Treat, Train and Retain

LONDON (Reuters) - Crumbling health systems and chronic staff shortages are hampering efforts to provide AIDS sufferers with life-saving drugs, the head of the World Health Organisation's (WHO) HIV division said on Friday.

Dr Kevin De Cock said Africa, which has been hardest hit by the AIDS epidemic, is short of at least a million healthcare workers and, over the past quarter-century, infrastructures in many countries have eroded.

"If you work in these countries it is very obvious, very quickly, that the elephant in the room is not the current price of drugs," De Cock told Reuters in an interview.

"The real obstacle is the fragility of the health systems, particularly in Africa."

The Belgian-born infectious disease expert said bolstering health systems will be a priority for the global agency, along with expanding HIV testing and counselling, maximising prevention efforts, scaling up treatment and investing in surveillance, monitoring and research.

Although the WHO failed to meet its target of getting 3 million people on AIDS drugs by the end of 2005, De Cock said the 1.3 million that were on treatment by the deadline represented an eight-fold increase in Africa and three fold worldwide since end-2003.

Most of the estimated 40 million people living with HIV/AIDS live in sub-Saharan Africa.

"Treatment for AIDS is a legitimate aspiration for everybody in the world no matter where they live or how poor they are," De Cock said. "There is no going back on that."

The real challenge now, he added, is to sustain the momentum, to push for universal access to AIDS drugs and to get the political commitment to rebuild healthcare systems that have crumbled in the past 20-25 years.

"You have health infrastructure that is dilapidated, a health workforce that is demoralised, labs that don't work, supply chains that don't exist and diagnostics that are missing," he said.

"And in parallel with that, you have had the emergence of the AIDS epidemic."

To try to tackle the shortage of well-trained workers, De Cock said the WHO will launch a healthcare workers' initiative at the XVI International AIDS Conference in Toronto, Canada from August 13-18.

The initiative, called "Treat, Train and Retain," aims to address the problems, which are acute in Africa which has 24 percent of the global burden of disease but only 3 percent of health workers commanding less than 1 percent of world health expenditure.

"These are long-term issues but they are crucial," said De Cock.

"The whole issue of getting long-term treatment out to people puts into very brutal focus this issue of infrastructure, personnel and systems."