NAIROBI -- The horror story of the AIDS pandemic in Africa has at last switched from prevention to hopes of treatment, but the groundwork that lies ahead is daunting for the goal dwarfs anything in medical history, AFP reported.

The International Conference on AIDS in Africa (ICASA) which finished here on Friday found a consensus: the world's poorest, AIDS-devastated continent now has access to the serious money and modern drugs that it has fruitlessly sought for years.

But optimism is mixed with cold realism about what needs to be done to ensure that these long-awaited treatments are distributed quickly, safely and fairly.

If it works, sub-Saharan Africa has a realistic chance of smashing the disease which has claimed 20 million African lives in 22 years and left 30 million infected today.

But a fiasco would plunge Africa into further darkness and build drug resistance, destroying the few weapons that exist to fight HIV. A failure would resound around the world. "The task is unprecedented, let's all agree," said UNAIDS Executive Director Peter Piot. "This is something that has no precedents in history or development practice."

Some five billion dollars are needed to fund the World Health Organization's "Three by Five" initiative, of providing antiretrovirals to three million seriously ill people with HIV by the end of 2005.

More than two million of them are Africans. New figures released this week showed that, at present, just 75,000 have access to these drugs.

So the WHO's goal is to multiply that number by a factor of more than 25 in little more than two years, in a continent where medical infrastructure is with rare exceptions pitiful.

There have, of course, been previous big pharmaceutical campaigns, such as smallpox vaccinations and tuberculosis treatment.

But smallpox jabs were a one-off and could be administered by mobile teams; TB treatment entails ensuring that the patient takes antibiotics and gets a follow up check, and this can be administered by simple rural clinics.

Treating the human immunodeficiency virus (HIV) with sophisticated antiretroviral drugs is a vastly different proposition.

For one thing, the drugs are ongoing rather than a one-off, for the patient has to take them for the rest of his life.

And getting the right mix of medications is vital, because some people suffer toxic side effects to some drugs and others encounter resistance. The regimen is demanding, requiring the individual to take them twice a day or more.

Lab tests and support staff are needed to check on the patient's progress.

"We have fought hard to get antiretrovirals in Africa," Papa Salif Sow, a professor at the University of Dakar and head of the infectious diseases unit at the city's Faan hospital, told AFP. "They are coming at last, but are we completely ready for them? The answer has to be no." He and others outlined these nuts-and-bolts tasks in the months and years ahead: -- Financial Management: Ensuring that poor countries can handle the rapidly rising inflows of donor cash without waste or corruption, a problem endemic to most of Africa -- Human Resources: training enough doctors, nurses, social workers and laboratory technicians and purchasing and maintaining test equipment -- Preventing a Black Market: Building networks for distributing and storing the drugs securely in order to prevent theft and the creation of a black market -- Medical Surveillance: Monitoring treatment in order to ensure that drug resistance, which will inevitably happen in Africa as it has done in the West, is kept as low as possible

Paying for all this is not included in the WHO's five-billion-dollar estimate for the "Three by Five" goal.

That means the race is on to find ways of cutting costs.

Existing infrastructure, such as tuberculosis clinics which are already used by many people infected with HIV, could become distribution points for the drugs.

Expensive tests, such as monitoring the level of virus in the blood, which is routinely done in rich countries, could be reduced to a minimum.

And cheaper, simplified types of treatment regimes are now available, such as requirements to take only two pills a day.

One of the biggest dilemmas is deciding who should be treated first once the drugs arrive, for rationing will be inevitable in the early years.

Countries have to set down ethical guidelines to identify clearly and fairly who would be given priority for treatment, Piot told AFP. The issue "is so visible, it's about life and death, and it has be done right, because that could lead to real revolts," he said. "'Why am I not treated?' -- it's a time bomb, a political time bomb."