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Summary

It should be a cause for celebration that over 1.6 million people in the poorest parts of the world are now on antiretroviral treatment to halt the advance of HIV. But in a rush to improve access mistakes have been made. These mistakes, many of which were predictable, will be costly in terms of money and lives as drug resistance accelerates and more advanced (second-line) drugs may be unaffordable in poor countries.

The World Health Organization's 3 by 5 Initiative (to treat three million people with HIV drugs by end of 2005) failed to hit its target. Proponents of the initiative nevertheless claim it has generated massive interest to increase treatment and acted as a motivation for those working in health and aid agencies. But as the following paper explains, in some instances it has cut corners, over-strained fragile health systems and increased risk for those it purported to help. A recent report3 states that despite an increase in numbers on treatment in sub-Saharan Africa, AIDS deaths are still rising there.

Unusual features of the 3 by 5 Initiative include a high-level acknowledgement of failure and a comprehensive, (partially) independent evaluation, funded by a major donor. This evaluation vindicates criticisms of 3 by 5 made before and during the Initiative, but makes an optimistic prognosis for HIV/AIDS work at WHO, which seems unwarranted given the findings. Indeed, the international community appears to be moving ahead as though 3 by 5 was a total success. This could be highly damaging to future efforts to combat AIDS around the world.

This paper is the first in a series looking at policy and field practice to find the good and the bad in attempts to fight the AIDS pandemic. Later papers will focus specifically on: the nature and scope of the disease in Africa, whether the treatment model used by Western and mid-income nations is appropriate to Africa; what is being done to effectively combat and treat HIV infections in Africa; and the overall implications of these findings for the future of HIV treatment and control in Africa.

Roger Bate is a resident fellow at AEI. Lorraine Mooney is a is a medical demographer at Africa Fighting Malaria.

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