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This is an archived article published in December 2003.
Some 8,000 people
die of AIDS every day

By Ruth E Maguire, Health Editor

The World Health Organization (WHO) and UNAIDS plan to provide antiretroviral treatment to three million people living with AIDS in developing countries and those in transition by the end of 2005. The ‘3 by 5’ plan was unveiled in Geneva on World Aids Day 2003 (1 December 2003). A WHO spokesman told City Mayors that this was a vital step towards the ultimate goal of providing universal access to AIDS treatment to all those who need it.

Latest information on HIV and AIDS

"Preventing and treating AIDS may be the toughest health assignment the world has ever faced, but it is also the most urgent," said Dr LEE Jong-wook, Director-General of the World Health Organization. "The lives of millions of people are at stake. This strategy demands massive and unconventional efforts to make sure they stay alive."

Earlier, UNAIDS announced that 40 million people around the world are infected with HIV, and that the global AIDS epidemic shows no signs of abating. Five million people became infected with HIV worldwide and three million died in 2003 alone - that's 8,000 people every day. WHO estimates that six million people worldwide are in immediate need of AIDS treatment.

The strategy is a key element in a combined programme of accelerating HIV/AIDS prevention and treatment. Much has already been done by countries, by UNAIDS, the World Bank, foundations, WHO and many other groups. After twenty years of fighting the epidemic, it is now clear that a comprehensive approach to HIV/AIDS must include prevention, treatment and care.

"The 3 by 5 framework is a plan for action by a broad alliance of nations, institutions, and committed people, including those living with HIV/AIDS,” said Dr. Jack Chow, Assistant Director-General of WHO for HIV/AIDS, Tuberculosis and Malaria. “We urge all concerned to work to reach the 3 by 5 target as rapidly as possible.”

Evidence and experience shows that rapidly increasing the availability of antiretroviral treatment in line with 3 by 5 targets can lead to more people knowing their HIV status and more openness about AIDS. Individuals on effective treatment are also likely to be less infectious and less able to spread the virus. Good treatment programmes will make more people come forward for testing HIV/AIDS status. Treatment can therefore contribute to the rapid acceleration of prevention.

Building on work done by UNAIDS, developing and donor countries, NGOs and other multilateral agencies, WHO and UNAIDS are taking another big step forward in the global movement to increase access to prevention and treatment services.

"The lack of HIV treatment is without a doubt a global emergency," said Dr Peter Piot, UNAIDS Executive Director. "We firmly believe that we stand no chance of halting this epidemic unless we dramatically scale up access to HIV care. Treatment and prevention are the two pillars of a truly effective comprehensive AIDS strategy."

The 3 by 5 Strategy
To reach the 3 by 5 target, WHO and UNAIDS will focus on five critical areas:
• Simplified, standardised tools to deliver antiretroviral therapy
• A new service to ensure an effective, reliable supply of medicines and diagnostics
• Rapid identification, dissemination and application of new knowledge and successful strategies
• Urgent, sustained support for countries
• Global leadership, strong partnership and advocacy

Antiretroviral therapy programmes can only be expanded if there is coordinated, scaled-up action in countries, particularly those hardest-hit by AIDS. Countries are at the heart of the 3 by 5 strategy and will be the focus of all efforts to meet the 3 by 5 target. Many countries have already demonstrated their commitment to this target. Immediately following the declaration of a global AIDS treatment emergency, more than 20 countries requested collaboration and input from WHO, UNAIDS and other partners.

Teams have already travelled to Kenya, Burkina Faso, Malawi and Zambia. Other teams have done preparatory work in Ukraine and India. In each case, the teams will be working with governments to identify and help remove obstacles, so that antiretroviral medicines can be provided quickly to the people who need them most. Many other countries, including Russia and Djibouti, have also requested assistance.

Training of health workers
Training of health workers is an urgent need in all countries involved. Many of the countries with the highest numbers of people living with HIV/AIDS have very few doctors or other trained health staff. Many of these health workers have died as a result of untreated AIDS; others have moved to seek better pay and job security in wealthier countries.

One of the most innovative aspects of the 3 by 5 strategy is a method for urgently training tens of thousands of community health workers to support the delivery and monitoring of HIV/AIDS treatment. An intensive training programme would enable these health workers to evaluate and monitor patients, and make sure they receive and are taking their medicines.

The strategy acknowledges that the involvement of communities and community workers is essential to the success of this initiative. Significant evidence and experience shows that without strong community support, people may have a more difficult time adhering to their medical regimens. Also, community involvement is a critical element of any successful HIV prevention strategy.

Funding
Reaching the 3 by 5 target will require substantial new funding for AIDS treatment from all sources - countries, donor governments and multilateral funding agencies. WHO has estimated that the funding required amounts to approximately $5.5 billion over the next two years.

"We know what to do but what we urgently need now are the resources to do it," said Dr Lee. We must waste no time in building strong alliances immediately to implement this strategy. Three million people are counting on it.”

In the areas shaded dark red, less than five per cent of HIV and AIDS sufferers receive antiretroviral treatment

Treating three million HIV and AIDS sufferers by 2005
This WHO strategy aims to set out in clear detail how life-long antiretroviral treatment can be provided to 3 million people living with HIV/AIDS in poor countries by the end of 2005. Core principles include urgency, equity and sustainability.

Treating three million people by the end of 2005 will require concerted, sustained action by many partners. To chart the direction and to show what WHO itself will be doing to accelerate action, WHO has developed an initial strategic framework. WHO’s 3 by 5 team assembled and refined the framework in intensive consultation with partners. This consultation will continue, and the framework itself will continue to evolve.

WHO’s strategic framework for emergency scaling up of antiretroviral therapy contains 14 key strategic elements. These elements fall into five categories – the pillars of the 3 by 5 campaign:
• global leadership, strong partnership and advocacy
• urgent, sustained country support
• simplified, standardized tools for delivering antiretroviral therapy
• effective, reliable supply of medicines and diagnostics
• rapidly identifying and reapplying new knowledge and successes