Bangkok Post - July 4, 2005
Jim Yong Kim

For years, the world stared at the unfolding Aids disaster and debated whether effective Aids care could ever be practical in poor countries. Many experts said Aids drugs were too costly or too difficult to deliver where they are needed most. Providing care in Africa would lead to massive drug resistance. Prevention efforts would receive less funding if we invested time and resources in providing therapy.

A new report from the World Health Organisation and UNAids shows that these concerns have been greatly overstated. Aids treatment works in the developing world. One million people are now receiving anti-retroviral drugs in the poorest and worst-affected nations. HIV treatment access in Africa and Asia has more than tripled in the past year.

Partnership between donors, international agencies and governments is beginning to pay off. National governments in countries such as Mozambique, Zambia and Cambodia, working with the support of programmes sponsored by the UN, United States and faith-based groups are building clinics and training health workers. In many countries, people with HIV/Aids are standing in long lines to get the treatment that - it has now been proved beyond any doubt - is just as effective in Lesotho as it is in New York.

Some say one million people on treatment is too little, too late, and I agree. More than six million people in the developing world need treatment today. This week's progress report makes recommendations for speeding efforts to dramatically increase the number of people on HIV treatment in low and middle-income counties. This can only be accomplished with greater support from political leaders in several of the most affected countries and the adoption of standardised, simplified, quality treatment approaches.

What does treatment mean for the million who now receive it? Since almost everyone with HIV in the developing world is young - under 30 - it means renewed hope for the future and extra years to support their families and educate their children. HIV treatment strengthens the pillars that keep societies from disintegrating into chaos.

At the same time, treatment also strengthens efforts to prevent HIV infection in the first place. The fact that effective treatment for HIV/Aids is available is driving people at risk to show up in unprecedented numbers for testing and counselling, during which they also receive information on how to protect themselves from HIV. In one district in Uganda, the availability of treatment has led to a 27-fold increase in demand for testing and counselling services.

Much remains to be done to ensure that health care in the developing world is both affordable and sustainable. Yet responses to HIV have already begun to create what may truly be revolutionary changes in global public health. The brand-name pharmaceutical industry has cut Aids drug prices for the developing world. The low-cost generic drug industry is expanding access to many formerly unaffordable therapies. And quality medical services are being offered for the first time in countries in which spending on health has hovered around 40 baht a person a year. The potential impact of these changes on efforts to treat other diseases, such as malaria and tuberculosis, as well as chronic diseases such as diabetes, heart disease and stroke, is enormous.

And yet, one million on treatment means that we are just beginning. Now that we have the tools and technology to slow this massive epidemic, universal access to Aids care is the only acceptable response.

Moving forward, greater financial resources are needed. These must be pledged not on a year-by-year basis, but as a long-term commitment that encourages poor countries to match donor support by investing their health-care funding, knowing that Aids treatment will not disappear when the international community takes up other priorities. All agencies, including WHO, must do a better job of coordinating the support for health worker training, drug procurement and the building of robust health systems that can support treatment not just for HIV, but for other diseases as well.

In reaching the one million mark, we have learned a tremendous amount about what works. But we have also missed great opportunities. More than five million more people need treatment now.

We are beginning to respond, but we can and must do better.

Jim Yong Kim is director of the Department of HIV/Aids, World Health Organisation

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