Full text PDF - International Policy Network

Cost effective means of fighting the diseases of poverty 187had access to these drugs – representing only 43 per cent of theWHO target of 3 million people by the end of 2005 (UNAIDS,2006). In sub-Saharan Africa, only 11 per cent of those whoneeded treatment were receiving it in June 2005 (UNAIDS/WHO,2005a).Depressingly, the failure of the initiative was entirely predictable.The necessity of reaching its ambitious target led the WHO to scaleup treatment despite the manifest absence of workable health infrastructurein the worst afflicted countries. The overwhelmingmajority of people living with HIV/AIDS (PLWHA) are in sub-SaharanAfrica, where public health systems are fragmented, dilapidated ornearly non-existent. Most countries in the region lack sufficientqualified health workers and doctors, not to mention pharmacies,clinics and doctors. Figure 1 shows that some of the worst afflictedcountries also have the fewest medical professionals.Antiretroviral drugs are complex to administer, requiring specifiedregimens and oversight by knowledgeable professionals andtesting equipment, both of which are in short supply in most of Sub-Saharan Africa. Seen in this light, the WHO’s decision to push its masstreatment initiative as the key to solving the AIDS crisis was a grossstrategic error. Without sufficient staff and facilities, there is a substantialrisk that inappropriate doses will be handed out to patients,and patients will not adhere to regimens. This raises the spectre ofresistance, which has the potential to render many of the currentlyavailable treatments ineffective (Blower et al., 2003). Samples takenbefore 1996 showed about 5 per cent drug resistance to existing HIVstrains, rising to at least 15 per cent between 1999 and 2003. This allimplies significant extra costs as drug-resistant patients have to bemoved onto expensive second-line and third-line therapies (REF).It is unlikely that the governments of these most afflicted countries,with a good knowledge of their infrastructural and humanresource constraints, would have imposed such ambitious ARV treatmenttargets on themselves – indeed, the WHO never consulted orasked for approval from member states when it launched “3 by 5”in December 2003. Many extremely poor countries have enormous