Conference Addresses Universal Access to Antiretroviral Drugs, Health Systems

Although antiretroviral drugs have become "so effective" that a 20-year-old HIV-positive person in a wealthy country can now expect to live another 43 years on average -- "close to a normal lifespan" -- the "near-miraculous effects" of the drugs highlight the need to treat as many people as possible worldwide, advocates and researchers said on Wednesday at the XVII International AIDS Conference in Mexico City, Toronto's Globe and Mail reports.

About three million people in the developing world have access to antiretrovirals -- an estimated 31% of those in need. About as many people again with HIV/AIDS are taking the drugs in wealthy nations, where treatment is virtually universal, according to the Globe and Mail. "I ran out of fingers and toes to count the inequalities," Anton Pozniak, executive director of HIV research at the Chelsea and Westminster Hospital, said.

While the United Nations' goal of achieving universal access to antiretroviral drugs by 2010 likely will not be reached, continuing to work toward the objective is essential, according to Gregg Gonsalves, program coordinator at the AIDS and Rights Alliance for Southern Africa. Speaking at the conference, Gonsalves said, "The scale-up of antiretroviral therapy is the most ambitious public health undertaking of our lifetimes."

According to Gonsalves, although the lives of millions of HIV-positive people worldwide depend on antiretrovirals, the world should understand the difficulty of providing the drugs to a vast number of people. "We've already accomplished the impossible in the last 10 years," he said, adding, "We can succeed, but our future is precarious. The technical challenges are formidable, and the political ones are brutal."

One of the most "contentious" debates at the conference this week has been over when it is best to start HIV-positive people on antiretroviral treatment (Picard, Globe and Mail, 8/8). Despite research showing the benefits of early treatment, Gonsalves cautioned that widening access to treatment in countries with weak health systems could undermine drug programs. Although Gonsalves said access to antiretrovirals during the early stages of the virus may be "clinically beneficial for individual patients," more patients in public health settings may weaken antiretroviral programs by "creating longer queues in already saturated national programs using relatively temporary facilities, where even now the sickest patients still have trouble accessing medicines."

He added that beginning antiretroviral regimens earlier "without assessing the effectiveness and indeed the feasibility of this intervention at a population level in low- and middle-income countries may end up doing more harm than good." Gonsalves called for research into when to start antiretroviral treatment in resource-limited settings and urged delegates at the conference to set firm global targets and deadlines to make sense out of "the definition of universal access" to antiretrovirals, which "is now irresponsibly vague." Gonsalves said, "Approximately 10-million people need antiretroviral therapy today. Perhaps we can't reach that goal by the next time we gather in 2010 in Vienna, but let's not leave Mexico City without attaching a firm deadline nonetheless" (Cullinan, The Star, 8/8). Gonsalves also said that well-managed HIV/AIDS programs require training of health workers and construction of clinics and laboratories (Chase, "Health Blog," Wall Street Journal, 8/7).

In related coverage, Tierramerica on Thursday included a discussion with Pedro Cahn, head of the International AIDS Society, on universal access to antiretrovirals, the conference and the worldwide fight against HIV/AIDS (Valente, Tierramerica, 8/4).

Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. Webcasts of a plenary session and press conference featuring Gonsalves and Pozniak are available online.

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