The global epidemic of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/ AIDS) is the greatest threat to human health and development since the bubonic plague and the advent of tobacco consumption. It threatens not only to continue the decimation of millions (over 20 million deaths so far, with 34-46 million people currently living with HIV/AIDS (1)) but also to reverse many of the gains made in developing countries over the past 50 years (2).
Consequently, as The world health report 2004 states, history will judge the current generation by its response to this global threat (2). The ambitious "3 by 5" initiative of WHO and UNAIDS to reach three million people with antiretroviral therapy by the end of 2005 (3) intends to halve the treatment gap, in which only 400 000 of the six million people who need treatment currently receive it. "By tackling [HIV/AIDS] decisively," says LEE Jong-Wook, Director-General of WHO, "we will also be building health systems that can meet the health needs of today and tomorrow, and continue the advance to Health for All" (2).
There is no room for complacency, however, in the false assumptions that we have all the solutions and that we know how to use them. Tuberculosis (TB) and malaria have shown that the availability of effective drugs, control measures and a vaccine do not guarantee success. To await the results of pilot projects of AIDS treatment expansion would be courting disaster, as every day it is estimated that over 6000 people die and 12 000 more are infected with HIV. The motto adopted by 3 by 5 of "learning by doing" ensures that research, monitoring and evaluation are firmly embedded in national antiretroviral treatment expansion programmes--as is the case in the South African plan (4). This voyage of discovery must be a shared one, however, as developing countries share their experiences and participate in the implementation of treatment programmes, with people living with AIDS playing a prominent part.
In the absence of a cure for HIV/AIDS, treatment activities must strengthen prevention programmes --serving as motivating and enabling factors for people to be tested and to modify their sexual behaviour. The five pillars of the 3 by 5 strategy emphasize this integrated approach (3).
Providing access to affordable and effective antiretrovirals alone will not defeat the HIV/AIDS pandemic. Sustainable supplies (and their provision by local manufacture) of the whole panoply of AIDS drugs are vital. Cheaper and more effective diagnostics must be developed and supplied through public/private partnerships such as FIND Diagnostics (5). Food must be provided for those who are hungry, as well as the nutritional supplements that are so effective as additional therapy for AIDS (6). …