Bulletin of the World Health Organization

Global HIV/AIDS target will not be achieved by WHO alone, says WHO HIV/AIDS Director

1 June 2004

The global target of providing 3 million people in developing countries with antiretroviral treatment by 2005 — "3 by 5" — is still achievable but its ultimate success depends on how much political will, money and resolve the world is willing to invest, said Dr Jim Yong Kim in a special interview in the July issue of the Bulletin of the World Health Organization (2004;82(6):474-476) .

"WHO has chosen to hold itself accountable to the "3 by 5" target because we feel it is the most concrete, transforming and appropriate goal around which to organize our activities at this point in the epidemic," said Kim. "Whether or not the world can achieve "3 by 5" will depend on many other actors. In proclaiming our [WHO's] commitment to the target, we are saying that we will do everything in our power to help countries reach their aspirations in treating their HIV-positive citizens."

WHO's primary role in combating the global AIDS pandemic has been to develop the public health approach that, according to Kim, is essential for the successful and sustainable expansion of HIV treatment in developing countries: "In order to quickly and equitably roll out HIV treatment in resource-poor settings, we could not take a one doctor, one patient approach." Until recently, the only way HIV could be treated was in a hospital-based, first-world type approach where physicians were the only ones able to administer HIV/AIDS treatment but this approach fails in poor countries, explained Kim.

WHO's decision to focus on HIV/AIDS rather than any other global health problem reflects in part a growing recognition by the world's leaders of the gravity of an epidemic which in many countries, is wiping out the segment of the population essential for its social and economic survival. This is reflected in the fact that much of the new money invested in health has been flagged for HIV/AIDS, said Kim.

Although more funds than ever before have been pledged for AIDS relief in developing countries — over US$ 20 billion so far, in 2003 only 400 000 of the six million people requiring antiretroviral treatment were actually receiving it. Over 90% of those needing antiretroviral treatment live in developing, mainly sub-Saharan, countries.

"The world has voted — presidents and prime ministers have voted — to put their money into the fight against HIV/AIDS. For WHO to turn its back on HIV/AIDS would be tantamount to a dereliction of duty," said Kim who see WHO's key role now to be at the country level, helping to ensure that the funds are spent efficiently on the ground.

WHO has also been able to use its unique position to address the gap in drug quality assurance faced by many developing countries able to import cheaper generic drugs under a trade and intellectual property agreement developed at the World Trade Organization. Using its pre-qualification system, WHO has been able to act in a global drug regulatory capacity and evaluate the quality of imported drugs for use in those countries which may not have good drug regulatory authorities themselves. The pre-qualification system uses the expertise of drug regulators from countries like Switzerland, Canada, Australia and France and from 16 other countries.

During the interview, WHO's HIV/AIDS strategy under the spotlight, Kim also addressed some of the ethical issues surrounding the "3 by 5" strategy such as the difficult decision faced by many countries scaling up treatment of who to treat first as well as how those same countries will face up to the challenge of protecting patient confidentiality.

Key issues that still need to be addressed, said Kim, include the possible emergence of HIV resistance and the role of supervised therapy in preventing this, the cost of second-line drug regimens and a potential price rise in first-line regimens following 2005 when countries become TRIPS [trade-related aspects of intellectual property rights] compliant.

Discussing whether "3 by 5" is achievable is not as important as identifying the obstacles to achieving it and developing ways of overcoming them, said Kim.

"Right now, we are doing everything we can to help bring all the players together because the whole world needs to rally around this incredible challenge, if we are going to reach "3 by 5."

For further information please contact Ms Samantha Bolton, Communications Officer, HIV/AIDS Department, WHO, Tel: +41 22 791 1970, email: boltons@who.int. All WHO Press Releases, Facts Sheets and Features can be obtained on the WHO home page http://www.who.int.