Barcelona - At the XIV International AIDS Conference in Barcelona, Médecins Sans Frontières (MSF) and Health GAP accused wealthy nations of wilful neglect that is costing millions of lives.

Before a joint satellite meeting called 'Time to Treat', activists focused attention on the failure of most governments to deliver on promises of lower cost antiretroviral treatment, particularly the world's wealthiest nations who have failed to fund the fight against AIDS.

This represents an enormous political failure on the part of developing and rich country governments. "If I, as a doctor, ignore a sick person in desperate need of care, I am committing medical malpractice and can be charged with a crime," said Morten Rostrup, MD, President of MSF's International Council. "Today and every day, more than 8,000 people with AIDS will die.

Yet the international community refuses to mount and fund an adequate global response - we are faced with nothing less than a crime against humanity." The NGOs said that, because so little funding is available, precious time is being wasted debating the "cost-effectiveness" of prevention over treatment interventions, when in fact it is necessary to implement both simultaneously.

This debate could be put to rest if resources were not so scarce and if allocated funds could go towards the lowest price drugs. Relying on the goodwill of pharmaceutical companies instead of making use of generic competition and bulk purchasing means that some countries are paying three times more than necessary for ARV cocktails.

"The refusal of the US, the European Union and other donor governments to commit funds for lowest cost medicines has already condemned millions to death," said Alan Berkman, MD, founding member of Health GAP. "The feasibility of treatment has never been more certain. But as long as wealthy countries refuse to pay, feasibility does not matter.

Donors must be held accountable for their wilful neglect." Many have argued that even if adequate funding were available, treatment would not be feasible in resource-poor settings. "There are some people who say that in Africa, people will not be able to take these drugs because they cannot tell time," said Fred Minandi, a farmer from Malawi.

"I may not have a watch, but I can assure you that since I started taking my triple therapy in August last year, I haven't missed one dose. I had 107 CD4 cells when I started the treatment and today I have got 356 and I am very proud. I am one of the first patients to get ARVs for free in Malawi and if I am speaking here today, it is because of this treatment." At today's satellite meeting, MSF presented results from seven pilot projects in — South Africa, Malawi, Cameroon, Kenya, Cambodia, Thailand, and Guatemala — that show that providing effective treatment has concrete clinical benefits as well as dramatic effects on the lives of individuals and their communities.

Patients in MSF projects enter the programmes in advanced stages of AIDS (median CD4 cell counts of 48 cell/mm) and are treated in diverse health care settings, including primary health clinics in poor townships, rural clinics, and outpatient units at district and capital hospitals. The probability of survival for the 743 patients followed was estimated at 93% at six months .

At six months, patients who were weighed had gained an average of three kilos and patients who had CD4 cell counts taken had an increase of 104 cells/mm3 on average. In the three projects that systematically tested viral load at six months of treatment, 82% of patients showed undetectable levels of virus in their blood (<100 copies/ml). Patients' compliance to treatment has also been impressive, with 95% of patients taking their treatment properly at six months.