TABLE 1-1 Coverage of ART in Developing Countries, 2003 (adults by WHO region)

Region

Number of People on ART

Estimated Need

Coverage

Africa

100,000

4,400,000

2%

Americas

210,000

250,000

84%

Europe (Eastern Europe, Central Asia)

15,000

80,000

19%

Eastern Mediterranean

5,000

100,000

5%

Southeast Asia

60,000

900,000

7%

Western Pacific

10,000

170,000

6%

All WHO Regions

400,000

5,900,000

7%

 

SOURCE: WHO, 2003.

already enormous treatment challenge. The high AIDS mortality rate in sub-Saharan Africa, which remains the worst-affected region in the world, contrasts sharply with the decreasing HIV-related death rate in high-income countries where ARVs are widely available and affordable. Those acutely affected by the widespread lack of treatment include not only the millions of infected individuals, but also the millions of children orphaned when their parents die from HIV-related illness. Because HIV-related deaths occur disproportionately among young, economically productive adults, moreover, the epidemic is undermining the economic development and social fabric of entire countries (Bell et al., 2003; Dixon et al., 2001).

CHALLENGES AND OPPORTUNITIES: ANTIRETROVIRAL THERAPY IN RESOURCE-CONSTRAINED SETTINGS

Most of the clinical, epidemiological, behavioral, and other aspects of the HIV/AIDS pandemic have been addressed predominantly within the United States and other resource-rich settings. As a result, there are a multitude of unanswered questions regarding how best to introduce ARVs on a broad scale in resource-constrained settings, where the public health and drug delivery infrastructures are often weak or nonexistent and operational capacity is largely lacking. Although several pilot initiatives worldwide have garnered early success and proven the feasibility of implementing ART programs in resource-poor settings, we have yet to determine how these pilot initiatives can be scaled up to meet larger needs. No one program or country can provide all the answers.

The urgent demand to provide free or affordable ARVs to the millions of people in need must be tempered by awareness of the crucial importance



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