Access to Care

Abstract

At the beginning of the fourth decade of the epidemic, HIV continues to remain a complex global public health challenge, with universal access to HIV prevention, treatment, care and support an elusive target. In 2009, the Joint United Nations Programme on HIV/AIDS (UNAIDS) reported 33.3 million people living with HIV (PLWH) worldwide, including 2.6 million newly infected with HIV; in the same year 1.8 million people died of AIDS. Before the development of effective antiretroviral therapies (ART) beginning in the mid-to-late 1990s, PLWH could progress to AIDS and even death in just a few years. Currently, people can live much longer—even decades—with HIV before they develop AIDS if they have access to appropriate medications and care. ART has continued to evolve at a breathtaking speed, as new medications are developed and additional data from clinical trials is presented. Even so, efforts to address the epidemic through access to care have historically been challenged by the availability and cost of treatment, clinical challenges of the disease itself and its toll on the health and well-being of those infected, and the many social/psychosocial issues linked with the communities that it has heavily impacted, all affecting access to and retention in care. While ART can dramatically improve the health of PLWH and slow progression from HIV infection to AIDS, existing treatments may need to be taken daily for the rest of a person’s life, need to be carefully monitored, and come with potential side effects.