Care, Support & Treatment

A decade ago, antiretroviral drugs arrived on the market.  Hailed as life-savers for millions of people living with HIV, these treatments soon created a larger gap between rich and poor, going mostly to those in wealthy countries that could afford them.  This lack of affordable drugs, a feasible drug supply and adequate health systems, especially in the poorest places, is hindering an effective response to HIV/AIDS(1).   By signing the Declaration of Commitment, governments recognized that access to care, support and treatment is fundamental to the right of everyone to the highest possible standard of physical and mental health(2).  Certainly, increased access to affordable medicines will focus much-needed attention on voluntary counselling and testing, effective healthcare infrastructures, and more sustainable funding.

Several encouraging factors make this a critically important time for governments to take further action and keep their promise to expanding care and treatment.   First, drug prices have fallen.  Under pressure from people living with HIV/AIDS, the increase of generics, and the good work of invested organizations, prices have dropped from up to $15,000 annually to as low as $300 per year in some developing countries.  Next, researchers continue to develop dramatic new technologies, changing how countries manage the disease.  For example, a recently developed pill combines three of the most effective ARV compounds, making treatment easier to integrate into the lives of people living with HIV.  Third, state leaders no longer need to make the agonizing choice of whether to care for AIDS patients or prevent the spread of HIV.  Successful models of prevention, care and treatment – working in tandem – have shown that HIV can be halted and AIDS can be treated even in very poor countries.

The Declaration of Commitment, which outlines several steps to take advantage of these opportunities, also recognizes the complexity of the challenges ahead in scaling-up care, support and treatment efforts.  To ensure delivery of care and treatment, several elements must be in place including health, human resources and social infrastructures, which are currently in many places inadequate to serve all those in need(3).   Certainly, effective care and treatment – like prevention strategies – require behaviour change, increased research and development, and access to antiretroviral therapy and diagnostics(4).   The current standards of drug availability and affordability, and the impact of international trade agreements on access to drugs, should be further evaluated, with an eye to increased collaboration between the private sector and pharmaceutical companies(5).   Increasing access to treatment also means a long-term commitment must be made, since the drugs do not cure the disease and must continue for life.  Finally, the family, in all its many forms, is recognized as playing a key role in prevention, care, support and treatment of people affected and infected by HIV/AIDS(6).

Understanding all of these factors, governments committed themselves to:

• Make every effort to provide the highest attainable standard of treatment for HIV/AIDS and opportunistic infections;
• By 2003, develop strategies, in collaboration with the international community, civil society and the business sector, to strengthen health-care systems and address access to drugs through affordability, pricing, and the capacity of the system to deliver those drugs;
• By 2003, develop national strategies to provide psychosocial care for individuals, families and communities affected by HIV/AIDS(7); 
• Remaining consistent with international law, cooperate in strengthening pharmaceutical policies to promote innovation and the development of domestic industries(8); 
• By 2005, implement care strategies to: strengthen families and communities to provide treatment for all people living with HIV/AIDS; support individuals, households, families and communities affected by HIV/AIDS; improve the capacity and working conditions of health-care workers; and improve supply systems, financing plans and referral systems to provide access to drugs, diagnostics, and medical, palliative and psychosocial care(9).

There remain many challenges to achieving these goals. For a more comprehensive overview of progress made in reaching the 2003 and upcoming 2005 targets, please see “Meeting the Targets.”

Footnote

(1) Paragraph 25, Declaration of Commitment

(2) Paragraph 15.

(3) Paragraph 22.

(4) Paragraph 23.

(5) Paragraph 24 and 26.

(6) Paragraph 31.

(7) Paragraph 57

(8) Paragraph 55.

(9) Paragraph 56. Keeping the Promise, summary of UNGASS Declaration of Commitment. UNAIDS.