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Is it just about ARVs?

4th September 2006

15052006_aids1.jpgThe 16th International AIDS Conference took place recently in Toronto. The theme for this conference was Time to Deliver. History will be the judge of its impact.

But, at the very least, the needs of the poor who are HIV infected had a voice. Three of the world’s most prominent AIDS activists –Bill and Melinda Gates as well as ex-president Bill Clinton – spoke passionately about the need for the world to act, and to act now.
 
Bill Gates opened the conference calling for more funds to be committed to the cause, after putting his money where his mouth is and committing a further $500 million from the Bill & Melinda Gates Foundation to address HIV issues. He called for the development of cheaper and safer drugs and for the roll out of ARVs (antiretrovirals – the treatment for HIV). Bill Clinton pointed out that still only 1 in 5 of those needing ARVs have access to them. This statistic is worse for children and pregnant women where less than 1 in10 are getting these life-saving drugs. This is hard to believe given we have the science, the ability and the money to solve this problem. Melinda Gates summed it up ‘Let us not turn our backs on anyone. Let’s agree that every life has equal worth and saving lives is the highest ethical act. If we accept this, then science and evidence – untainted by stigma - can guide us in saving the greatest number of lives.’

The aim of the ‘3 by 5’ initiative, launched by the WHO in 2003, was to provide 3 million of those in low/middle income countries with ARVs. In December 2005 the ‘3 by 5’ missed its target by 1.7 million people. Despite this, it has given the necessary impetus to get the ball of ARV provision rolling. As we look to the future however, the world is on a trajectory that will fall far short of the internationally agreed universal access goal for 2010. An international alliance of civil society advocates has called for setting a new global AIDS treatment target of ‘10 by 10’ – 10 million accessing treatment by 2010.

ARV provision is important, but it is far from being the much muted panacea. There are complexities in administering these drugs. ARVs can be difficult to take and can have many side effects. People need to be closely monitored and supported, to ensure that they take every single tablet. Missing a tablet gives the virus an opportunity to mutate and escape the action of the drug. For those who develop mutations, continuing to take ARVs can do more harm than good. Second line drugs must be available for those with mutated virus, but in developing countries second line treatment is either not available or it is much more expensive than first line drugs. Ensuring infrastructure, adequate support and affordability of newer medicines is the only way to ensure long term quality care for people with HIV/AIDS in the developing world.

Like many other areas of life in developing countries, HIV/AIDS, is also intrinsically tied up with major issues like trade, development, healthcare infrastructure and the empowerment of women. HIV/AIDS provides us with an opportunity to address these concerns, and encouragingly, promises have been made – the knock on effects of which could be enormous – but it is only the beginning. World leaders need to deliver on the promises they made in 2005 – currently France, Ireland and Sweden are the only countries meeting the support expectations of The Global Fund. We too have a responsibility, to call to account the national leaders who are not doing enough to lead the fight to end the AIDS pandemic.

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