Falling behind HIV: The need for prevention.

Since scientists isolated the first known case of AIDS in 1959, the highly resistant HIV has mutated, showing great resilience in the face of various treatments. In 2005 alone, 38.6 million cases of HIV infection were reported worldwide, up from 36.2 million in 2003. In addition, regions, such as the Asia-Pacific, that in the previous decade did not have an AIDS epidemic, have seen a dangerous growth of HIV cases. Though the prevalence of the disease has not yet reached the levels seen in Sub-Saharan Africa, this does not mean that the disease will not have catastrophic effects in the future, especially if national governments and international organizations continue to fail in their efforts to curb the dramatic increases in infection of the last decade.

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The governments of Asian countries have attempted to fight the disease before it reaches uncontrollable levels. However, HIV has continuously survived preemptive strikes against its invasion and does not show signs of disappearing any time soon. Despite vigorous efforts and campaigns to provide expanded treatment while concurrently reducing AIDS cases, HIV continues to spread as mankind's most formidable communicable disease. One of these failed attempts, the "3 by 5" campaign, while proposed with the best intentions, did not reduce the cases of HIV.

The "3 by 5" campaign was proposed in 2003 by the World Health Organization (WHO) and Joint United Nations Program on HIV/AIDS (UNAIDs) to provide three million people in developing nations with anti-retroviral treatment as a small step toward the overall goal of providing universal treatment for HIV. While providing treatment for HIV is a vital component of addressing the AIDS epidemic, the disappointing results of the "3 by 5" initiative on HIV treatment and the overall growth in the number of cases of global HIV reflects a dire need for the Asia-Pacific region and its neighboring nations to not only utilize treatment methods, but to create preventive measures that would more effectively reduce the cases of AIDS.

A Grim Reality in 2003

In December 2003, The World Health Organization reported that 3 million people had died from HIV in that year alone and that another 40 million were living with AIDS. These numbers reflect a steady increase since 1999 of HIV infections and AIDS-related deaths. Demonstrating the ineffectivesness of current strategies, the situation in 2003 demanded a desperate reappraisal of solutions to the HIV epidemic.

The Asia-Pacific region alone gained one million cases of AIDS to claim a total of about 7.4 million cases of the disease, indicating an ominous acceleration of HIV infection in a region that had, until then, not encountered serious problems with the disease. The government of India estimated that the country's numbers had grown to about 4.58 million cases in the past decade, panti-retroviral treatmently due to increasing drug and sex trafficking in the region. China demonstares similar problems in its more rural provinces. According to the HIV/AIDS in Asia and Pacific Region 2003 Handbook, some provinces such as Yunnan, Xinjiang, Guangxi, and Sichuan have HIV prevalence rates that range from as much as 80 percent as a result of heavy drug injection use.

Most ominous about these rates of infection is the fact that they are occuring among the largest populations in the world, China and India. Such an increasing presence of HIV is an even more pressing issue to deal with when looking at the future of healthcare costs and fatalities from disease. China was not the only country that had a large concentration of AIDS cases in its more remote provinces; Thailand, Cambodia and Vietnam experienced unprecedented rates of HIV infection. Many of these developing countries did not and still do not have the economic means to provide effective Anti-retroviral treatment, and this inevitably causes greater susceptibility to future infections.

Another aspect of this unfortunate trend that is appearing in Asia is the prevalence of HIV among younger people. About 1 to 3 percent of those in the 15 to 49 age group in countries such as Thailand, Cambodia, Myanmar, and India are infected. What is more disheanti-retroviral treatmentening is the growing rate among children born to parents with the virus. In the Asia-Pacific region, 19,000 children were living with HIV. This younger population is vital for the economic sustainability of their nations. If more is not done to treat and prevent infection, rising cases of HIV among children will result in shocking economic effects in the future. To avoid this, these nations are implementing pilot programs and studies in prevention education that target younger populations and have proven to be successful in reducing the incidence of HIV contact. Beside the obvious health benefit, prevention provides an overall economic benefit because it eliminates the need for future spending on anti-retroviral drugs for individuals and especially preserves the younger generations that will maintain the national labor force.

Government Efforts before "3 by 5"

Prior to the "3 by 5" initiative, governments in the Asia-Pacific Region had already implemented their own AIDS and HIV policies and prevention programs. Many increased spending on the programs, allowing for more flexibility in delivering anti-retroviral therapy. Some increased spending on education programs and promoted condom use, especially among sex workers. While plans to provide more antiviral medicines to people were underway in various countries, these plans were obstructed, in the words of Indonesia's Minister of Health Achmad Sujudi, "by the continuing gap between the availability of resources and the demand for effective and prompt implementation of the AIDS commitments." The cost per person of HIV treatment per year is between US$300 and US$1200, which is an impossible expenditure for many lesser developed nations.

In 2001, China allocated 100 million yuan, an increase from its previous 15 million yuan, for AIDS prevention and invested 1.25 billion yuan into improving blood centers. The central government, in a 6.8 billion yuan joint collaboration with local governments, established endemic disease prevention and control facilities. The Chinese government also began to put greater efforts into research and manufacturing of domestic antiviral drugs. The province of Yunnan also set up the first domestic AIDS Prevention Care Center, hoping to provide for effective treatment for not only the Chinese, but patients from other nations as well. However, according to a report by WHO and the UK Depanti-retroviral treat-mentment for International Development, it was difficult to distribute a great many of these drugs because of the shortage of doctors. While these new developments indicated an effort to alleviate the effect of the disease on those currently infected, China must identify and target the causes of the disease in order to avoid the need for antiviral drugs.

In India, efforts were heavily aided by a US$76.5 million grant from the Bill and Melinda Gates Foundation. Yet, despite these large amounts of money and an increase in centers for AIDS patients, the growth of HIV infection in 2003 in the Asia-Pacific region reflected serious errors in the way those nations used their resources to deal with the disease. The rapid spread of HIV infection also presented major bureaucratic obstacles in containing the disease for those governments struggling to keep up with the disease.

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The Initiation of the "3 by 5" Process

The "3 by 5" initiative's ambitious goal of providing Anti-retroviral treatment was especially important because among the 6 million people infected in the developing world, only 300,000 had the drugs they needed to prolong their lives. The situation was especially dire in Africa, where only 1 percent of those who needed the drugs had access to them. This program, in concurrence with the United Nations Millennium Development Goals concerning HIV, focused on halting and reversing trends of infection.

Many crucial goals of the "3 by 5" campaign were dependent on cooperation from the beneficiary, the country receiving the aid. One key component to progress, as stated by the late-Director General of the WHO, Dr. Lee Jong-wook, was expansion of the "training and capacity development for health professionals for delivering simplified, standardized anti-retroviral treatment." This was the aim of the Human Capacity Building Plan, a program developed to support the "3 by 5" initiative. The program was created to provide for simple HIV treatment administration training and certification according to an individual country's capacity to carry out such a program. This was an extremely difficult plan to execute in the Asia-Pacific region because many of the governments in those developing nations were more concerned with fueling and stabilizing their own governments than using their limited resources to create HIV training programs. Thus, these countries were placed between competing sets of obligations, having to choose between developing their economies and addressing the ever-growing problem of HIV by following the plans outlined by an international organization.