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188 Fighting the Diseases of Poverty
difficulty delivering simple vaccines and essential medicines to their
populations, let alone delivering and monitoring complex ARV
regimes.
Meanwhile a variety of factors – including the mismanagement
of funds, inefficiency, waste, expensive technical assistance and corruption
within recipient governments – has meant the cost of
treating a developing-country patient for two years ballooned to
$12,538 by the end of 2005 – nearly 10 times the $1,633 initially
estimated by UNAIDS. Such inflated costs will be unsustainable if
the UN is to meet its current target of placing 10 million PLWHA on
ARV treatment by 2010.
It is not even clear that the WHO’s efforts directly led to the
achievement of 1.3 million on ARV treatment by the end of 2005,
not least because many of the countries that have been most successful
in scaling up treatment – such as Thailand and Brazil –
were already running successful treatment programmes independent
of WHO advice. Furthermore, it is recognised that by the end
of 2005, some 716,000 people were receiving ARV treatment independently
of “3 by 5” through the Accelerating Access Initiative,
a partnership between the UN and several pharmaceutical companies.
14
Prevention
Leading public health experts are virtually unanimous in concluding
that prevention is of paramount importance in the fight against
AIDS (Salomon et al., 2005). However, by making itself publicly
accountable to meeting such ambitious treatment targets, the WHO
has been forced to devote far more resources to treatment at the
expense of prevention.
The overriding focus on treatment was one result of the 2000
international AIDS conference in Durban, South Africa. At about this
time, advances in medical science were making AIDS in the west a
manageable (but not curable) condition, as opposed to the automatic
death sentence it was a few years previously. Health activists