The world health report



The two photographs on the opposite page show how the history of HIV/AIDS is changing. They are snapshots of the past and the present, a vivid example of how, today, innovative treatment programmes are not only saving lives but also helping to strengthen health systems on which to build a brighter future.

Joseph Jeune is a 26-year-old peasant farmer in Lascahobas, a small town in central Haiti. When the first picture was taken in March 2003, his parents had already bought his coffin. Suffering from the advanced stages of AIDS, Joseph Jeune probably had only weeks to live. The second picture, taken six months later, shows him 20 kg heavier and transformed after receiving treatment for HIV/AIDS and tuberculosis (TB) coinfection.

There are millions of people like Joseph Jeune around the world. For most of them, HIV/AIDS treatment is still beyond reach, but Joseph shows what can be achieved. He receives care at the small clinic in his home town. The clinic’s HIV/AIDS and TB treatment programmes are part of a wider initiative to strengthen the health service infrastructure across much of Haiti’s central plateau. The effort involves nongovernmental organizations, the public sector and communities, with major support from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Using antiretroviral therapy as an entry point, the programme is building up primary health care in communities, for a total population of about 260 000 people. It does so through improved drug procurement and management, the expansion of HIV counselling and testing, increased salaries for local health care personnel, and the training of numerous community health care workers. Primary care clinics have been refurbished, restocked with essential medicines, and provided with new staff. They are receiving up to 10 times more patients for general medical care daily than before the project began.

The World Health Report 2004 shows how projects like this can bring the medical treatment that saved Joseph Jeune to millions of other people in poor and middle-income countries and how, crucially, such efforts can drive improvements in health systems.

Effectively tackling HIV/AIDS is the world’s most urgent public health challenge. Already, the disease has killed more than 20 million people. Today, an estimated 34–46 million others are living with HIV/AIDS. In 2003, 3 million people died and 5 million others became infected. Unknown a quarter of a century ago, HIV/AIDS is now the leading cause of death and lost years of productive life for adults aged 15–59 years worldwide.

A comprehensive HIV/AIDS strategy links prevention, treatment, care and support for people living with the virus. Until now, treatment has been the most neglected element in most developing countries. Yet among all possible HIV-related interventions it is treatment that can most effectively drive health systems strengthening, enabling poor countries to protect their people from a wide range of health threats. This report shows how international organizations, national governments, the private sector and communities can combine their strengths to expand access to HIV/AIDS treatment, reinforce HIV prevention and strengthen health systems in some of the countries where they are currently weakest, for the long-term benefit of all.

Almost 6 million people in developing countries will die in the near future if they do not receive treatment – but only about 400 000 of them were receiving it in 2003. In September 2003, WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Fund declared lack of access to AIDS treatment with antiretroviral medicines a global health emergency. In response, these organizations and their partners launched an effort to provide 3 million people in developing countries with antiretroviral therapy by the end of 2005 – the 3 by 5 initiative, one of the most ambitious public health projects ever conceived.

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