women who are infected.

In addition, he said, the Thai government has set aside $20 million to make anti-HIV drugs available for up to 40,000 patients and the Global Fund will pay for treatment for another 10,000.

"I believe ... there is light at the end of the tunnel," Shinawatra said.


Ed Susman covers medical issues and research for UPI Science News. E-mail [email protected]

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