$3 billion in 2002 and $4.7 billion in 2003, with additional funding promised by foreign governments and international donor agencies (WHO, 2003b). In less than a year, international discourse on HIV/AIDS in resource-constrained countries has changed from “Is there a moral obligation on the part of industrialized nations to provide treatment?” (there clearly is), to “How can we best administer AIDS treatment programs?” Unfortunately, managing patients with HIV/AIDS is not just about providing drugs. As succinctly put by Dr. Gordon Perkin:

Even if we had free and unlimited supplies of ARVs and other essential HIV/AIDS commodities, they still would not be available to the majority of people who need them because of poor infrastructure (DELIVER, 2002).

Building capacity and mobilizing resources on the scale needed to meet national treatment targets is daunting for many countries. Most health systems in sub-Saharan Africa and other resource constrained regions are overstretched, underdeveloped and operate at suboptimal levels. There is a real danger that the benefits of drug availability could be undone by ineffective distribution and misuse, both of which could lead to the development of drug resistant viruses and the withdrawal of donor funding. In order for scale-up programs to be successful they must provide a package of services, including voluntary counseling and testing, monitoring of disease progression, prophylaxis, diagnosis and treatment of opportunistic infection, delay of viral replication with antiretrovirals, management of drug side effects, prevention of mother-to-child transmission, and provision of psychological and moral support to patients and their caregivers (WHO/UNAIDS, 2000). Therefore, to maximize the benefits of ARV drug regimens, countries have to urgently make concrete plans to scale up their treatment programs, establish or strengthen their national drug procurement and distribution policies, develop quality control mechanisms, and engage in the relevant operational research.

On average, the treatment targets set by countries remain cautious, amounting to a combined total in 52 countries of approximately 500,000 people on antiretroviral treatment by 2005, less than 10 percent of those currently in need (WHO/UNAIDS, 2003). Some countries are moving beyond pilot treatment programs to set targets that more accurately match feasibility with need. For example, Thailand is currently providing treatment to 13,000 people with HIV/AIDS and aims to provide universal access by 2005 (WHO/UNAIDS, 2003). The Economic Community of West African States (ECOWAS) is aiming to expand coverage to at least 400,000 people in 15 countries by 2005 (WHO/UNAIDS, 2003). In addition to these country programs, nongovernment organizations such as Médicins sans Frontièrs (MSF) are providing ARV treatment through small pilot



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