The World Health Organization's 3 by 5 Initiative, which plans to treat three million HIV-positive people in developing countries by the end of 2005, is "not convincing" on a number of levels, Amir Attaran, an associate professor of population health at the University of Ottawa in Canada, and Peter Hale of Georges Pompidou European Hospital in Paris, write in an International Herald Tribune opinion piece (Attaran/Hale, International Herald Tribune, 5/29). The 192 member nations of the WHO General Assembly last month unanimously approved a draft resolution to increase access to HIV/AIDS treatment in low-income countries and supply them with low-cost, high-quality antiretroviral drugs (Kaiser Daily HIV/AIDS Report, 5/24). Attaran and Hale say that "the fact that WHO is only just now ... proposing a $5 billion plan to treat those with the AIDS virus as its flagship initiative suggests that the agency has not always been realistic in its approach to AIDS." WHO's current "business plan" for treating HIV-positive people is "supposed to reverse that," but it is "not convincing on three levels," according to Attaran and Hale.

• First, although the plan "contains a lot of correct advice on what needs doing," it gives little advice "on how to do it," the authors say. HIV/AIDS treatment has many "uncertainties and outright unknowns," but the WHO plan "addresses almost none of these," the authors say, adding that the plan fails to specify how the 25 WHO departments that are expected to participate in the initiative plan to communicate and how much it will cost to train 100,000 health care workers and refocus 10,000 clinics.

• Second, the WHO plan does not cater to the organization's strengths -- including setting the standards of clinical care and treatment -- and instead "ventures into areas where WHO has little expertise," such as advocacy for public policy reform, Attaran and Hale say.

• Finally, WHO proposes to "judge the effectiveness" of the effort by "measuring things that are internal to WHO itself, such as funding and staffing at offices," instead of "monitoring ... the number of people with the AIDS virus who are successfully treated and who are kept alive," Attaran and Hale say.

The current plan "is an embarrassment," and the 46 million people living with HIV/AIDS "deserve better than this," the authors say. Attaran and Hale conclude, "We are the first to argue that a strong WHO is needed to bring unity, synergy and cohesion to this effort" (Attaran/Hale, International Herald Tribune, 5/29).

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