Global Policy Forum

By Lawrence K. Altman

About two million people in the world are receiving drugs for AIDS, an increase of 700,000 in the last year, the United Nations said in a report issued yesterday. But the two million total is a million less than the three million people that the World Health Organization had hoped would be receiving treatment by the end of 2005. It represents only 28 percent of the 7.1 million people with advanced AIDS who need such therapy in poor and middle-income countries.

Still, the effort is "a remarkable success" considering that only 2 percent of infected patients needing antiretroviral therapy were receiving it three years ago, said Dr. Kevin De Cock, the H.I.V./AIDS director at the World Health Organization, a United Nations agency in Geneva. Countries in every area of the world are making substantial progress in 5 scaling up efforts, he said.

Studies show that survival rates were about 93 percent after one year among people starting antiretroviral therapy in developing nations, a rate that is similar to those in the United States and other rich countries, Dr. De Cock told reporters by telephone. Studies have also shown that levels of immune cells known as CD-4 were similar to those in rich countries, as was the drop in the amount of H.I.V., the virus that causes AIDS, in the blood.

But many numbers were discouraging. In 2006, about six times as many people became infected with H.I.V. as started treatment, meaning prevention efforts are faltering or not in place, Dr. De Cock told reporters by telephone. In 2003, only 400,000 people were being treated. So when the World Health Organization set an ambitious goal of treating three million infected people by the end of 2005, the plan met with enormous skepticism. Though the numbers achieved are smaller than desired, those receiving therapy are benefiting, Dr. De Cock said.

"If you visit these countries, go to clinics and go to people's houses, you see people going back to work," Dr. De Cock said. "It is pretty impressive." More governments must issue specific plans on how they will achieve greater success in preventing and treating AIDS, the report said. More than 150 countries committed themselves to setting targets for universal access to treatment by the end of 2006. But only 90 have provided data on such plans by that date, the report said.

The report recognized that preventing and treating AIDS was a complex problem hampered by weak health systems in poor countries. But the United Nations urged governments to do more to provide relatively simple antiretroviral regimens to mothers to prevent transmission of the virus to their infants. Only 11 percent of pregnant women in developing countries are receiving such therapy now, the report said.

Better tests and improved drug formulations are needed to treat children, and better care is needed for injecting drug users who are at high risk of becoming infected with H.I.V. Although prices for the standard antiretroviral drugs have fallen, health officials are concerned about the high costs of second-line, or backup, drugs that are needed when the first-line drugs fail.

The report urged greater efforts to control tuberculosis because nearly a million people with H.I.V. develop tuberculosis each year, leading to about a quarter of a million deaths. The Bush administration's emergency plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria were paying for care of about 1.27 million of the two million total, the United Nations said.