BioEd Online

The World Health Organization is marking World AIDS Day today by launching its commitment to get antiviral drugs to three million people with HIV by the end of the 2005.

Of the estimated five million patients who need treatment in developing countries, the drugs are available only to 300,000. "The shortfall is a global public-health emergency," says the WHO's Charles Gilks, who is leading the initiative, called the '3 by 5' project.

The project, first mooted when Jong-Wook Lee took over as WHO director-general in July, needs an extra US$5.5 billion, which the WHO hopes to get from international partners. The WHO hopes to work with local governments to develop medical training programmes and treatments.

Worldwide, an estimated 42 million people are infected with HIV. Eventually, all of these people will need treatment. "[The 3 by 5 project] is not a drop in the ocean, but it's not enough," says Frances Gotch, who studies HIV at Imperial College, London, and in Uganda.

Anti-retrovirals slow virus replication. They prolong and improve patients' lives by allowing the immune system to make a partial recovery. Without the drug cocktails, the immune system deteriorates.

In affluent countries, anti-retroviral therapy helps most HIV-positive people to lead healthy, productive lives. Not so in sub-Saharan Africa, where treatment is scarce and one in ten adults - more than 26 million - is infected with HIV.

The WHO will focus its efforts on this region of Africa. It aims to provide support teams to get the drugs to where they are needed, and hopes to train 100,000 people - including doctors, nurses and locals - to administer anti-retroviral therapy. The WHO will simplify and standardize treatment guidelines, help governments to choose and source drugs, and aid industry in gauging demand.

Anti-retrovirals, once too costly for poor nations, are now more affordable - treatment can cost as little as US$300 per year. Earlier this year, the World Trade Organization agreed to let developing countries import cheaper, generic versions of patented HIV drugs. Last month, the South African government approved a plan to distribute the drugs free of charge.

Nonetheless, the WHO needs to secure further funding from the Red Cross and the World Bank, as well as charities, research organizations and the private sector.

"It's quite clear that our current global efforts remains inadequate for an epidemic that is continuing to spiral out of control," says Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS. A recent report found the epidemic to be spreading rapidly through Eastern Europe and gaining a foothold in China and India1. Prevention programmes also need to be scaled up, Piot says.