San Francisco Chronicle - June 3, 2008
Sabin Russell, srussell@sfchronicle.com.

"Achieving the goal two years late is still quite remarkable," said Dr. Kevin De Cock, director of HIV/AIDS at the World Health Organization, the medical arm of the United Nations, headquartered in Geneva.

The idea of extending AIDS treatments to 3 million people by 2005 - the "3 by 5" program - was first raised at a U.N. special session on the epidemic in July 2001. It was formally adopted by World Health Organization Director-General Dr. Lee Jong-wook in December 2003.

But the goal was criticized as overly ambitious, and 2005 closed nearly 2 million short of the goal. Lee did not live to see the milestone reached. He died in May 2006 at the age of 61.

"In retrospect, maybe it was excessively aspirational," De Cock said Monday in a telephone news conference. But he said that in battling the AIDS epidemic, "aspiration is necessary."

Supporters said the goal helped galvanize the global response, which was given a significant boost by the Bush administration's five-year, $15 billion overseas AIDS assistance program and by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Both efforts were just gaining traction in 2005.

Prodded by treatment-access activists, the United States and international programs secured supplies of low-cost, generic versions of the same AIDS drugs that dramatically lowered the death rate from the disease in Western countries. The programs also developed the means to distribute the medicines in African cities and remote rural clinics and to monitor the health of patients taking them.

In late 2003, when Lee embraced the 3 by 5 program, antiviral drugs were available only to about 50,000 AIDS patients in Sub-Saharan Africa, the epicenter of the pandemic. Today, said De Cock, roughly 2.25 million people in that region receive the medications.

"More Africans are taking antiretroviral drugs than any other group of people in the world," De Cock said.

In 2007 alone, 950,000 AIDS patients worldwide were newly enrolled in drug treatment programs, but it's unclear whether that growth in coverage will be repeated through the current year. "We do not wish to speculate on future trends," De Cock said.

Despite the vast expansion of HIV-treatment programs, only about one-third of the 9 million people worldwide who are estimated to need AIDS drugs to survive are receiving them. The program is constrained by lack of funds, poor health care facilities in low-income nations and a shortage of trained personnel.

Most of those receiving antiviral drugs are adults, but 2.1 million children under the age of 15 are living with HIV infection worldwide. The number of children receiving antiviral medication has increased to 200,000 from just 75,000 in 2005, but only 1 in 10 infected children has access to the drugs today.

A more encouraging picture is emerging in the provision of short courses of antiviral drugs to infected pregnant women - preventive measures that can reduce transmission of HIV to their newborns by more than two-thirds.

For years, the percentage of infected pregnant women given the regimen has been hovering around 10 percent - scandalously low, say activists such as Stephen Lewis, the former U.N. special envoy for HIV/AIDS in Africa. In the latest accounting, the percentage of women participating in Prevention of Mother-to-Child Transmission programs has more than tripled to 33 percent.

"The numbers had been going up, but the data weren't available until now to highlight just how much," said Dr. Nick Hellmann, vice president for medical and scientific affairs at the Elizabeth Glaser Pediatric AIDS Foundation, which spends $110 million annually - much of it from the federal government - on prevention efforts.

The good news on progress against AIDS is still overshadowed by the relentless pace of the epidemic, however. For every 2 people who start drug treatment, 5 are becoming newly infected worldwide, according to Elhadj Sy, spokesman for the Joint United Nations Program on HIV/AIDS, or UNAIDS.

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