About 1 million people in the developing world are now getting antiretroviral drugs for AIDS, twice as many as 18 months ago but too few to reach the original goal of treating 3 million people by the end of 2005.
That was the conclusion of a report released yesterday by the World Health Organization on the status of its "3 by 5" effort.
The most ambitious treatment project in the history of public health, "3 by 5" was launched two years ago to counter the belief that it was not feasible or affordable to try to bring life-extending AIDS care to the places where 90 percent of the world's AIDS sufferers live. At the time, only 400,000 people were on antiretroviral treatment in low- and middle-income countries.
Problems of safeguarding and delivering the drugs, and a shortage of people trained to deliver AIDS care -- rather than a lack of money or willpower -- are the chief reasons the target will be missed, said Jim Yong Kim, head of AIDS programs at WHO.
"We don't believe that progress has been fast enough. . . . We are now quite concerned that we will not reach 3 million by the end of 2005," Kim told reporters during a telephone briefing from Geneva.
With him were representatives of UNAIDS, the United Nations' and World Bank's AIDS program; the free-standing Global Fund to Fight AIDS, Tuberculosis and Malaria; and the Bush administration's $15 billion AIDS plan. The gathering seemed to symbolize that missing the target was nobody's -- or everybody's -- fault, and that efforts to bring optimal AIDS treatment to the world's poor will continue unabated.
WHO does not itself provide treatment. Its role was to set the target, develop guidelines for low-cost, low-tech care, and help formulate national AIDS plans. Jong-wook Lee, the Korean physician who heads WHO, made "3 by 5" the highest-profile project of his term, which began two years ago.
Three million was chosen as the target because it was half the number of people in poor countries at risk of imminent death if they did not get antiretroviral therapy. Because of new infections and the progression of old ones, there are more people in that condition -- about 6.5 million, 660,000 of them children.
Because of the growth in the number of people getting treatment, however, global AIDS mortality in 2005 may actually decline from 2004, when 3.1 million people died, said Ties Boerma, director of measurement at WHO.
To reach the target of 3 million patients, WHO estimated that 1.6 million people would need to be getting therapy by now. Instead, only 970,000 are.
Nevertheless, that total represents huge progress, Kim said. The number of Africans on antiretroviral therapy tripled in the past year, and with each six months the number being added gets larger. Growth has been nearly as rapid in Asia.
The greatest success has been in Brazil, a relatively rich country that more than five years ago committed itself to providing treatment to all AIDS patients who qualify. About 155,000 are now being treated.
Treatment of about 350,000 people around the world is being supported by grants from either the Global Fund or the Bush administration's AIDS plan. The former has committed about $1.9 billion in the past two years to fighting AIDS; the latter plans to spend $15 billion over five years.
In addition, about 427,000 people are taking some drugs sold at extremely discounted prices by Western pharmaceutical companies, said Jos Perriens, another official in WHO's AIDS department. Most of the rest are taking generic antiretrovirals.
Bernhard Schwartlander, an epidemiologist with the Global Fund, said there have been particular difficulties setting up "supply chains" for drugs and medical equipment.
"It is easy to get them to the airport, it is easy to get them to the port, but to get them to the places where people are being treated is a huge logistical challenge," he said.
The report did not estimate the complications from expanded antiretroviral therapy, in particular the spread of drug-resistant AIDS virus, which is now relatively common in the United States and other places where many people have taken AIDS drugs for years.