At the start of the year, UNAIDS published a report predicting the future of the global AIDS epidemic. Three very different scenarios highlighted how much would depend on the responses of governments, donors and civil society.64
Also in January, both the WHO and PEPFAR published figures detailing numbers of people receiving AIDS drugs. PEPFAR said it had helped to provide treatment to nearly 155,000 people in its fifteen focus countries by end of September.65 The WHO said that the total number receiving treatment in all developing and transitional countries had risen to 700,000 by the end of 2004, meaning that the 3 by 5 initiative had achieved its latest target.66
The US Food and Drug Administration (FDA) for the first time approved a generic AIDS drug made by a foreign company. PEPFAR had decided not to trust any drug that had not been approved by the FDA, which meant that all PEPFAR-funded programmes had had to stick to the more expensive brand-named products. However in January the FDA gave its approval to two drugs made by the South African company Aspen Pharmacare. This came just weeks after a product of the US company Barr Laboratories had become the first ever FDA-approved generic, and was predicted to mark a turning point in providing cheaper treatment in Africa.67
Nelson Mandela announced that his eldest son Makgatho had died of AIDS, aged 54.
"Let us give publicity to HIV/AIDS and not hide it, because [that is] the only way to make it appear like a normal illness."Nelson Mandela68
Publication of death certificate data from South Africa revealed that the total number of reported deaths had increased by 57% between 1997 and 2002. Among those aged 25-49 years, the rise was 116% in the same six year period.69 Based on an analysis of a sample of death certificates, the South African Medical Research Council estimated that nearly two-thirds of deaths related to HIV had been misclassified (wrongly attributed to other causes) during 2000-2001.70
In April, the US Institute of Medicine published the results of an extensive review of data relating to the use of the drug nevirapine. It found that the drug was a safe and effective way to prevent mother-to-child transmission of HIV, and that news stories suggesting otherwise had distorted the facts.
"It is conceivable that thousands of babies will become infected with HIV and die if single-dose nevirapine for mother-to-infant HIV prevention is withheld because of misinformation."National Institute of Allergy and Infectious Diseases -71
Brazil turned down $40 million offered by PEPFAR because it refused to agree to a declaration condemning prostitution. The director of Brazil's HIV/AIDS programme said the government had taken the decision "in order to preserve its autonomy on issues related to national policies on HIV/AIDS as well as ethical and human rights principles".72
A new set of international treatment figures were published by the WHO in June. They revealed that the 3 by 5 initiative was a long way off track, because only 970,000 people (15% of those in need) were receiving treatment, compared to a target of 1.6 million. The WHO admitted that it would be unlikely to achieve its goal of 3 million by the end of the year.73
PEPFAR said it had exceeded one of its own targets by helping to provide treatment to 235,000 people in its focus countries by the end of March.74 The figure given for Botswana was disputed by the country's health officials. They said the US was claiming credit for helping thousands of people whose treatment had in fact been funded overwhelmingly by the Botswanan government.75
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