Brazzaville, 26 January 2005 -- Developing countries, several of them in sub-Saharan Africa, made steady progress in 2004 towards meeting the global target of reaching three million people living with HIV/AIDS (PLWA) with antiretroviral (ARV) treatment in 2005 (the "3 by 5" target), WHO and UNAIDS say in a joint report released Wednesday.

"Initial data (for 2004) show adherence and treatment rates in developing countries are similar to if not higher than those obtained in affluent countries," WHO Director General Dr LEE Jong-wook and UNAIDS Executive Director Dr Piot say in their foreword to the report.

The report illustrates the "enormous progress" made in sub-Saharan Africa during the second half of 2004 with the number of service delivery points which had increased to well over 1,000 in the region, leading to a sharp rise in the number of people starting treatment. During the same period, the number of people on treatment in sub-Saharan Africa doubled, rising from 150,000 to 325,000. Five of the countries - Botswana, Kenya, South Africa, Uganda and Zambia - ensured that the number of people receiving treatment increased by more than 10,000 in each country.

WHO estimates that more than four million of the 25.4 million people living with HIV/AIDS in Africa are in need of antiretroviral (ARV) treatment, but only 315,000 (7.9%) of these have access to it.

Treatment works 

Quoting empirical data to show that treatment works, the report cites studies in Botswana and Senegal where treatment benefits to individuals have been "dramatic", as survival rates after treatment for 15 months were estimated at 91% and 80% respectively. Similar encouraging results were observed elsewhere in the WHO African Region.

"As the health of people living with HIV/AIDS improves, we are beginning to see the rejuvenating impact on families, communities and economies", states the report.

Political will

Political will has been key to the progress made in implementing the "3 by5" plan during the year under review.

For example, in Cameroon where 49,000 of the estimated 560,000 PLWA die of the disease every year, a dramatic decrease in treatment costs from US$600 to US$30 per month in four years has facilitated treatment scale-up.

The report also attributes the progress made to partnership, pointing out that in 2004, at least 136 partner organizations worldwide mobilized around the "3 by 5" target as advocates, donors, advisers, collaborators and providers of funding and technical and other services. Similarly, community-based organizations played a pivotal role in several African countries such as Burkina Faso, Burundi, Mali, Kenya and Nigeria.

Funding

Funding has also been a critical success factor, with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) disbursing US$600 million in 2004 from receipts of US$3.2 billion against pledges of about US$5.8 billion. The United States President's Emergency Plan for AIDS Relief (PEPFAR) spent US$2.4 billion worldwide. The governments of Canada, the United Kingdom, Italy, Norway, Sweden, Belgium, Spain, Luxemburg, as well as bodies such as the World Bank and the OPEC Fund for International Development also made significant contributions.

The report notes that, in spite of the steady progress recorded during the year under review in increasing the number of people with access to ART, coverage in sub-Saharan Africa remains low, at 8%. Treatment for children is still a neglected issue although the number of women on therapy has increased as rapidly as that for men.

Overall, the report also sends out a clear message: prevention and treatment go together. It says, "Prevention and treatment must be synergistic, and achieving the "3 by 5" target involves scaling up both. Effective treatment is a form of prevention as it lowers viral load and decreases the chances of transmitting HIV. The more people learn about HIV and AIDS, the better able they are to prevent transmission and to protect themselves from opportunistic infections. If they test negative, they can take measures to protect themselves and their families from getting infected."

Prospects for 2005

The report says that for the world to achieve the "3 by 5" target on schedule, 2.3 million people in need of ARV treatment worldwide will have to have access to treatment this year.

Using a recent Zambia treatment model with an average drug cost of US$304 per person per year as a standard and applying it to 49 countries, the report estimates that between US$ 3.55 billion and US$ 3.8 billion would be required in 2005.

Based on pledges, about US$1.5 billion would be available in 2005 from developing and transitional country sources, the GFATM, the World Bank and other donors. This would still leave a funding gap of more than US$2 billion.

"Clearly, the equation does not balance", the report says. "The level of international commitment to the "3 by 5" target must be matched by action on the ground. This will require, over the next 12 months, a concerted, collaborative effort to speed up the rate of disbursement and coordination between funders, country officials and providers to ensure that funds are swiftly absorbed and to ensure that oversight and urgent scale-up are complementary aims."

For further information: