A ‘€œ3 by 5’€ progress report released by the World Health Organisation and Joint United Nations Programme on HIV/AIDS (UNAIDS) this week revealed that South Africa had fallen short of its target by a staggering 866 000.

South Africa’€™s ‘€œunmet’€ need was by far the highest in the world followed by India (735 000) and Nigeria (598 000). Neighbouring Zimbabwe had over 300 000 people waiting on treatment.

The report did praise South Africa for committing U$1-billion over the next three years to scaling up ART, by far the largest budget allocation of any low- or middle-income country.

Another positive was that the number of people receiving combination anti-retroviral therapy for HIV/AIDS in developing countries had more than doubled in the past 18 months ‘€“ from 400 000 at the end of 2003 to about one million in June this year.

In sub-Saharan Africa, the region most severely affected by HIV, about 500 000 people are currently receiving ART, more than triple the number of people on the drugs in June last year, and nearly double the number six months ago.

However, the report predicted that despite good overall progress it was unlikely to be fast enough to reach the target of treating three million people by the end of 2005.

As of June this year, 49 countries accounted for 87 percent of all adults and children living with HIV/AIDS globally, 78 percent of mortality from AIDS globally and 89 percent of people needing treatment in low- and middle-income countries.

Six countries comprised over 50 percent of treatment needs in low- and middle-income countries: Ethiopia, India, Nigeria, South Africa, Tanzania and Zimbabwe.

Leading international medical journal, The Lancet commented earlier this year that South Africa in particular needed to show its commitment to treating HIV positive people with anti-retrovirals if the ‘€œ3 by 5’€ target was to be met.

‘€œIf the 3 by 5 programme had the political clout to influence South Africa alone to implement all its recommendations, where the necessary infrastructure largely exists, then the 3 million target would be more likely to be attained. Without South Africa on board, with its leadership position within Africa, 3 by 5 is but a pipe dream,’€ the editorial said.

Health minister Dr Manto Tshabalala-Msimang responded at the time stating that she would not be pressured into meeting United Nations HIV/AIDS treatment targets.

‘€œI don’t want to be pushed or pressurized by a target of three million people on anti-retrovirals by 2005,” she said.

“WHO set the targets themselves. They didn’t consult us. I don’t see why South Africa must be the scapegoat for not reaching the target,” she said at the time.

This week’€™s report highlighted human resources as a critical focus area in the push to provide treatment. It acknowledged that effective responses to the epidemic in low- and middle-income countries had been greatly undermined by specific weaknesses in the area of human resources.

The WHO was looking towards implementing novel models of ART delivery, already used in Uganda and South Africa, in 30 countries by the end of 2005. This included the simplification of treatment regimens and clinical monitoring which allowed a shift from a doctor-centred model to one that relies on an expanded clinical team including nurses, clinic workers and people living with HIV/AIDS employed and trained to perform community outreach and treatment support.

‘€œToday’€™s report emphasizes that while political, financial and technical support for ART scale-up have in some cases met or exceeded expectations, in others the prerequisites of a successful response are not fully in place,’€ UNAIDS and WHO said in a statement.

The ‘€œ3 by 5’€ target, endorsed by all 192 WHO member states including South Africa, was intended as an interim step toward the goal of universal access to HIV treatment for those who need it. The target was based on what could be achieved if countries, donors, and international agencies were fully successful in expanding political will, mobilizing funding resources, and building health infrastructure and systems.

To access the full report click here

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