"3 by 5": Changing History
Advocacy Brief
“3 by 5” is the global TARGET to get three million people living with HIV/AIDS
in developing and middle income countries on antiretroviral treatment by 2005.
It is a step towards the GOAL of providing universal access to treatment
for all who need it as a human right.
Globally, between 35 and 42 million people are estimated to be infected with HIV/AIDS. Every single day AIDS kills 8,000 people and orphans thousands of children. Heavily affected countries face total social and economic collapse within just a few generations if decisive steps are not taken.
• Six million people need treatment now. At the United Nations General Assembly Special Session on
HIV/AIDS in September 2003, the failure to deliver life prolonging
drugs to millions of people in need was declared a global health
emergency. On World AIDS Day 2003 (December 1), the World
Health Organization (WHO) and UNAIDS launched “3 by 5” - a
global target to get three million people living with AIDS on
antiretroviral treatment by the end of 2005. This target is a vital
step towards the ultimate goal of providing universal access to
AIDS treatment for all those who need it.
• Three million people die every year because they cannot get it.
• Worldwide only 440,000 people have access to treatment.
• In Africa, where 70% of people with HIV/AIDS live, ART is
available to less than 4%of those in need.
WHAT WILL WHO DO TO CONTRIBUTE TO “3 BY 5”? “WHO provides support to developing countries in the form of
simplified tools and guidelines and other forms of direct technical
assistance for scaling up ART. Procurement and management
of pharmaceuticals and diagnostics pose a problem for most
resource-limited countries. Therefore, WHO has established the
AIDS Medicines and Diagnostics Service (AMDS) to assist countries
with all aspects of selecting, procuring and delivering AIDS
medicines and diagnostic tools to the point of service delivery.
To assist in reaching the “3 by 5” target, WHO and UNAIDS
are focusing on key areas including:
• Providing simplified, standardized tools and treatment guidelines
for ART in poor countries.
• Creating the new service (AMDS) to help countries to ensure
an effective, reliable supply of medicines and diagnostics.
• Rapid identification, dissemination and application of new
knowledge and successful strategies.
• Providing urgent, sustained support for countries to help with
scale up of treatment.
• Providing assistance to countries and developing guidelines for
capacity building and training.
WORLD MUST UNITE TO MEET THE TARGET “3 by 5” is a global target that has been endorsed by 192 countries
at the World Health Assembly held in May 2004. Partnerships and
collaboration at country and international level between national
authorities, UN agencies, multilateral agencies, foundations,
non-governmental, faith-based and community organizations, the
private sector, labour unions and representatives of the community
of people living with HIV/AIDS are absolutely essential if “3 by 5”
is to be accomplished. Everybody has to play their part.
“ART prolongs lives, making HIV/AIDS a chronic disease, not
a death sentence. Affluent countries have seen a 50 - 70%
decline in HIV/AIDS deaths since the introduction of ART.
ART will help reduce stigma and change attitudes towards
HIV/AIDS.
ART can significantly reduce HIV transmission.
ART - once very costly - is now much more affordable in
developing countries.
ART can reduce overall health care costs and restore
quality of life.
TREATMENT AND PREVENTION GO TOGETHER “To ensure a comprehensive response to HIV/AIDS, treatment
and prevention programmes must enhance and accelerate each
other. When people have hope that they can be treated and lead
productive lives, the incentive to know their status and to protect
themselves and their partners is much greater. Evidence and
experience show that rapidly increasing the availability of ART
leads to greater uptake of HIV testing. Availability of treatment, as
well as enhanced community outreach, can lead to more openness
about AIDS - which helps break down stigma and discrimination.
People on effective treatment are also likely to be less infectious
and less able to spread the virus. A growing number of countries have shown that increasing
access to treatment is both possible and effective. Brazil has the
most advanced national HIV/AIDS treatment programme in the
developing world. It is estimated that between 1994 and 2002,
almost 100,000 deaths have been averted in Brazil (a 50% drop
in mortality) through the introduction of ART. The programme in Brazil clearly demonstrates how scaling up
can also help to strengthen health systems and dramatically
reduce public health costs. As a result of the programme, there
has been a significant decline in the number of hospital admissions.
Cost savings in reduced hospital admissions and opportunistic
infections are estimated at more than US $ 1 billion. The
programme has also been effective in reducing the rates of
TB and other opportunistic infections. WHO has published guidelines to increase the availability of
treatment in poor countries by recommending standardized
treatment regimens and simplified approaches to clinical
monitoring. These simplified guidelines also make it easier
to train the thousands of health care workers needed to make
scale up happen. Fixed dose combinations (FDCs) of antiretroviral drugs are pills
containing two or three AIDS drugs in one tablet. FDCs are a
major breakthrough for AIDS treatment in poor countries as
they offer significant operational advantages, including ease
of distribution and storage, the likelihood of greater adherence,
reduced incidence of treatment failure and drug resistance.
Wherever possible, WHO recommends that FDCs be used
in ART. Countries most in need of life-saving antiretroviral and other
drugs often do not have the regulatory capacity to ensure
the safety and quality of medicines from different suppliers
around the world. They often rely on procurement agencies,
such as UNICEF and some non-governmental organizations
to puchase these medicines in bulk and distribute them. The
Prequalification project, set up in 2001, is a service provided
by WHO to facilitate the procurement of medicines that meet
international standards of quality, safety and efficacy for
HIV/AIDS, malaria and tuberculosis. Prequalification was originally intended to give United Nations
procurement agencies such as UNICEF the choice of a range
of quality medicines. With time, the growing list of medicines
that have been found to meet the set requirements has come
to be seen as a useful tool for anyone purchasing medicines in
bulk, including national governments and other organizations.
For instance, the Global Fund to Fight AIDS, Tuberculosis
and Malaria grants money for medicines that have been
prequalified by the WHO process. Lack of access to antiretroviral therapy (ART) is a global health emergency.
To deliver ART to the millions who need it, we must change the way we think
and change the way we act.”
Dr. LEE Jong-Wook, Director-General, World Health Organization
MAKING IT EASIER