BioEd Online

Bureaucracies working at cross purposes, lack of funds and weak leadership are all standing in the way of getting AIDS drugs to the world's poorest people. So says a report compiled by an advocacy group called the International Treatment Preparedness Coalition, the contents of which were released yesterday.

"It's a true view from the front line," says Paul Zeitz, executive director of the Global AIDS Alliance in Washington DC, a nonprofit group that was not involved in the study.

The report, which is based on interviews and questionnaires of people involved in delivering HIV care in six hard-hit countries, is timed to coincide with the deadline for the '3 by 5 Initiative' of the World Health Organization (WHO) to meet its HIV-treatment targets.

This is an ambitious project aimed to expand access to the antiretroviral drugs used to combat HIV. The goal is to provide treatment for 3 million HIV-infected people in poor and middle-income nations, about half of those needing the drugs, by the end of 2005.

Off target

The WHO will release final numbers next year, but as of June this year, only one million people had been treated, and the agency has already apologized for the fact that its target will not now be met.

The report also emerges a week after the United Nations released its most recent HIV statistics, showing that the number of people with the virus has topped 40 million, with 5 million newly infected in 2005.

Barriers to implementing the WHO targets were cited in the report, alongside assessments of how to achieve the goal set in July by world leaders at the G8 meeting in Gleneagles, UK. This was to achieve "as close as possible near-universal access" to HIV drugs.

Common problems

Although each country is unique, several common barriers exist, according to the report. One is the lack of coordination among various agencies, including the Global Fund to Fight AIDS, Tuberculosis and Malaria; private groups; and a separate US-run initiative called the President's Emergency Plan for AIDS Relief. The coordination problem also extends to the World Bank and International Monetary Fund.

Both of these organizations impose caps on government spending that limit the amount available for healthcare. These restrictions intensify an acute shortage of nurses and doctors, who often migrate to countries with better wages and working conditions, as previous studies¹ have noted.

"The world system takes away with one hand what it gives with another," says Mark Harrington, executive director of Treatment Action Group in New York, part of the coalition that released the report.

Cash shortfall

Funding is also falling short, the report adds. The Global Fund says that it needs US$7.1 billion for the next two years but has received only $3.8 billion in pledges. In 2001 many African nations pledged to increase health-care funding to 15% of government budgets. So far, none of them has followed through, says Harrington.

The coalition has also identified specific problems affecting individual countries. Russia, for instance, lacks centralized systems for drug procurement, and South Africa has suffered from weak leadership, which has exacerbated the social stigma associated with HIV infection.

But despite these fallbacks, healthcare advocates have praised the WHO for setting an ambitious agenda with the 3 by 5 programme. When the initiative began two years ago, 400,000 people in low and middle-income countries were being treated. By June 2005, 14 countries had met their targets, and the number treated in Africa had trebled.

"They developed a plan to do it, and they should maintain the momentum," says Harrington.