Less than a decade ago, someone living with HIV/AIDS had little hope.HIV infection brought a steady inexorable decline towards the complete destruction of the immune system and death. The introduction of ARVs in 1996 was a turning point for hundreds of thousands of people with access to sophisticated health care systems. Although they cannot cure HIV/AIDS, antiretrovirals (ARVs) have dramatically reduced mortality and morbidity, prolonged lives, and improved the quality of life of many people living with HIV/AIDS.

Today we are once again at a turning point - this time in favour of the developing world. Thanks to the work of hundreds of individuals and activists in NGOs, governments, UN agencies and the private sector, prices of ARVs have fallen and we are now in a position to consider scaling up access in resource limited settings.

Scaling up will not be possible in the absence of a clear public health approach that promotes the rational and safe use of these powerful and precious medicines. These technical guidelines, developed with the support of the US National Institutes of Health, present such an approach, promoting the use of standardized regimens and simplified monitoring. They recommend standards for the large-scale introduction of ARVs that prevent misuse. This is essential for good patient adherence and correct use by prescribers.

WHO estimates that in 2002, some 6 million people in developing countries are in need of life-sustaining ARV therapy now. Instead, only 230,000 have such access today, and half of these live in one country, Brazil. We believe that the countries of the developing world should be able to have 3 million people on ARVs by the end of 2005 – provided that the world follows through on the international concerted effort to expand access to HIV treatment and care. This ten-fold increase matters for many reasons. Three million people will be granted a new lease on life, wider access to treatment will stimulate prevention and there will be positive impacts on social and economic development as people living with HIV live longer and more productive lives.

These guidelines offer a chance of hope to those who despaired. They affirm the human rights and dignity of people living with HIV. They represent an opportunity to build upon the solidarity and energy of the global movement against HIV/AIDS by redressing the inequities between rich and poor in access to care. They will be updated on a regular basis as new information and evidence becomes available. As we look to the future, WHO will continue to work with its partners around the world to further increase access to care and support to all who need it.

Tomris Türmen

Executive Director
Family and Community Health
World Health Organization
Geneva
April 2002