on WHO Progress Report on Access to Treatment

[Guest guest]

,

UN Special Envoy for HIV/AIDS in Africa, speaks to a meeting of civil society

organizations on the WHO Report on Access to Treatment for AIDS:

Nairobi, Kenya, Wednesday,

June 29, 2005

The report launched today, by WHO and UNAIDS, as a status update on

where the world stands in the provision of treatment for AIDS is a predictably

fascinating document.

There will be comments aplenty. I have five.

First, the 3 by 5 initiative seems to me to be entirely vindicated.

Mind you, I can even now hear the curmudgeonly bleats of the detractors,

whining that we will fall short of the target of three million in treatment by

the end of this year. Tell that to the million people who are now on treatment

and who would otherwise be dead. The truth is that the 3 by 5 initiative ---

which, I predict, will be seen one day as one of the UN’s finest hours

--- has unleashed an irreversible momentum for treatment. I see it everywhere

as I travel through Africa. Governments are moving heaven and

earth to keep their people alive, and nothing will stop that driving impulse.

It is surely noteworthy that 3 by 5 has ushered the phrase “universal

treatment” into the language of the pandemic, meaning that we’re

now all fixated on getting everyone who needs treatment, into treatment, as

fast as possible. It is, I readily admit, both painful and horrifying to see

the numbers who are dying as they wait for treatment to be rolled out, but at

least there is hope amidst the despair.

Second, it becomes irrefutably clear that treatment has been a boon to

prevention. I can recall from many quarters all the caterwauling about the

neglect of prevention as the world began to focus on treatment. But the

detractors were wrong again. Not only do we continue to emphasize prevention

and reinforce it at country level, but the provision of treatment significantly

accelerates testing and counseling, one of the primary ingredients of

prevention. Buried in the report, is the astonishing statistic from a study of

a district in Uganda, showing a 27-fold increase in counseling

and testing as a result of the introduction of treatment!

Third, the G8 certainly has its work cut out for it. What this report

appears to do is to throw many of the financial estimates of resource needs for

Africa into a cocked hat. WHO and UNAIDS categorically assert

that we will need an additional $18 billion dollars, over present commitments,

for the three years 2005-2007. We know from the recent UNAIDS estimates for

2008, that we will require $22 billion annually, minimum, from that year

forward. In the face of these resource imperatives, the idea of doubling

foreign aid for Africa by 2010, which would represent another $25 billion per

year, is clearly inadequate, some might say paltry. The $25 billion is supposed

to address all of the Millennium Development Goals; it will barely address the

one goal of defeating communicable diseases. Unless the G8 can do a lot better

than the present calculus, Gleneagles will be much like all the G7/G8 summits

before it: a rhetorical triumph, a pragmatic illusion.

Fourth: the report has one particularly evocative diagram. It’s a

world map portraying the twenty countries with the highest unmet treatment

needs … twenty countries where the estimated number of people in

treatment is pathetically low. Six of those countries --- South

Africa, Zimbabwe, Tanzania, Nigeria, Ethiopia and India --- represent fully

half of the unmet treatment needs. Five of them are in Africa. South Africa

alone has the largest shortfall in the world, some 866,000 people who should at

this very moment be in treatment. The country appears to have something

slightly in excess of 100,000 people in treatment, but that represents only 10%

to 14% of those who are desperately in need. The numbers for the other African

countries, while smaller, are proportionately even more grim. This is where the

international community must rally urgent support.

Fifth, the report says, without caveat, that treatment should be

provided free at the point where it is given. Finally, we’re building a

new consensus around the destructive nature of ‘user fees’,

particularly as they prejudice the poor. User fees are a sordid relic of the

old economic conditionalities: it will be excellent to see the end of them.

It was a good and illuminating report that was released today. It

identifies many of the obstacles and bottlenecks, and with spirited

intelligence suggests, in each case, a way around them. It’s a first-rate

blueprint at this point in time.

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