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Stephen Lewis, 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

29 June 2005

Commentary from Patrick Bond, 4 July 2005

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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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