PartnersGF - 2004-07-17
IAC 2004: Staying alive while we wait for ARVs
HDN Key Correspondents Team
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Widely-available, proven and cost-effective interventions to delay AIDS-related conditions and deaths are being ignored by an international HIV/AIDS community determined to increase access to antiretrovirals
Three million people will lose their life in 2004 as a result of HIV-related conditions. The vast majority live in developing countries. There has been a dramatic decrease in AIDS-related deaths since introduction of antiretroviral (ARV) drugs in 1996 but only in rich countries and communities that can afford to pay for these medicines. Only a tiny proportion of the estimated six million people who need them are taking these lifesaving medicines today.
As we have heard loud and clear during the International AIDS Conference this week, large-scale efforts have recently started to expand the availability of ARVs to the poorer countries of the world. The World Health Organization, for example, is responding to the global health emergency by starting a programme to ensure lifetime access to ARVs for three million people in poorer countries by the end of 2005 the 3 by 5 initiative.
We heard that large-scale ARV initiatives such as this are beginning to save lives and must continue to do so until universal coverage of ARVs is achieved. But we also heard that global initiatives of this nature take time to set up and are already encountering delays and health systems obstacles. From the discussions taking place in Bangkok this week, it is likely to be at least five years before the estimated six million people who need ARVs today will have access to them. What we didnt hear too much about was that by that time, many of those who need the drugs today will have already died, and been replaced by further millions
and more
Rather than allowing these successive millions of people to die while waiting for ARV expansion programmes to deliver on their promise, we should be turning to other life-extending options. As the conference comes to a close, the incredible conclusion seems to be that effective, cheap approaches to keeping people with HIV alive have been largely ignored by an international HIV/AIDS community determined to increase access to ARVs.
TB is too often a death sentence for people with AIDS. It does not have to be this way, said former South African President Nelson Mandela, as the conference came to a close. We have known how to cure TB for more than fifty years. What we have lacked is the will and the resources to quickly diagnose people with TB and get them the treatment they need.
Proven non-ARV interventions like TB prevention and treatment are essential and could be used more widely to extend the life of people living with HIV. They can be used early in HIV infection to delay progression to AIDS and the opportunistic conditions associated with HIV. Like TB treatment, many of them are available today, affordable and effective. But most of them have never been scaled up in light of the global HIV/AIDS pandemic.
They should be.
We know that HIV/AIDS is the quintessential disease of poverty. The pandemic has its greatest impacts on the poor and most vulnerable populations: those with no access to clean water and sanitation; poor nutrition and overall health status - and those who are constantly challenged by a variety of other infections.
Is it possible that interventions to potentially address and delay some of these underlying causes of HIV-related conditions and deaths and which could, therefore, also keep people alive during the journey to universal ARV access have been ignored by an international HIV/AIDS community fixated on increasing access to ARVs? Unbelievably, the answer to this question might be yes.
If judged by their relative prominence during the conference, some of the non-ARV options that are yet to be scaled up with anything like the same vigour as ARVs are:
Prevention and/or treatment of tuberculosis in people living with HIV;
Voluntary counselling and testing for HIV as the entry point for access to all health services;
Drugs to treat/prevent other opportunistic infections (e.g., cotrimoxazole, fluconazole; etc.);
Home- and community-based care approaches;
Tackling HIV-related stigma, especially in healthcare settings, which keeps people away from health services;
Pharmacotherapy (e.g. methadone) for recovering injecting drug users;
Traditional healing and treatment approaches;
Promoting food security and micronutrients (vitamin A, zinc, etc.).
Elements of this life-extending package are not simply a response to the inevitable delays that ARV programmes currently face they are an integral part of those programmes. They provide the essential foundations that ARV programmes need to succeed. Organising them will help to build bridges between clinical and community interventions and the working partnerships that ARV programmes will inevitably require.
Nor are they an excuse for governments, international agencies or communities to slow down or do less in their ARV expansion efforts it must be additional to those efforts.
This package is not new, of course. These care services and support are being delivered in response to the HIV/AIDS epidemic. They are often driven largely by individual governments or organisations, local and personal leadership and dedication - but they are currently fragmented efforts, with much greater political, community and international attention going to ARV programmes. As a result, securing resources to do this kind of intervention on a larger level is impossible which is perhaps why they had such a low profile during the conference this week.
HDN Key Correspondents Team
Email: correspondents@hdnet.org