Abstract
This paper reviews the healthcare issues facing nations which have a substantial caseload of chronic HIV cases. It considers the challenges of extending antiretroviral coverage to an expanding caseload as supplier price rises and international trade agreements come into force to reduce the availability of affordable antiretrovirals just as the economic downturn restricts donor funding. It goes on to review the importance in this context of supporting adherence to drug regimens in order to preserve access to affordable antiretrovirals for those already on treatment, and of removing key barriers such as patient fees and supply interruptions. The demands of those with chronic HIV for health services other than antiretroviral therapy are considered in the light of the fearful or discriminatory attitudes of non-specialist healthcare staff due to HIV-related stigma, which is linked with the weakness of infection control measures in many health facilities. The implications for prevention strategies including those involving criminalisation of HIV transmission or exposure are briefly summarised for the current context, in which the caseload of those whose chronic HIV infection must be controlled with antiretrovirals will continue to rise for the foreseeable future.
Highlights
In 2009, an estimated 33.3 million [31.4 million-35.3 million] people were living with HIV, according to UNAIDS[1]
Life expectancy for people living with HIV (PLHIV) can be restored to near normal: HIV has latterly been transformed into a manageable chronic illness, compatible with fairly good health, lifestyle and economic participation
Most countries have from a few to many thousands of their population maintained with chronic HIV infection on antiretroviral treatment (ART)
Summary
In 2009, an estimated 33.3 million [31.4 million-35.3 million] people were living with HIV, according to UNAIDS[1]. Life expectancy for people living with HIV (PLHIV) can be restored to near normal: HIV has latterly been transformed into a manageable chronic illness, compatible with fairly good health, lifestyle and economic participation. Most countries have from a few to many thousands of their population maintained with chronic HIV infection on antiretroviral treatment (ART). This situation already causes some significant challenges, which will increase as the ongoing spread of HIV adds to the caseload. Much less has been said about planning for the situation when PLHIV have been stabilised on treatment so that their immunity is largely restored and they can resume familial and social roles, a number of important medical and social issues emerge at this stage. This paper aims to raise awareness of some of the key questions for health ministries and governments
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