Boston - With his ambitious goal of treating 3 million patients
in poor countries with AIDS drugs by year's end looking
increasingly out of reach, Dr. Jim Yong Kim of the World Health
Organization called for a renewed push by world leaders and top
scientists to get the medicines to as many poor people as
"Please stop speculating whether we will make it or not, and do
all you can to make it happen,'' Kim said Tuesday in a keynote
address to the 12th Annual Retrovirus Conference, the leading
scientific meeting on progress in AIDS research.
Kim said that extraordinary progress toward the goal of the
so-called 3- by-5 program had already been made: In the last six
months of 2004, the number of people in poor countries receiving
AIDS drugs rose to 700,000 from 440,000.
To reach 3 million, the number treated would have to double by
July, then double again by January. That would take a new level
of political will from the leaders of India, Nigeria and South
Africa, where 41 percent of the 5.1 million thought to need AIDS
drugs currently reside.
Kim said small African nations are starting to outperform the
public health efforts of South Africa, where President Thabo
Mbeki has yet to embrace with any enthusiasm his own government's
plan to provide drugs. Kim noted that tiny Swaziland, Lesotho and
impoverished Zambia have made great strides in meeting their
"If those three countries meet their goals at the end of 2005, it
might be quite embarrassing to South Africa to say they have
reached only 10 percent, " Kim said.
In remarks to reporters earlier in the day, Kim called Mbeki "a
very smart man who spent all his life fighting for social
justice." But, he said, he believes the South African president
does not understand the "social justice implications" of
providing a rapid scale-up of an AIDS treatment program there,
where more than 5 million people are living with HIV.
"The rich people in South Africa are getting access to
treatment,'' said Kim, who was born in South Korea, raised by his
immigrant parents in Iowa, and trained in medical anthropology at
Kim doled out praise to the World Bank, the Global Fund to Fight
AIDS, Tuberculosis and Malaria, and to the Bush administration's
emergency program for AIDS relief, for making the progress of the
last six months possible.
For too long, he said, the world health community has been
content to describe the scope of the AIDS problem -- and to urge
that international attention be paid to it -- but has failed to
put words into action. The 3-by- 5 program is an effort, he said,
to get the "World Health Organization back in the AIDS business"
by setting "a clear, measurable target.''
Speaking before an elite audience of 3,900 AIDS researchers from
72 countries, Kim called for a "public health approach" to the
epidemic, shunning perfection in favor of practicality. He said
that doctors who object to "second-class therapy" for the Third
World are ignoring evidence that simplified treatment regimens,
without extensive laboratory testing, produce good outcomes for
the overwhelming majority of patients.
Waiting for sophisticated tests of viral load and white blood
cell counts before providing antiviral drugs would mean "millions
dead,'' Kim warned.
Much of the Boston meeting will be devoted, however, to the
sophisticated analysis of the AIDS virus and to studying the
nuances of treating the infection with various combinations of 20
approved AIDS drugs.
Much of the buzz at this year's session centers about the
revelation a week and a half ago in New York that a single
patient had come down with a possible new strain of HIV that was
resistant to all but one antiviral drug and that apparently led
to a rapid decline in the man's health. On average, it takes 10
years for HIV to wear down a patient's immune system to the point
where he or she develops the opportunistic infections that are
symptomatic of AIDS. This patient -- who was an abuser of
methamphetamines -- may have reached that point in months.
The issue is hotly debated among AIDS experts in Boston, however,
because no evidence has been presented that the virus is readily
transmittable, or that it is in fact a unique and new strain of