

The AIDS treatment emergency was defined at the XIV International AIDS Conference in Barcelona two years ago: six million people were in urgent clinical need of antiretroviral (ARV) therapy, but a mere fraction had access to it.
Two years on from Barcelona, only 440,000 out of the total of six million people needing treatment have access to it in developing countries, and one-third of those treated live in one country, Brazil. Most governments, including donors, continue to move at a snail's pace.
As a result, only a small fraction – around 7% - of those who need treatment are getting it. In addition, recent international initiatives to fund and scale up treatment programmes generally do not address the vital need for new health tools and innovative strategies to tackle HIV/AIDS. This is a gap that needs to be filled urgently: there is no excuse for accepting the status quo.
This paper describes some of the progress as well as some of the emerging operational and clinical challenges from the perspective of a medical humanitarian organisation providing treatment to people living with HIV/AIDS in resource poor settings. These critical issues must be addressed and must not be allowed to divert attention or resources from the urgent need to expand treatment now.