African has experienced a rapid increase in the number of people on antiretroviral medication over the last two years, but the continent is still a long way away from getting the life prolonging drugs to the targeted 3 million people.
A number of countries have made bold and majestic steps towards the 3-million-people goal set by the UN, but the road has been rough and tricky with lots of logistical and technical problems.
The World Health Organization (WHO) says that some 6 million people in developing countries require the ARVs, but that fewer than 300,000 are receiving them. In sub-Saharan Africa, where the pandemic is most acute, only 50,000 are accessing the drugs, while about 30 million are HIV-positive, according to the health body.
At the end of 2003, WHO announced a plan to put 3 million people living with HIV/AIDS in developing countries on ARV treatment by the end of 2005 in what came to be known as the 3x5 campaign. This campaign realises that the ARVs are a matter life or death for a growing number of people living with HIV and AIDS in Africa.
The ARVs attack the virus and can dramatically reduce deaths. But because of the high costs, their use in Africa has been minimal. UNAIDS estimates that only about 50,000 of the 4 million Africans in urgent need obtained them in 2002. But with prices relenting to a strong worldwide campaign for easy access, many more people have been able to use the drugs.
The results so far have been encouraging. In January, this year, WHO, the US government, UNAIDS and the multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria, announced that the number of people receiving ARV treatment in developing countries had gone up by 75 per cent by 2004 to over 700,000, about half of whom were in sub-Saharan Africa. According to public health experts, the rapid increase vindicates the WHO on criticism that its 3x5 goal was ill-advised. South Africa, Nigeria and India account for over 40 per cent of the total number of people still in need of ARV treatment, and experts say that a focus on the three countries could produce major gains for treatment access within a short time.
But a US$2 billion shortfall in funds is threatening the quest to reach the 3 million mark by the end of this year. UNAIDS says it needs S$6 billion in additional resources this year for the full range of programmes in developing countries.
A major impediment to Africa's 3x5 race is the severe shortage of trained medical personnel and facilities, and the continuing controversies over drug prices and patents.
Doctors without borders (Medecine Sans Frontiers) is credited with work in getting ARVs to many people in Africa and other advocacy groups point out that the 700,000 people on ARV treatment represent only about 12 per cent of the nearly 6 million people in developing countries who need it. With the disease taking 8,000 lives daily, and new infections topping 5 million last year alone, MSF declared that the global outlook is bleak and the world should be getting alarmed.
A number of voices in public health reiterate that it will take more than a heavy injection of ARVs into Africa to turn back the tide of the pandemic.
Dr. John Kilama of Uganda says the information is noble, but may be counterproductive. Let's be clear, reducing the cost and increasing the supply of medicines to the poor is a good thing. But on its own it is not enough. Nor should it be today's priority. The roots of Africa's health care crisis run far deeper and broader than a mere shortage of drugs, he says.
Spending billions on drugs is likely to prove a disappointing waste. He, like many who share his school of thought, believe that without vast improvements to Africa's health-care infrastructure, the 3x5 goal could even sink the continent into deeper trouble.
What Africa really needs is investment in its healthcare infrastructure. It needs to guarantee that patients comply with the needs treatment. This calls for patient education and training to help medics monitor and promote compliance in the rural areas. Africa has never had enough hospitals and clinics, especially in the rural areas. It then follows that the mechanism to ensure effective delivery of medicines is insufficient.
The global response to HIV/AIDS has shown little signs that it wants to get involved in helping improve Africa's public health systems as a strategy to fight the disease. However, even as experts debate on what route is effective, many countries across the continent are moving in different directions to provide their citizenry with ARVs.
South Africa carries a heavy burden. Its battle to provide cheap ARVs has been long drawn. President Thabo Mbeki has been criticized for his controversial stand on the cause of the pandemic, which many faulting his government for having failed to properly respond to the disease. Initially, South Africa was not keen to make ARVs available to all the people who needed them. The government did not think the drugs were a cost effective way of treating HIV. That position changed in November, 2003 with a cabinet decision to provide ARVs across the board. The government pledged to make the drugs available in at least one point in each of the country's 53 districts. Over 120 centres are now dispensing ARVs and almost 40,000 people are receiving them. But many critics still think the progress is too slow, especially in the rural areas.
The matter is complicated by a government decision to implement a broad strategy to deal with the problem, which involves providing ARVs whilst also making multi-vitamin supplements available to more than a 150,000 peopl.
Kenya's decision to open the gates for ARVs did not happen until very recently. According to the ministry of health's National AIDS and Sexually Transmitted Diseases Control Programme (NASCOP), about 270,000 people urgently require treatment. But no more than 4,000 are receiving the drugs. UNAIDS estimates that more than 2 million people are HIV-positive, out of a population of 30 million.
