sexta-feira, novembro 25, 2005

3 by 5 falhou

The Lancet 2005; 366:1828


Maintaining anti-AIDS commitment post “3 by 5”

As 2005 draws to a close, so too does the time within which WHO and UNAIDS pledged to provide antiretroviral treatment to 3 million HIV-infected individuals—the “3 by 5” initiative. The newest update on the AIDS epidemic, released on Nov 21, shows that treatment rollout is continuing steadily. But the report also includes a solemn warning: “… the AIDS epidemic continues to outstrip global efforts to contain it.”

The past two decades have witnessed a massive change in the perception of AIDS control. HIV has evolved from a purely social problem to a clinical one—as evinced by the research published in this issue. This change is clearest when viewed in the context of 3 by 5. Before 2003, most countries with high burdens of HIV believed that treatment was complicated and not cost effective. But WHO's commitment to saving lives through treatment—the basis of 3 by 5—succeeded in overturning this prejudice by providing the first global target for treatment, and demonstrating that clear, detailed actions and goals can have a tremendous effect.

But the data released last week show that focusing on treatment is not enough. AIDS has reached a new peak: there are now more than 40 million individuals living with the disease, double the number 10 years ago. And 2005 is likely to be remembered more for the 3 million deaths and almost 5 million new infections it heralded than for the 300.000 lives saved through treatment. The year-on-year escalation in new HIV infections demands a new and integrated approach in which access to care and treatment is expanded simultaneously with HIV-prevention efforts.

It is inescapable that 3 by 5 will be remembered for its failure. But it should also be lauded for its extraordinary political successes—not least for spurring world leaders to agree to the G8 goal of universal access to treatment by 2010. The test for UNAIDS and WHO now will be whether they can create the necessary commitment to see the past 2 years' grand promises turned into action.

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