Restricting access to HIV-related services: A bad public health and economic policy

Abstract

Antiretroviral therapy (ART) has dramatically modified the natural history of HIV disease. At the individual level it has transformed an otherwise fatal disease into a chronic manageable condition.1–3 At the community level there is now a compelling evidence that ART virtually eliminates HIV transmission.4–9 Further, early initiation of ART not only prevents morbidity, mortality and new infections, but it is also cost-saving.10–13 This has led to calls to scale-up access to HIV care and treatment worldwide as an effective means to curb and eventually control the growth of the AIDS pandemic, commonly referred to as “Treatment as Prevention” (TasP).14–16 As of December 2013, more than 12 million individuals worldwide were receiving ART, demonstrating that we are on track to meet the 2015 MDG goal of providing access to ART to 15 million individuals by 2015.15 Despite these extraordinary achievements, challenges remain, as late HIV diagnosis, poor linkage to and retention in care, as well as incomplete long-term adherence to ART remain relatively frequent. Of particular concern is the fact that many at-risk and marginalized populations continue to face multiple barriers to HIV diagnosis and care. Sadly, such barriers stand to undermine national and global HIV responses, as it will not be possible to end the AIDS pandemic without universal facilitated access to high quality HIV services. Migrants are one of such highly vulnerable populations, particularly those who are undocumented or uninsured. In 2012, a report from GESIDA warned about the potential unintended negative consequences associated with the implementation of the Royal Decree (RD) 16/2012 on the health of immigrants living with HIV in Spain.17 The report projected that limiting access to health care to immigrants would likely lead to increased morbidity and mortality among this population. However, given what we now know about the impact of ART on transmission dynamics, it is obvious that not only immigrants living with HIV would be affected by this