Simplified treatment guidelines : Achieving the 3 by 5 target requires simplified global standard antiretroviral (ARV) treatment regimens. The number of such regimens has been cut to four from 35. All four are equally effective. The selection of an individual regimen for a patient will be based on a combination of individual needs and the availability and suitability of any particular regimen in a country. The aim is to ensure that all AIDS patients are treated either with fixed dose combinations or blister packs of medicine. Packaging the medicines together improves adherence, and makes distribution easier.

An AIDS Medicines and Diagnostics Service (AMDS): to improve access to quality medicines and diagnostics needed for ARV treatment. This is one of the most significant challenges countries face. AMDS will help countries to improve the procurement of quality commodities at sustainable prices and support them in all aspects of management and distribution. AMDS’s activities will forecast global needs, help reduce prices, ensure quality, speed the uptake of simplified treatments, and secure distribution.

Uniform standards and simplified tools to track the progress and impact of ARV treatment programmes, including surveillance of drug resistance to capture the full impact of antiretroviral therapy.

Provide Country Support Teams at the request of governments, with the support and involvement of partners including the UN system, NGOs, donors, community based organizations and people living with HIV/AIDS. These teams will work with treatment implementers and will conduct a rapid assessment of the barriers and opportunities that exist in achieving the 3 by 5 target;

Start the emergency expansion of training and capacity development for health professionals and community workers to deliver simplified, standardized ARV treatment. WHO supports those partners already involved in training, and works with countries to help build a critical mass of highly competent and skilled trainers to expand national capacity for ARV delivery;

Advocate for funding , together with its partners. Achieving the 3 by 5 target will require not only funding for medicines and diagnostics but a massive investment in training and for strengthening health services in countries. Health systems strengthening will benefit ARV delivery, but also delivery of other health services.

Almost 30 million people have already died of AIDS and at least 40 million more are infected. Sub-Saharan Africa is the hardest hit continent, with one out of ten adults – about 27 million currently living with HIV/AIDS of a total adult population of 291 million. Prevalence in southern Africa is particularly high, for example, Lesotho has HIV rates as high as 31% and Botswana as high as 38.8%;

Of the estimated five to six million people in developing countries and in countries in transition in immediate need of AIDS treatment, less than 400,000 now have access to ARVs. In Africa, just 1% of HIV positive people - 50,000 out of 4.1 million who need it - have access to treatment;

At current rates of delivery less than one million people in resource-constraint settings will have access to ARV treatment by the end of 2005;

By robbing communities and nations of their greatest asset - their people - AIDS drains the human and institutional capacities that drive sustainable development. This, in turn, distorts labour markets, disrupts production and consumption, erodes productive and public sectors and ultimately diminishes national wealth. A World Bank report warns that HIV/AIDS causes far greater long-term damage to national economies than previously assumed;

Providing treatment complements and accelerates prevention efforts. Prevention strategies cannot solve the current AIDS health crisis in the most severely affected countries unless parallel treatment strategies are put in place;

Delivering treatment for HIV/AIDS in the developing world is necessary if the international community is to live up to commitments on human rights, the Millennium Development Goals (MDGs) and the Declaration of the United Nations General Assembly on HIV/AIDS.

Without access to ARV drugs, the lives of infected people follow an inevitable course: progressive destruction of the immune system, increasing ill-health and episodes of life-threatening associated diseases, (e.g. tuberculosis, or pneumonia), wasting, and ultimately death;

When ARV drugs are given in combination (three drugs together), the rate at which the virus reproduces itself is reduced and the body’s immune system can partly regenerate itself, thereby restoring health and quality of life;

WHO recommends that ARV therapy should be started when the damage caused by HIV to the immune system reaches a certain threshold, as indicated by clinical condition and/or laboratory tests. The 3 by 5 strategy recommends easy-to-use tests such as body weight and colour-scale blood tests when more expensive tests for viral load and white cell (CD4) count are not available .^*

ARV medicines have dramatically reduced death rates, prolonged lives, improved quality of life, revitalized communities and, to a large extent, transformed HIV/AIDS from a fatal condition to a manageable illness;

While there is still no cure for HIV/AIDS, ARV treatment can add many years of life to an infected person. In high-income countries, an estimated 1.5 million people currently live with HIV/AIDS. Most of them lead productive lives, largely due to ARV therapy. In the US, for example, the introduction of triple combination ARV therapy in 1996 led to a 70% decline in deaths attributable to HIV/AIDS;

Delivering ARV therapy has other returns. Millions of dollars spent now can save billions in the future. Data from Brazil indicates that the costs associated with providing universal access to ARV therapy from 1996 to 2002 amounted to US$1.8 billion, but the savings in hospital and ambulatory care services reached US$2.2 billion – not to mention the broader savings related to teachers who keep on teaching, parents who remain with their children, and farmers who continue to work on their land;

Brazil has also proven that it is possible to contain HIV/AIDS in resource-poor environments with relatively weak health infrastructure. It has delivered free ARVs to virtually every AIDS patient in need – in spite of the size of the country and its large population. From 1996 to 2002, Brazil saw a decrease in mortality rates of 40%-70%, morbidity rates of 60%-80%, plus a seven-fold drop in hospitalization needs;

The availability of ARV therapy makes it more likely that people will come forward for HIV testing, learn their status, receive counselling and care and become knowledgeable about preventing the spread of the virus. Access to treatment will reduce the fear, stigma and discrimination associated with HIV/AIDS, thereby enabling societies to discuss the epidemic more openly and to prevent new infections more effectively. Individuals on treatment are also likely to be far less infectious and less able to spread HIV.

There is awareness that prevention and treatment are both necessary for controlling the spread of HIV/AIDS and that these two approaches are mutually reinforcing elements of a comprehensive response to HIV/AIDS;

There has been a significant reduction – more than 90% in some cases – in the price of ARV drugs offered to all sub-Saharan African countries; reducing costs from about US$10,000 per year to as low as US$ 300 for some combinations;

Many developing countries, including several in Africa, have made a promising start by showing that ARV treatment is not only implementable, but also affordable and sustainable;

The World Trade Organization decision in late August 2003 allowing poorer nations to import generic versions of patented antiretroviral drugs under certain circumstances, can facilitate the provision of low cost drugs for people living with HIV/AIDS in developing countries;

There are growing numbers of partners engaged in the response to the epidemic, and continuing forceful activism and advocacy by people living with HIV/AIDS and civil society;

The increased availability of international financial resources, including the creation of the Global Fund to fight AIDS, Tuberculosis and Malaria, signals a renewed commitment from the international community with the global fight against AIDS.

At the UN General Assembly High-Level Meeting on HIV/AIDS on 22 September 2003, the WHO declared the lack of access to HIV treatment a global health emergency.