The fight against AIDS, Tuberculosis and Malaria: past progress and hope for the future.

• Author: Scott, Jr., Edward W.

Each year, 2.5 million people become infected with HIV, 8 million contract tuberculosis (TB), and between 300 million and 500 million fall ill from malaria. Together, these diseases kill more than 5 million people per year, the equivalent of a full 747 airplane crashing every 44 minutes. (1) They are diseases of poverty and inequality, but all are treatable and preventable. The vast majority of those affected live in countries that have only a few dollars to spend on health care each year and are least prepared to respond to pressing needs.

The fight against these diseases can be won. AIDS, TB and malaria can be prevented. The lives of those living with HIV can be successfully extended for many years; malaria and TB can be cured. In southern Africa's Lubombo Spatial Development Initiative, for example, a multi-pronged approach to prevent and treat malaria led to nearly a 90-percent drop in transmission of the disease. (1) To fight TB, China's use of the DOTS treatment strategy allowed the country to prevent 30,000 deaths from the disease per year. (2) Thailand has been able to stem the spread of AIDS and guarantee universal access to AIDS treatment for all who need it. Its aggressive prevention efforts are estimated to have averted over 7 million new HIV infections. (3) In addition, data on the global prevalence of HIV/AIDS is also improving through better collection methods and widespread surveillance systems.

Even in the poorest African countries, major progress has been made. HIV prevalence rates have declined in several highly affected countries, including Kenya and Zimbabwe. (4) Nearly 90 per cent of TB cases across Africa, with the exception of war-torn countries, are being treated with DOTS; (5) many are re-energizing national programmes to combat malaria. Zambia, for example, has achieved notable early success against the disease through a combination of hut spraying, insecticide-treated bed nets and drug treatment. Malaria deaths have already begun to decline. (6)

Progress in fighting these diseases has been facilitated by the dramatic increase in resources provided by international donors, including the United States President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. About 70 per cent of all global AIDS funding comes from international donors, and roughly half of the money contributed directly by donor Governments comes from PEPFAR, (7) which has succeeded in moving money quickly. PEPFAR has vastly expanded treatment programmes while investing significantly in prevention and care activities. Its funds have supported treatment for over 1.4 million people infected with HIV (8)

The Global Fund is another significant funder for AIDS programmes, providing over one fifth of the world's financing, and is the leading funder for malaria and TB programmes, providing over two thirds of global resources for both diseases. (9) The Global Fund has pioneered an innovative financing model that...