UNAIDS: The First 10 Years

Chapter 6was the requirement that 33% of PEPFAR prevention money be spent on abstinence-onlyprogrammes. Yet PEPFAR is also the world’s largest funder of condoms.171The “3 by 5” initiative promotes access to treatmentOnce PEPFAR’s treatment targets had been announced, ‘whether and how WHO shouldfurther advance the treatment agenda therefore loomedas an important challenge for Lee Jong-wook (thenew Director-General of WHO). That Lee unequivocallyembraced the treatment agenda is now part of hislegacy’ 30 .In September 2003, Lee joined with Piot and Feachem tolaunch the “3 by 5” (‘Treat 3 million by 2005’) initiative,which had first been announced at the 2002 Barcelona AIDSconference by Brundtland, Lee’s predecessor. The aim wasto treat half of those in need of treatment in developingcountries 31 . This was presented as an achievable (thoughmany thought unlikely) target, given increased resources,on the way to the ultimate goal of universal access. It alsoheralded a significant scaling up of WHO’s work on AIDS,including a much larger department, more country-basedstaff focusing on the epidemic and strong leadership fromLee, as well as the directors of the HIV/AIDS Department,Paolo Teixeira followed by Jim Yong Kim.Washington Postop-ed article by LeeJong-wook and PeterPiot, September 2003,announcing the“3 by 5” initiative.WHO/UNAIDSBut to succeed in scaling up access to treatment, “businessas usual will not work”, Lee stated at the launch of “3 by 5” 32 . Countries had to act faster and,in some cases, differently, but they needed support from the global community.Such support was rather slower in coming than had been hoped for. Some people felt uncomfortablewith such a time-bound target. Donors were slow to provide funding because theyfelt they had not been fully consulted and that a consensus on the initiative had not beenreached. It took time to involve donors in the initiative, explained Kim, who was Directorof WHO’s HIV/AIDS Department from 2004-2005. “The donors felt “3 by 5” put too muchpressure on them, that it set too high a target; they felt they should have been consulted. Itell you if we’d consulted on it, almost all of them would have said ‘Don’t do it’ and, indeed,many of them opposed the initiative all the way along … it was frankly my personal lack offamiliarity with the donors and my background as an activist that made me push it through30Schwartländer, Grubb, Perriëns (2007).31In 2001, partners within UNAIDS and other organizations had calculated that, under optimal conditions, threemillion people living in developing countries could be provided with antiretroviral therapy and access to medicalservices by the end of 2005. However, there was then little support for acting on this from governments ordonors.32WHO (2003). Press Release, 22 September. Geneva, WHO.