The government recently announced plans to offer free ARVs through 3,400 hospitals and clinics across the country. It is relying on the Global Fund to Fight AIDS, Tuberculosis and Malaria to provide the funds for the ambitious programme. Yet it is not clear how much, if any, the global fund should pump into the efforts.
Health activists have launched campaigns calling for pharmaceutical companies to lower the prices. The government has already achieved some success. AIDS activists further contend that laboratory tests necessary for the drugs to be administered are also too expensive for the average Kenyan. They include tests to establish CD4 counts and the viral load. Each test costs US$128 and very necessary because it helps doctors to tell when to start ARV treatment and monitor the success of treatment.
The East African country's health ministry and MSF on April 28, 2005 inaugurated a facility designed to give comprehensive healthcare to people living with HIV/AIDS in the capital, Nairobi.
The Comprehensive Care Centre (CCC), jointly run by the ministry of health and MSF-Belgium, will carryout counseling, testing and treatment with antiretroviral (ARV) drugs.
Nearly 2,000 patients are already registered to receive regular treatment. The centre was set up at the Mbagathi district  hospital in Nairobi, and will also train the hospital staff diagnosis and care.
MSF provides the ARVs free of charge, but patients referred to the centre from other government health facilities are required to pay US$ 5 a month for tests but the health ministry acknowledges many patients cannot afford this.
Speaking during the centres' opening recently, Mrs. Charity Ngilu, the minister, said: Those who are poor and living with AIDS should not be denied treatment just because they are poor.
MSFs head of mission in Kenya, Christine Janet, said ARVs must be provided free of charge. Poverty should not be allowed to get in the way of care, she said.
Mrs. Ngilu said the ARV treatment programme would, by the end of this year, be extended to cover a total of 95,000 people. The time to act is now, she said, Let us not hold continuous meetings, we must start acting so that we can save lives.
The race to that target was boosted when Europe's largest drug maker Glaxo SmithKline Plc agree to license a Kenyan firm to make and sell generic versions of its antiretroviral drugs used to treat HIV/AIDS.
British-based Glaxo said it has allowed Cosmos Limited to make the drugs in Kenya and sell them in Kenya, Uganda, Tanzania, Burundi and Rwanda.
Kenya has passed laws to allow so-called compulsory licensing, to increase access to life-prolonging AIDS drugs, but Glaxo said the deal was voluntary.
The licence is the fourth granted to African generics firms to manufacture and sell Glaxo SmithKline antiretrovirals in the continent, the one hit hardest by the AIDS epidemic.
Although the prices of antiretrovirals have dropped substantially over the years, from about 15,000 Kenya shillings ($184.7) four years ago to 3,000 shillings per monthly dose, they still remain beyond the reach of many Kenyans.
Kenya's minister for Trade and industry, Mukhisa Kituyi, said at least three other local pharmaceuticals companies were seeking a licence to manufacturer antiretrovirals, adding that he hoped all would be granted a licence voluntarily.
In Botswana, an estimated 50 per cent of those in need of the drugs currently receive them. This is due in large part of the government's pioneering decision in 2002 to provide them free of charge through the public health system.
Uganda, whose prevention campaign is already considered a model for effective programmes, now provides ARV treatment to 40 per cent of the 114,000 people who require it. In Cameroon, says WHO, strong political leadership combined with increased funding an a sharp drop in prices, has allowed some 12,000 people to begin ARC therapy. Cameroonian authorities say they will triple that number by the end of 2005.
Overall, notes WHO in its December 2004 3x5 campaign report, antiretroviral medication is now available at more than 700 sites across the region. The study also found out that African ARV patients are as likely as those in developed countries to maintain the drugs strict daily treatment schedule. This finding has confounded critics who argue that poor adherence rates accelerate the emergence of the virus drug-resistant strains.
Despite the progress, obstacles to treatment access stubbornly remain. Chief among them is the absence of the public health capacity hospitals and clinics, diagnostic and laboratory facilities and trained medical personnel to maintain millions of people on the powerful medication.
Part of the problem, notes a recent study by WHO and other international health organizations, is the fatal flow of African health professionals to better-paying jobs overseas. The study notes that there are more Malawian doctors practicing in UK city of Manchester than in the African country itself, while Zambia, with one of the highest HIV-infection rates in the world, has lost to foreign employers 550 of the 600 doctors it has trained since independence.
UNAIDS estimates that by 2007, about $20 billion will be needed for the fight against AIDS.