Access to Affordable Highly Active Anti–Retroviral Therapy (HAART) for HIV/AIDS Patients. Where Do We Stand?

Abstract Background: The human immunodeficiency virus (HIV) epidemic remains a major global public health challenge, with a total of 33.4 million people living with HIV worldwide. In 2008 alone, 2.7 million people were newly infected with HIV. Unfortunately, the majority of patients with HIV infection worldwide live in resource poor areas were access to therapy is severely limited. Objective: This review summarizes the progress noted during the recent years concerning antiretroviral therapy scale-up in resource-limited settings and analyzes the economic, social and legal framework of services already provided. Results: The 2010 WHO report states that among 144 low- and middle-income countries reporting program data, eight had already achieved universal access to antiretroviral therapy at the end of 2009, providing treatment to at least 80% of patients in need. Furthermore, 15 countries had achieved the 80% target for coverage with antiretroviral prophylaxis to prevent mother to child transmission of HIV. An increase of over 1.2 million people, including women and children receiving antiretroviral therapy was noted by the end of 2009. Health care facilities have expanded and as a result, the average number of people receiving therapy per health care facility has increased. Moreover, task shifting has been applied, with promising results. Conclusions: Although there is considerable room for improvement, HIV programs have had a positive impact on equal, affordable and early antiretroviral therapy provision to those who need it most. Special approaches though, remain necessary to address the particular circumstances and needs of those populations at greater risk for HIV infection. Rights-based national strategies must include special efforts to reach the poorest and those who are socially excluded. Interventions must be designed and implemented in ways that ensure equity in access for all