The War Against HIV/AIDS: The 3 by 5 Initiative and its Failure to Consider the Barriers That Limit Treatment-Reena Doshi
It is estimated that 42 million people are now infected with HIV, while 30 million people have already died from the virus (23). In developing countries, 6 million people are in need of antiretroviral therapy (ART), though only 8% receive it (23). Today, the HIV/AIDS pandemic is the world’s most pressing matter, one that is destroying communities and health care systems, while taking away futures. Projections have indicated that if the pandemic continues at its current rate sub-Saharan
The World Health Organization saw ART as the simplest solution to the current HIV/AIDS pandemic and in 2003, with UNAIDS, released an extensive plan to treat 3 million HIV sufferers in 50 developing countries with antiretroviral therapy by 2005. The strategy, called the 3 by 5 initiative focused on devising more simplified and standardized tools of delivering ART therapy, including the creation of a new service, which would guarantee the necessary supply of medicines, intertwined with a strong global partnership (23).
In 2007, two years after the goal was to have been reached, only 33% of the 3 million have actually received treatment (1). The World Health Organization pledged much and gave little, since more than half of the 33% were treated with other initiatives such as the pharmaceutical industry's Accelerated Access Initiative, donations from the European governments, and U.S. donations toward the Global Fund, as well as President George W. Bush's initiative (1). Although, it unfair to declare the initiative a complete failure, one can wonder why the 3 by 5 initiative was so far from reaching its goal. Offering treatment to HIV/AIDS sufferers in developing countries is not a simple task and may have been more successful had the intervention considered the barriers that often limit an individual’s treatment access. Although the 3 by 5 initiative acknowledged that various barriers preventing treatment existed, the initiative failed to incorporate specific strategies to target these areas. The shortage of healthcare facilities and healthcare workers in the target countries is a pivotal blockade to a successful treatment plan. In addition, the narrow focus of initiative targeted a smaller population, those who need immediate antiretroviral therapy instead of focusing on the total population and including those at risk of infection. Moreover, the intervention failed to address the stigma and discrimination surrounding HIV/AIDS.
An Inadequate Infrastructure Cannot Support a Large Scale Treatment Intervention
“Health for All by the Year 2000,” pledged the World Health Organization member nations in 1978 at the
For example, 10% of the world’s population resides in
A Narrow Intervention is Not Sufficient
The 3 by 5 initiative aimed to treat 3 million HIV/AIDS infected people with antiretroviral therapy by 2005. The interventions target: those already infected with the virus, ignoring those at risk of developing the disease. This narrowly focused intervention failed to consider the total population, focusing solely on those already HIV positive. But where does that leave those at risk of acquiring the infection? Currently, worldwide ignorance is common, with surveys around the world indicating that awareness and comprehension of HIV is low (3). The numbers of infected individuals is rising steadily. In 2005 alone, an estimated 4.1 million new infections occurred (4). Numbers in the youth population are also quickly rising, with estimates of 6 to 7 thousand new youth infections daily and 11.8 million already infected (3). In the
Education involving factual and uninhibited knowledge is critical for both the HIV negative and the HIV positive population of all ages, helping to further prevent transmission by providing people with information about the disease, transmission, and how one can protect oneself. Education has also shown to be effective in improving the quality of life of HIV positive individuals, including teaching those infected, the importance of not passing the virus. Finally, education is critical if we hope to reduce the stigma and discrimination surrounding the pandemic, probably the most significant barrier preventing treatment. Without educating, allocating treatment becomes difficult. Those unaware of the problem and the virus effects will simply not be willing to accept treatment.
Additionally, the 3 by 5 initiative suffered from a funding gap of over 5.5 billion dollars, yet in spite of that, hoped to achieve an enormous goal (23). Consequently, implementing the most cost effective interventions, which target the greatest number of people, are critical to the program’s success. In a study conducted at the
The 3 by 5 initiative was unable to reach its goal because of its failure to incorporate broader development strategies into the invention. The initiative addressed only one issue-treatment-while ignoring those at risk of infection. A successful intervention must focus on providing people with the information to expand their understanding of the disease, as well as the tools to protect themselves and others. They must understand how the disease is transmitted, how it is prevented, the severity of the problem, and how it is treated. They must also understand that the disease is not biased against gender, age and economic status. The 3 by 5 initiative failed to take into account the fact that the HIV/AIDS crisis is multi-faceted, without the having the appropriate knowledge, treatment can only provide limited protection. The initiative’s core values were narrowly centered on treatment alone. Before offering treatment, awareness must be created. As the number of new HIV infections continues to escalate is it important that we speak to the entire population, whether infected or at risk. A fair public health intervention must protect the rights of those infected as well as those that are uninfected.
