The New York Times - July 11, 2004
Lawrence K. Altman

The program, known as 3 by 5, has been a subject of debate since the agency's director general, Dr. Lee Jong Wook, announced it last fall. In its first progress report, issued a day before the 15th International AIDS Conference here on Sunday, the World Health Organization estimated that 440,000 people were being treated. That is about twice as many as in 2002, said Dr. Jim Kim, director of the agency's AIDS program. But the agency's goal had been to treat 60,000 more people by now.

Dr. Lee said that the United Nations agency could not let it fail because "the collective response to the H.I.V./AIDS pandemic is the benchmark by which our generation will be judged."

Critics have said the effort was too ambitious. But Dr. Lee said he wanted to set "a difficult, time-limited undertaking that would force us to change the way we work at W.H.O."

Critics also said that affected countries did not have enough workers to deliver the drugs and that the agency did not have enough money. The report was intended "to measure ourselves against specific targets to assess the progress we are making," Dr. Lee wrote. "Progress is not rapid enough," because each day 8,000 people are dying from AIDS, the report said, while asserting that the slow start still would generate enough pressure to speed the effort later.

The agency attributed slow progress to a lack of money, but that has improved through contributions from Canada, Britain and Sweden.

At a news conference here on Saturday, agency officials were long on promises but less specific about the effort that the agency, which is based in Geneva, is conducting with government and private groups.

The agency published the estimated number of people receiving antiretroviral treatment by country for 49 countries. The total was 327,000. The agency did not provide the list of countries with the remaining 113,000 people being treated.

Stephen Lewis, the special United Nations envoy for AIDS in Africa, said he felt certain from visits to a number of countries that the 3 by 5 plan would succeed in Africa.

Since December, 56 countries have asked the agency for help in developing national antiretroviral programs, more than expected. The agency said it had sent workers to more than 20 of the countries.Twelve countries have established official treatment goals that meet the 3 by 5 objective of providing treatment for 50 percent of those in need.

Only Botswana, Indonesia and Uganda have published such plans. Botswana is treating 18,000 people, with a goal of 30,000; Indonesia is treating 1,500, with a goal of 3,500; and Uganda is treating 20,000, with a goal of 55,000, said Melanie Zipperer, an agency spokeswoman.

The agency said progress has been slowed by the time it takes to develop clear, standard and simplified technical guidelines and training materials, and by the time needed to develop standards and processes to certify workers. Dr. Peter Piot, the director of the United Nations AIDS program, a partner in the 3 by 5 effort, said, "We have to be frank and admit that we have a long way to go."
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