What Works for Women and Girls

Chapter 7.TreatmentA. Provision and AccessB. Adherence and SupportC. Reducing TransmissionHIV is a chronic, incurable illness requiring ongoing therapy. Antiretroviral therapy “is remarkablyeffective for infected persons who can receive treatment on an ongoing basis. Indeed,many people with HIV infection can now look forward to achieving undetectable viral loadsand relatively normal lives and life spans—developments that were once hard to imagine…Unfortunately, only 20% of people with HIV infection in low- and middle-income countriesknow that they are infected, and less than a third of those who need therapy are receiving it”(Steinbrook, 2008: 886). The Millennium Development Goals include achieving universalaccess to HIV prevention, treatment, care and support by 2010 and to “halt and reverse thespread of HIV/AIDS by 2015.” As a recent report of the All Party Parliamentary Group on AIDSin the UK noted in July 2009, “We are not on track for either target” (All Party ParliamentaryGroup on AIDS, 2009: 5). In addition, all those millions of people who do get on treatment willneed to continue being treated, cared for and supported for many decades to come.Treatment for HIV begins prior to antiretroviral therapy with access to routine monitoringof HIV infection, including diagnosis of opportunistic infections, and routine testing of CD4counts (WHO, 2009j, WHO, 2006b). Antiretroviral therapy is not curative—it suppresses butdoes not eradicate HIV-1 infection. Studies show, however, that ARV therapy does increase lifeexpectancy of people living with HIV (The Antiretroviral Therapy Cohort Collaboration, 2008,Jahn et al., 2008, Chigwedere et al., 2008). Continuous therapy is important. With an inter-167