GENEVA - Medical treatment for the millions of people with HIV/AIDS could bring the worst epidemic of the last few centuries under control, and mark a hope-giving change in global public health, say experts.

Some six million people in developing countries could survive the disease if they were to receive antiretroviral treatment for HIV/AIDS, but in 2003, just 400,000 people in poor countries were provided these life-saving medications, says the World Health Organisation (WHO).

A health divide of such great proportions is unacceptable, and bridging it is of utmost important for public health, says the United Nations agency.

The fight against AIDS (acquired immune deficiency syndrome), a disease "unknown barely a quarter of a century ago," has become "the world's most urgent public health challenge," said Thomson Prentice, one of the authors of the World Health Report 2004, released Tuesday by the WHO.

The study, "Changing History", details the need to extend medical treatment against the disease that has claimed more than 20 million lives and currently affects 34 to 46 million people worldwide.

"The world has reached a crucial moment in the history of HIV/AIDS, and now has an unprecedented opportunity to alter its course," Prentice said.

An effort to expand HIV/AIDS treatment could produce important benefits in other areas, because, says WHO director-general Lee Jong-Wook, we would at the same time be building health systems capable of attending to tomorrow's health needs.

In the industrialised countries, access to the potent "cocktails" -- combinations of antiretroviral medications, ARVs -- has prompted a dramatic decline in AIDS-related deaths, which plummeted 80 percent in the four years after these therapies began to be applied in Europe and North America, according to health experts.

In contrast, the lack of such treatment -- which halts the spread of HIV (human immunodeficiency virus), the precursor to AIDS, through the body -- is concentrated in developing countries, and in sub-Saharan Africa in particular.

Some countries in that region face economic collapse if they do not find a way to stop the epidemic, warns the WHO study.

Many African companies have been seriously hurt by the reduction of available workers resulting from HIV/AIDS, especially by the loss of experienced workers during their most productive years, increased absenteeism, lower profits and reduced ability to compete in the international markets.

AIDS is the leading cause of death among adults 15 to 59 years old worldwide. In Africa, at least one of every 12 adults is a carrier of the virus.

Because of the high mortality rate in many countries of sub-Saharan Africa, there are increasingly fewer working-age adults to care for children and the elderly.

The WHO underscores the responsibility of international institutions in making effective ARV treatment available to the millions of people who urgently need it.

The global divide when it comes to medical treatment of HIV/AIDS reflects the broader inequalities in health care and puts to the test the international community's commitment to correct them, say experts.

The campaign promoted by the U.N. health agency, known as "3 by 5", aims to provide ARV treatment to three million people with HIV/AIDS in developing country by the end of 2005.

But WHO chief Lee says the initiative will not end in 2005, because the challenge remains to extend ARV therapy to millions more, and to maintain it for the rest of their lives, while also building and supporting health infrastructures to make that effort possible.

At the cores is the agency's objective to reduce social inequalities by developing effective and equitable health systems for all.

The WHO director-general said extending coverage of ARV treatments would help countries establish more efficient approaches to providing medical attention for all chronic diseases, thus expanding capacity to attend to long-term health needs.

The initiative's promoters are encouraged by the successes of countries like Brazil, which provides HIV/AIDS-fighting drugs free of cost to nearly all of its inhabitants who have the disease -- around 130,000 people.

The result has been a sharp decline in AIDS-related mortality -- a whopping 70 percent. With this approach to the epidemic, Brazil prevented 60,000 new cases of AIDS between 1996 and 2002.

And, over four years, the Brazilian state saved an estimated 200 million dollars in hospitalisation costs.

The WHO has recognised that extending treatment for the disease depends heavily on participation by civil society. Without the mobilisation of organisations, activists and communities, the consequences of the epidemic in the past quarter century would have been much worse, says the agency.

Non-governmental groups like Doctors Without Borders and Partners in Health-Zanmi Lasante have proven to the world that it is feasible to provide ongoing ARV treatment in the poorest areas.

The HIV/AIDS epidemic has directly affected 3.8 to 4.6 million people in India and an estimated 840,000 in China.

In many countries of Eastern Europe and Central Asia the disease is spread mostly through shared needles used to inject drugs, like heroin, but unprotected sex among the younger population also contributes to the relatively high HIV/AIDS rates in those regions.

ARV therapy is reducing the AIDS-related mortality rate in Eastern Europe, where the number of people infected with HIV is far greater than the number of AIDS deaths.

The WHO says there are some 750,000 people infected with the virus in the eastern Mediterranean region.

In the Americas, the Caribbean region has an infection rate of two to three percent of the population, the highest outside of sub-Saharan Africa.

And in Latin America there are around 1.6 million people with HIV/AIDS, while in the United States there are 30,000 to 40,000 new cases of infection reported each year, with a disproportionate number in the African American and Latino populations.

Copyright © 2004 IPS-Inter Press Service.

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