Acknowledging the complexity of getting drugs safely from airports to clinics, leaders in the global fight against AIDS said yesterday that medications should reach 1.5 million people by the end of the year - half the ambitious goal set two years ago.
Officials with the World Health Organization and the United Nations program on AIDS said they didn't fully appreciate the challenges of delivering drugs to remote regions of Africa and Asia.
"It's easy to get them to the airport, easy to get them to the ports," Dr. Jim Yong Kim, director of the WHO's HIV/AIDS department, said in a telephone news conference from Geneva. "To actually move them to the sites where drugs are actually given to people ... is the huge logistical challenge we're faced with."
Relief agencies found it harder than expected to assemble the drug "supply chain" - clean warehouses to store medications, staff to keep track of inventories, and the trucks and security needed to get medications to health centers. At times, Kim said, drugs have been diverted by profiteers.
But, against a backdrop of a worsening global AIDS crisis, officials with the WHO and UNAIDS claimed major successes, too - saying that relief groups have doubled the number of people being treated in 18 months.
"While we don't think we'll reach the target, there are tremendously exciting things happening in many countries," Kim said. "For the first time in history, we're talking about scaling up chronic care for a chronic disease in entire countries."
To date, he said, some 1 million people are being treated.
Officials with the two global health organizations acknowledged that relief groups are fighting an ever-widening epidemic. Last year, 5 million people became infected with the human immunodeficiency virus - a record. That same year, 3 million people died of acquired immune deficiency syndrome.
By delivering drugs faster, health workers hope to slow if not reverse the trend. "If 1 million people are in treatment, that will at least decelerate the growth of deaths," said Ties Boerma, director of the WHO's measurement and health information department.
The number of people receiving antiretrovial therapies - drug combinations capable of suppressing the virus and restoring people to health - is increasing in every region of the world, officials said. In sub-Saharan Africa, the region with the deepest AIDS problem, about 500,000 people are receiving drugs, triple the number a year ago and nearly double the number six months ago.
In Asia, the second most afflicted region, the number in treatment has tripled to 155,000 in the past year.
Yesterday's briefing came as the WHO and UNAIDS released a report on their effort to reach the so-called "3 by 5" goal - 3 million people in treatment by the end of 2005.
An estimated 6 million people worldwide are infected and in need of antiretroviral drugs. Nations belonging to the WHO had set a goal of serving half that many by the end of this year.
Though the world bodies have provided technical support, funding has come largely from the United States, through the President's Emergency Fund for AIDS Relief, and a nongovernmental program called the Global Fund to Fight AIDS, Malaria and Tuberculosis.
President Bush's program has pledged $15 billion over five years to fight AIDS in 15 of the hardest-hit countries in Africa and the Caribbean. The Global Fund has committed about $9 billion through 2006, targeting money for 128 countries.
All told, $6 billion went last year to fight AIDS in the developing world, with half coming from the United States. Other sources have included the World Bank, the Gates Foundation and various nongovernmental organizations.
The report gives a glimpse of how difficult the battle has become. In South Africa, for instance, just 10 percent to 14 percent of 1 million people needing drugs are getting them. In India, the Asian country with the widest epidemic, medications are getting to only 4 percent to 9 percent of the 800,000 in need.
A consortium led by the University of Maryland's Institute of Human Virology and Catholic Relief Services has been a major global player. Last year, the president's program awarded the group $335 million over five years to fight HIV infection in nine countries.
Last week, Zambian President Levy Mwanawasa visited the institute's labs on Lombard Street in Baltimore to see new diagnostic equipment that will be used in five clinics where the consortium is delivering care.
"You see HIV/AIDS is a huge problem," he told a gathering of reporters. "Through AIDS we have lost many teachers and have a lot of orphans."
Zambia, which has an estimated 600,000 orphans, is typical of the successes and challenges faced in sub-Saharan Africa. It was one of the first countries to request help through the "3 by 5" initiative, setting the goal of reaching 100,000 people by the end of 2005. Through March, an estimated 26,000 to 30,000 people were in treatment.
The Johns Hopkins School of Medicine is working with three countries in Africa. In Uganda, which has received $90 million from the president's program, Hopkins helped set up clinics to care for about 15,000 people.
"You have to look at this from the perspective that they went from almost zero - I mean, very few people accessing care - to now one out of four people being in treatment," Dr. Tom Quinn, a Hopkins AIDS specialist, said of the global battle. "We shouldn't be disheartened by not making it to 3 million."