Care and support for people living with HIV/AIDS

Report on the global HIV/AIDS epidemic – June 2000Drug Access Initiative more relevant to clients who cannot afford antiretroviral drugs,and to follow-up centres where antiretrovirals are not prescribed.Efforts to increase drug affordabilityDrug price negotiations led to a significant decrease in the price of antiretroviraldrugs in the region, both within the Drug Access Initiative and beyond. However, acomparison of these prices with those obtained by Brazil or Thailand (see Table 2)makes it clear that further price reductions should be possible to achieve, if need bethrough the introduction of generic competition.Uganda, a relatively poor country, opted not to use any public funds to subsidizeantiretrovirals supplied through the initiative (the cost being borne by the patients). InCôte d’Ivoire, a richer country, the Government committed itself to shoulder part ofthe cost for selected patients; however, the allocation of treatment subsidies wasvery slow. While an in-depth analysis of the use of antiretrovirals outside the initiativewas not conducted, the fact remains that the programme in Côte d’Ivoire attractedfewer clients than that in Uganda.Strengthening the health sectorThe educational efforts of the initiative were assessed as positive in both countries.In Uganda, laboratory follow-up was strengthened by the donation of CD4 countingequipment. The growing interest of the countries’ advisory boards in opportunisticdisease management has resulted in more operational follow-up centres.Three challenges to be met in the months ahead are: integrating the advisory boards’guidance on HIV management into national treatment guidelines; regulating antiretroviralsand advanced drugs for the treatment of opportunistic infections as partof the countries’ national drug management policy; and preparing to make the initiativesustainable after UNAIDS reduces its subsidy.Societal impactIn both countries, the presence of the initiative galvanized people with HIV and AIDSby holding out some hope for them, and led to a wide mobilization of health sectorstaff around HIV and AIDS. It also resulted in a great deal of discussion of AIDS inthe media – not only about the cost of HIV treatment but also HIV prevention. By raisingthe visibility of the epidemic, this level of discussion may enhance preventionefforts and yield significant benefits that extend beyond the clients and health careproviders of the initiative.104