Access to ART? Good Luck.

4 06 2010

We know how to control HIV—we do it with antiretroviral therapy (ART). We’re so successful, an HIV infection is now a chronic condition rather than a death sentence . . . for some. For those with access to ART.

Before and after ART

But what about those without access? What about everybody else? As of the end of 2008, just 42 percent of those in lower- and middle-income countries were able to get these drugs.

Why is it so hard to provide this lifeline to those in need? A report put out in May 2010 by Médecins Sans Frontières (a.k.a. Doctors Without Borders), says it’s about the lack of infrastructure, particularly human resources, for the administration of treatment and care, including:

  • Inadequate salaries and poor working conditions, which lead to ‘brain drain,’ attrition, and an inability to attract new health workers
  • National policy barriers that block the possibility to shift tasks to lower level health staff
  • Lack of adequate national and international resources committed to address the health care worker crisis
  • Lack of donor funding for recurrent human resource costs, particularly salaries, due to concerns about “sustainability” and other constraints
  • Limits on spending from ministries of finance and international finance institutions, which can hinder governments’ ability to invest adequately in the health workforce

In addition to infrastructure, the AIDS charity AVERT suggests that barriers to universal access to treatment include:

  • A safe and sufficient supply chain of drugs
  • A life-long commitment on the part of patients to antiretroviral drugs (ARVs) and the ability of healthcare workers to help patients stick to the regimen
  • An awareness of the need for testing and treatment

This group goes on to explain that, “Focusing too heavily on treatment can also be problematic if it detracts too much from efforts to prevent new HIV infections, a scenario which would only add to the eventual treatment burden. Furthermore, unless treatment programmes focus on the vital tasks of monitoring and patient retention, many patients will eventually die from treatment failure.”

The real risk of reducing the work being done in prevention by focusing so much on treatment adds a troubling layer to the discussion.

So, there we are—the usual mountain of reasons why we can’t do what needs to be done. But, what’s a mountain? There are steps we as individuals can take to support universal access to ART:

  1. Press our politicians to stop backing off their commitment to help fund HIV/AIDS services in poorer countries.
  2. Find a reputable charity already in place and doing the work, then do a little fundraising of our own and give it to the charities doing the most good.
  3. Keep talking about these challenges, and if we haven’t been doing so, then start talking.  Silence isn’t an option, given the potential outcomes

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