WHO says Aids drug target unlikely to be hit

One million people in developing countries are now taking Aids drugs, according to figures released yesterday by the World Health Organisation, but it admitted that the target of 3 million by the end of 2005 is unlikely to be reached.

Jim Yong Kim, the director of HIV/Aids at the WHO and the man who pushed for the world to set the "3 by 5" target, said fixing a difficult goal had driven the treatment strategy forward further and faster than could have otherwise been hoped.

"We are at 1 million. Who would have guessed we would have got to this point by now? We're not going to make 3 by 5, but the point is that we're not going to stop," he said.

The G8 finance ministers had declared that the goal could no longer be restricted to the 3 million people with HIV most urgently in need of drug treatment, but universal access, he said.

It would change the focus, and efforts would increase to get more women and children on the antiretroviral drugs that suppress the virus and keep people alive for longer.

Some activists are likely to say that progress has been too slow and that a much faster roll-out of treatment is needed as the scale of the pandemic increases. The WHO's progress report, released yesterday, says there has been acceleration.

In sub-Saharan Africa, the worst-hit region, about 500,000 people are on therapy, more than three times the number last June and nearly double the number six months ago.

In Asia, there has been a tripling of the numbers since June to about 155,000 now.

But the real bottlenecks have been the countries with large populations, including South Africa, Nigeria and India. In South Africa there are about 100,000 people on the drugs, mostly in the private sector.

Yet South Africa had 5.3 million people living with HIV at the end of 2003, which is the highest number infected with the virus in any country in the world.

India is thought to have the next highest number, but is responding slowly to the pandemic. Only 7,000 people in the private sector are on treatment, even though Indian companies make cheap copies of Aids drugs.

Nigeria has about 40,000 on treatment and is trying to scale up.

Action Aid, a campaigning group, blamed the failure to meet the 3 by 5 target on a lack of political will.

"This news is an indictment of leaders in rich and poor countries, who have failed to fully back this vital initiative," said Felicity Daly, its HIV and Aids policy officer. She called on the G8 to provide increased and sustainable funding.

"We are committed to universal access to HIV treatments by 2010," said Gareth Thomas, the British international development minister. "We will spend £1.5bn in the next three years on Aids, including £150m on orphans."

Lee Jong-wook, the WHO director general, emphasised the unique and difficult nature of the enterprise. "This is the first time that complex therapy for a chronic condition has been introduced at anything approaching this scale in the developing world," he said. "The challenges in providing sustainable care in resource-poor settings are enormous, as we expected them to be. But every day demonstrates that this type of care can and must be provided."

The more access there is to drug treatment, according to Peter Piot, executive director of UNAids, the more people come to be tested for HIV and get counselling, which is fundamental to preventing the spread of the virus.

There is considerable concern about the plight of children, for whom there are no paediatric formulations of the powerful three-drug cocktails that control the virus.

"Globally, access to HIV care and ART [antiretroviral therapy] has not extended widely to children, despite the fact that 50% of HIV-infected children will die before their second birthday in the absence of treatment," the progress report says. It suggests that 660,000 children in the world need drug treatment this year.