Comprehensive HIV/AIDS fight strategy can change history
-World Health Report focuses on treatment, care
Stabroek News
July 28, 2004

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In March 2003, 26-year-old Joseph Jeune, a peasant farmer living in a small town in Haiti was in the advanced stages of AIDS and his parents had already bought his coffin. Six months later and 20 kgs heavier the man's life was transformed after receiving treatment for HIV/AIDS and tuberculosis (TB).

This is the story the World Health Organisation's (WHO) 2004 World Health Report, titled `Changing History', opened with to vividly demonstrate what a difference access to treatment can make. Before and after photographs of Jeune heightened the impact of the story.

The report, launched at the Georgetown Public Hospital Corporation (GPHC) compound yesterday, calls for a "comprehensive HIV/AIDS strategy that links prevention, treatment, care and long-term support." At the launching of the report, Health Minister Dr Leslie Ramsammy said that since the start of the state-funded care programme, 500 persons who were near death are now receiving treatment and leading normal productive lives.

It confirms that tackling the virus is the world's most urgent public health challenge and addresses the global initiative to provide three million people in developing countries with anti-retroviral therapy by the end of 2005.

The report also looks beyond 2005 and goes on to explain how international organisations, national governments, the private sector and communities can combine their strengths to tackle HIV/AIDS and simultaneously fortify health systems for the enduring benefit of all.
Health Minister Dr Leslie Ramsammy (right) and PAHO Representative Dr Bernadette Theodore-Gandi with a copy of the report at yesterday's launching.

According to the report, there are millions of people like Jeune around the world and for most of them anti-retroviral treatment is beyond their reach. However, his case shows what can be achieved.

The young man fell ill in August 2002 and had travelled to several clinics seeking help, but his health deteriorated rapidly, and he eventually became bedridden with a gastrointestinal opportunistic infection.

Emaciated and close to death, Jeune was referred to the Lascahibas clinic in March 2003 and there he was diagnosed with HIV and TB co-infection and was started on antiretroviral therapy for HIV/AIDS and treatment for TB. He remained at the clinic for almost two months and has now resumed farming; he earns an additional income by shining shoes at the local market.

The report quoted Jeune as saying: "These medications have brought me back from the brink of death. Everyone except my mother had given up hope for me until I started treatment, but now nobody would know I am sick unless I told them. I feel as good now as I have in years. This treatment has been miraculous for me, and for others. To think that my family had already bought my coffin when I started treatment - and now look at me!"

The report said already some 20 million people have died from the disease and it is estimated that another 34-46 million others are living with it. "Unknown a quarter of a century ago, HIV/AIDS is now the leading cause of death and lost years of productive life for adults aged 15-49 years worldwide."

The report pointed out that until now treatment has been the most neglected element in developing countries.

It estimated that almost six million people in developing countries will die in the near future if they do not receive treatment - but only about 400,000 of them were receiving it in 2003.

This knowledge, the report said, underpins the commitment of the WHO and its partners to help provide three million people in developing countries with antiretroviral therapy by the end of 2005 - and not to stop there.

It acknowledged that the treatment expansion initiative far exceeds the capacities of any single organisation adding that it is the most ambitious public health project in history and is fraught with difficulties.

"But within the multiple partnerships of the international community, the knowledge that this can be done is leading to the recognition that it must be done."

Stating that a critical moment in the history of HIV/AIDS has arrived, the report noted that there is more money, more political will and more attention being paid to the disease than ever before. However, more people than ever are dying of AIDS and becoming infected with HIV. Using HIV treatment programmes to strengthen existing prevention programmes and improve health systems, the international community has a unique opportunity to change the course of history.

WHO, UNAIDS and partners are implementing a comprehensive HIV/AIDS strategy which links prevention, treatment, care and support for people living with the virus.

According to the report vital resources have now been pledged, including more than US$20 billion from donor countries and through multilateral funding agencies, including the Global Fund to fight AIDS, TB and Malaria, the US President's Emergency Plan for HIV/AIDS Relief and the World Bank. These funds, the report said, must be used swiftly and in a coordinated way to prolong the lives of millions of children, women and men who will otherwise soon die. Adequate technical support for HIV/AIDS programmes must be mobilised to ensure that the new investments have the greatest possible long-term impact on the health of people in poor countries.

Further, the report said where treatment has been made available this has led to overwhelming demands for testing and counselling. "Good counselling and HIV educations lead to more effective prevention in those who are uninfected, and significantly reduces the potential for infection transmission in those who have HIV."

The scaling up of testing and counselling in health services for people with TB, pregnant women and vulnerable populations including youth, sex workers and injecting drug users, also leads to greater engagement of those who may be vulnerable - again strengthening opportunities for prevention. It added that motivating communities to learn their HIV status in the context of access to antiretroviral treatment is altering community responses to HIV, encouraging greater openness and helping to reduce the stigma and denial that has enabled the virus to spread disastrously.

It was stated that as new funding flows in, technical resources and trained staff must be ready to ensure its effective use. To help accelerate the treatment initiative, WHO has developed a simplified set of antiretroviral drug regimens, testing and treatment guidelines that are consistent with the highest standards of quality of care. The guidelines are intended to be used at all levels of the health system, as well as in the community to monitor and promote adherence to treatment. And because these regimens make it possible for even the poorest areas to start treating those who need it, they ensure that rollout of treatment programmes can be done equitably.

The WHO has also designed streamlined guidelines for training health workers in a wide range of skills, from HIV counselling and testing and recruitment of patients to treatment delivery, clinical management of patients and the monitoring of drug resistance.

The report chronicled how the long-term economic and social costs of HIV/AIDS in many countries have been seriously underestimated, and that some countries in sub-Saharan Africa may be brought to the brink of economic collapse.

And building up health systems is essential, not just in the fight against HIV/AIDS but also in generally improving access to better health care for those most in need.

It concluded that beyond 2005 lies the challenge of extending treatment to many more millions of people, and of maintaining it for the rest of their lives, while simultaneously building and sustaining the health infrastructures to make that huge task possible. "The success of this action cannot be guaranteed. But inaction will not be forgiven. It will be judged by those who suffer and die needlessly today, and by the historians tomorrow. They will have a right to ask why, if we let the chance of changing history slip through our fingers, we did not act in time."

The launching of the report was attended by representatives of a number of organisations in Guyana that are affiliated in the fight against HIV/AIDS.

PAHO representative in Guyana, Dr Bernadette Theodore-Gandi and Minister Ramsammy delivered short addresses at the launching.