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Bush AIDS Plan Gets Drugs to 25,000 in Third World

By David Brown
Washington Post Staff Writer
Tuesday, September 14, 2004; Page A07

The Bush administration's global AIDS plan has helped put at least 25,000 people on antiretroviral therapy since it began disbursing money in February to organizations and governments in 15 targeted countries.

That estimate is contained in an interim report delivered to two congressional committees last week. It covers only nine countries. An accounting for all 15 countries will be available late this fall.

"We are moving incredibly rapidly. To support 25,000 people in such a short period of time is virtually unheard of," said Mark R. Dybul, an AIDS researcher at the National Institutes of Health who is now the chief medical officer of the Bush AIDS program.

The head of the program, retired drug company executive Randall L. Tobias, said that "despite all the obstructions of getting something like this up and running . . . there is every reason to believe that we are on target to meet the goals that we have laid out."

Putting people on antiretroviral therapy (ART) is not the only goal of the five-year, $15 billion global AIDS program, but it has the highest profile. The next target is to have 200,000 people receiving AIDS drugs by June 2005.

The new report said the Bush plan is directly paying for antiretrovirals for 18,800 people and is indirectly supporting ART for an additional 6,100 through contributions to AIDS programs. The 15 countries include Haiti, Guyana, Vietnam and 12 in sub-Saharan Africa.

Dybul said manpower and expertise, not the cost of drugs, are the main impediments to getting people on ART.

"Capacity is unquestionably the limiting step," he said, adding that the Bush plan is helping to pay for training programs at 150 sites.

Over the five years of the President's Emergency Plan for AIDS Relief, the program aims to treat 2 million people with ART, prevent 7 million new human immunodeficiency virus (HIV) infections, and provide care for 10 million AIDS orphans and infected people who do not need ART.

Although some federal agencies, such as the U.S. Agency for International Development and the Centers for Disease Control and Prevention, are directly providing services, most of the money flows through universities, charities and nongovernmental organizations.

At the recent 15th International AIDS Conference in Bangkok, officials of the World Health Organization estimated that by the end of June, 440,000 people were on ART in the developing world.

Some of the 25,000 newly treated people claimed by the Bush plan are among the 440,000 in the WHO estimates, but the amount of overlap is uncertain.

In December, WHO committed itself to helping the world's poor countries treat their AIDS patients with the same drugs that have transformed care in the United States and other wealthy nations. It set a goal of getting 3 million people on ART by the end of 2005 -- the number chosen as roughly half the number of AIDS patients in the developing world who need treatment immediately to stay alive.

Worldwide, about 45 million people are infected with HIV.

WHO's next target in this "3 by 5" initiative is 700,000 on ART by the end of December. WHO does not treat these patients itself or pay for their treatment but provides advisers, training programs and treatment guidelines.

Much of the money for the new treatment of AIDS patients in poor countries is coming from the Global Fund to Fight AIDS, Tuberculosis and Malaria. The two-year-old organization gets money from donor countries and foundations and distributes it to programs that it judges capable of performing.

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