Is the '3 by 5' initiative the best approach to tackling the HIV pandemic?

The World Health Organization (WHO) and its partners have set themselves a bold target: to get 3 million HIV infected people in poor and middle income countries on life-saving antiretroviral drugs by the end of 2005. But is this the right strategy for rolling back the world's worst infectious disease pandemic?

A provocative debate in this month's PLoS Medicine pitches Dr Jim Yong Kim, director of the WHO's Department of HIV/AIDS, against Dr Arthur Ammann, President of Global Strategies for HIV Prevention.

"The intentions are good, the approach is wrong," says Amman, who goes on to criticize the strategy for not emphasizing the importance of prevention, for being too cash-strapped to succeed, and for not encouraging countries themselves to take ownership of their HIV programs. The only strategy that will work, says Amman, is "universal offering of HIV testing, integration of HIV prevention and treatment into all health-care arenas, contact tracing [tracing all people who may been exposed to HIV], and treatment."

Kim, however, says that "while there are no sure prescriptions against plagues like HIV," setting a clear consensus target like "3 by 5" is "indispensable." He argues that scaling up treatment is essential to addressing the epidemic's devastating impact in much of Africa, critical for scaling up testing, counseling and other prevention interventions, and the best chance that the global health community has ever had to build health systems in resource poor countries. All 192 member states of the WHO have signed on to a resolution endorsing "3 by 5."

Linked to the debate, readers of PLoS Medicine are being asked their views in a poll on whether the "3 by 5" initiative offers the best hope for tackling the HIV catastrophe.


Contact: Paul Ocampo
Public Library of Science

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