AIDS Treatment Is a Lifetime Commitment

November 29, 2006—Since the first two known deaths from AIDS in California in mid-1981, AIDS has marched relentlessly across countries and continents, killing more than 25 million people along the way, and ushering in one of the gravest development threats of our time.

More than 38 million people are living with HIV worldwide, according to the latest figures from UNAIDS. Four million become infected each year, and AIDS is increasingly a disease of young women, who have few means to protect themselves and now account for a majority of new infections in many countries.

New UNAIDS data, however, shows some long-overdue progress on treatment.

Progress Report

More people now have access to anti-retroviral (ARV) drugs that prolong life sometimes for decades. In 2001, only 240,000 people in low and middle income countries could get these drugs; in 2006, that number has grown to 1.6 million people.

Despite problems with health systems and shortages of trained medical workers, sub-Saharan Africa is now treating more than a million people living with AIDS-10 times as many as in late 2003. ARV drug prices are also much lower and the drugs, including cheaper generic drugs, are more easily obtained.

But the growth in coverage has raised another challenge.

"Putting people on life-saving AIDS treatment is a commitment that can span decades," says Dr. Debrework Zewdie, Director of the World Bank's Global HIV and AIDS Program.

"So we can't have the 'here today-gone tomorrow' problem where governments and donors put people on treatment, and then walk away from them a couple of years later and say 'we haven't got the money to keep this program going.' That prospect worries me greatly."

Sustainable Treatment

She's not the only one who's worried. Many of the world's leading authorities on AIDS treatment joined Dr. Zewdie at a conference timed to coincide with World AIDS Day on December 1. Both the day and the conference are intended to underscore the urgent need to bring HIV prevention and treatment strategies to every community.

Co-sponsored by WHO, UNAIDS, and the World Bank, "Sustaining Treatment Costs—Who Will Pay?" is intended to explore how to handle the increasing costs.

Rising drug costs pose a big challenge for developing countries that spend less than $10 a year per person on health care. The ability of poor and middle-income countries to afford antiretroviral treatment programs for people with AIDS may very well depend on how well they can prevent new infections.

Signs of Life

The fact that even 1.6 million people living with AIDS are still alive, thanks to treatment, is something of a triumph after years of assuming that poor countries could never muster the medical expertise and money needed to make ARV possible. But as countries like Thailand and Brazil have shown, universal access to treatment is possible.

For example, since 1996, Brazil's treatment efforts have helped the country to prevent more than 60,000 new cases of AIDS and 90,000 HIV-related deaths. As of May this year, Thailand was treating roughly 78,000 AIDS patients (more than 90% of those in need of treatment).

According to a recent Bank report, Thailand's success is the result of

• highly effective prevention campaigns
• a vast network of district level hospitals and rural health clinics with the capacity to provide widespread treatment
• a strong community of non-governmental organizations that work closely with government on rolling out the expanded ARV program, and
• the close involvement of people living with HIV/AIDS themselves.

"Thailand's ART program is a useful beacon for other developing countries which are looking at how to provide this treatment to people with advanced HIV," says Ana Revenga, co-author of the Thailand report and a World Bank Lead Economist in its East Asia and the Pacific department who presented her work at this week's conference.

Peril in the Progress

While more than 20 low and middle income countries are now treating more than 50% of their citizens in need, real problems have to be resolved before more countries embark on treatment programs for people living with AIDS.

Countries and donors need to show continual results if AIDS is to keep the public's attention as a top priority for action at global and national levels.

Kevin De Cock, Director of the World Health Organization's HIV/AIDS department, who is co-sponsoring the meeting at the Bank this week, believes that the biggest roadblock to expanding universal treatment services is "the frailty of health systems—including human resources, physical infrastructure, laboratory capacity, procurement and supply systems, fiscal management, and the whole clinical and public health complex required to manage and deliver services."

De Cock also emphasizes the need to treat an estimated 800,000 children under 15 years of age who are living with AIDS, most of them in Africa. Children account for approximately 14% of AIDS deaths but for only about 6% of recipients of antiretroviral therapy in low- and middle income countries.

"We must conclude that treatment scale-up has so far left children behind."