Ei-iE

According to a new report published mid-April by the WHO, UNAIDS and UNICEF, access to antiretroviral therapy for people living with HIV/AIDS in low-income countries continued to grow during 2006, with more than 2 million receiving treatment in December 2006.

HIV is an uncommon type of virus called a retrovirus. Drugs developed to disrupt the action of HIV are known as antiretrovirals or ARVs. The AIDS virus mutates rapidly, making it extremely effective at developing resistance to drugs. To minimise this risk, people with AIDS are generally treated with a cocktail of ARVs that attack the virus on several fronts at once.

The introduction of ARVs in 1996 transformed the treatment of HIV and AIDS, improving its quality and greatly prolonging the lives of many infected people in places where the drugs are available. However in low- and middle-income countries, only a small proportion of HIV-positive individuals have access to the drugs. Although the price of ARVs has fallen dramatically in recent years, cost remains a major obstacle. Other challenges include inadequate health infrastructure and a lack of people with the relevant skills and training to provide the treatment.

For antiretroviral treatment to be effective over long periods of time, different antiretroviral drugs need to be combined. This is what is known as combination therapy. The term 'Highly Active Anti-Retroviral Therapy' (HAART) is used to describe a combination of three or more anti-HIV drugs. If one drug is taken on its own, it has been found that, over a period of time, changes in the virus enable it to build up resistance to the drug. The drug is then no longer effective. If two or more antiretroviral drugs are taken together, the rate at which resistance develops can be reduced substantially.

According to the new report, “Towards universal access: scaling up priority HIV/AIDS interventions in the health sector,” (http://www.who.int/hiv/mediacentre/univeral_access_progress_report_en.pdf), access to antiretroviral therapy for people living with HIV/AIDS in low-income countries continued to grow during 2006, with more than 2 million people receiving treatment in December 2006.

In most West African countries, ARVs are available to people living with HIV/AIDS. The cost of ARV treatments has decreased considerably over the last ten years. Several countries are even providing free ARVs to patients in need. Still, a lot needs to be done in order to take care of millions of people who need anti-HIV drugs.

In Guinea for example, where the HIV prevalence is relatively low (1.5%), ARV treatments cost US$70–100 per month in 2001 (thanks to UNAIDS support). By 2004, the prices had decreased to about US$10 per month. There are now 120.000 people living with HIV/AIDS in the country and 15,000 of them are eligible for treatment. Unfortunately only 3,500 benefit today from ARVs.

The challenges for Guinea are many: the most important is to maintain the status quo of a low HIV prevalence status. Others include the sustainability of partnerships in order to purchase ARVs at a low cost; greater political will to fight HIV/AIDS(the government has adopted a national policy but medical centres caring for AIDS patients are not free, only those owned by NGOs); the decentralisation of medical centres (they are mainly based in the capital and cities but rarely in rural areas) and finally a commitment for free ARVs and HIV screening tests is absolutely needed.

In Ivory Coast, all classes of ARVs are available in theory but there are occasionally out of stock. This has major implications for the patients dependent on them. The main problem the country faces is the durability of aid programmes supporting ARVs’ costs.

Senegal is a model country since it launched care and prevention programmes at a very early stage. Indeed, the first governmental programme for ARVs access came into being in 1998 – only two years after the introduction of antiretroviral drugs. The low rate of HIV prevalence in Senegal has been maintained since the beginning of the epidemic thanks to the mobilisation of all health sector actors and overall political commitment. Senegal was the first African country to propose bearing the costs of ARVs for people living with HIV/AIDS through a public programme. In 2003, Senegal it implemented that decision, becoming the first African country to declare free access to ARVs and related services (HIV screening tests, immunological follow-up). Again, this policy can only be prolonged with the assistance of international partners (UN agencies, The Global Fund to Fight AIDS, Tuberculosis and Malaria, NGOs etc.) and aid programmes.

The main problem faced by low-income countries is the continuity of aid programmes ensuring low-costs or free ARVs for people living with HIV/AIDS. Once external resources are exhausted, patients no longer have access to treatment. For that reason, the countries concerned need to diversify their funding sources as much as possible to get low-cost or free ARVs.

Due to increasing drug resistance, people on ARV treatment eventually need to switch to newer and improved treatment (socalled "second-line" and "third-line" medicines). In the developing world, access to these drugs will not be possible unless international institutions get serious about the high cost involved. The new drugs can be up to fifty times more expensive than today's most commonly used ARVs combination. According to the Director of MSF's Campaign for Access to Essential Medicines, "It's clear as day that at current prices, the cost of accessing newer drugs will bankrupt treatment programmes. But governments, industry, and multilateral agencies are doing far too little to address the issue."

ARV treatments are only accessible in the developing world because of the availability of affordable generic drugs. Treatment programmes will fail unless a continued supply of generic versions of newer medicines is also guaranteed. ARV treatment observance is linked to nutrition. Treatments have to be followed on a regular and on a long term basis and must be taken with food and water, which is not always always easy for people from poorer communities.

Finally medical centres offering ARV treatments are too often based in capitals and big cities and not nearly enough in rural areas where there is a huge need for them.

Sources: EI and WHO/UNAIDS

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