Stigma and Discrimination Pose a Threat to Treatment
At the 10th meeting of the Joint Nations Programme on HIV/AIDS, Peter Piot, the Executive Director of UNAIDS described the need to combat stigma as one of the five most pressing matters in the global community (15). However, when the 3 by 5 initiative was announced in 2003, the desire to combat stigma seemed long forgotten. The word Stigma dates back to ancient
Since, the 1980’s, when AIDS made its first appearance, the belief that AIDS sufferers were “contaminated and tainted” was created and continues to prevail (18). The fear of transmission typically leads to social isolation, loss or rights, reduced access to services, and fuels transmission of the disease. The severity of the illness and its association with illegal and sensitive behaviors such as prostitution and drug use intensify the stigma associated with the disease (20). Consequently, it is often felt that HIV is a product of poor personal choices, infecting those with no moral values; therefore it is one’s own fault if they acquire the disease (20). One study, in
In many developing countries, women are already often at a great disadvantage socially, culturally, and economically, making stigma and discrimination profound. Most already do not have equal acess to treatment or education, and if discovered to be infected are socially distanced from their communities. Mothers in
Stigma and discrimination discourage HIV testing, counseling, and prevention services. People are less likely to disclose their HIV to a sexual partner, women are less likely to practice safer infant feeding practices, and unnecessary stigmatization is conferred to family and friends. Stigma and discrimination are in truth the most severe barriers that limit treatment. If disclosing one’s HIV status or accepting treatment creates a risk of abandonment, social distancing, or death, it becomes clear why treatment alone is ineffective. The World Health Organization’s goal of supplying three million patients with antiretroviral therapy overlooks the main factor fueling the HIV/AIDS pandemic! The intervention failed to recognize that the HIV/AIDS problem is not solely based on a lack of treatment, but is intrinsically intertwined with the societal values. (17). Providing ART treatment will not rid society of the stigma and discrimination that persists. Creating an intervention which creates awareness and specifically targets stigma and discrimination is crucial. It is clear that large numbers of HIV sufferers in developing countries desperately need ART therapy, but therapy becomes ineffective when infected individuals are unwilling to utilize the treatment. Everyone deserves equal access to the drug, but with stigma and discrimination present, patients are not going to take advantage of the treatment that is placed in front of them. Jonathon Mann, Director of the World Health Organization’s former Global Programme on AIDS, claimed that the third phase of the AIDS pandemic was the most explosive. This phase, characterized by discrimination and stigma “are as central to the global AIDS challenge as the disease itself.” (15).
In 2007, we all agree on one thing, that the HIV/AIDS pandemic has progressed to a world-wide emergency. We can no longer sit back and watch the virus conquer our world. To combat the disease the World Health Organization created the 3 by 5 initiative, which hoped to provide antiretroviral treatment to 3 million HIV/AIDS patients by 2005. Sadly, the intervention did not reach its goal due to its failure to incorporate strategies targeting the barriers that limit treatmeant. The initiative failed to take into account that many of the target countries had poor infrastructures with severe shortages of healthcare facilities and healthcare workers. Additionally, the narrow focus of initiative targeted those needing immediate antiretroviral therapy, while excluding those at risk of infection. Finally, the intervention failed to address stigma and discrimination and its effect on acquiring treatment. Although, the 3 by 5 initiative was unable to reach its goal, it was not a complete failure. We learn from our mistakes and hopefully this aggressive treatment intervention can be incorporated into a more comprehensive plan that targets the underlying factors that have not only inhibited the success of the 3 by 5 initiative, but have been critical in fueling the pandemic.
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