Introduction
Halting the spread/progression of HIV/AIDS by the year 2015 is one of the United Nations Millennium Development Goals. The United Nations (2013) indicate that tremendous advancements have been made in efforts to reverse the spread of HIV among the world populations. Most regions in the world have reported a reduction in persons newly infected with HIV. However, from a global perspective the awareness and knowledge level of how HIV is transmitted and prevention measures still remain significantly low especially among the young generation. Moreover, adherence and access to HIV treatment still remain a challenge to the control of HIV spread (Bermúdez, and Casal, 2006). This submission reviews the advances in the management of HIV with special emphasis on policies and laws regarding HIV treatment.
The problem in HIV treatment
The global rise in the cost of acquiring antiretroviral drugs is a major threat to the goal of universal access to HIV/AIDS treatment. It is particularly pronounced in developing countries. Use of antiretroviral therapy (ART) by HIV positive people has been shown to increase their life expectancy almost matching that of the country's average compared to those who do not use ART.
According to United Nations (2013), there was an increase of more than 1.4 million of people on HIV treatment from 2010 to 2011. This indicates an increase in the number of people access treatment for HIV. However, by 2011 only 11 countries in the world had realized universal antiretroviral therapy access among their populations. This report suggests that, despite the increase in access to antiretroviral therapy (ART), the number is not significant enough to realize the MDG. In fact, by 2010 very few countries had achieved universal access to HIV treatment.
It, therefore, brings us back to the policies, legislation, and guidelines on general HIV. The HIV treatment policies need to be reviewed because globally, majority of the countries are way behind the goal of achieving universal access to HIV/AIDS treatment. United Nations indicate that only 9.7 million HIV positive persons were receiving treatment by 2012 while seven million others failed to access treatment. On the other hand, WHO (2014) reports that in 2012, more than 35 million people were HIV positive with more than 2 million new HIV infections. On those, who were receiving ART, the report indicated only 10 million people.
One of the challenges to the MDG number six is access to HIV drugs and adherence. Despite leading in the proportion of people living with HIV/AIDS, people in the developing world still have limited access to antiretroviral drugs. Moreover, the few whom access have problems with compliance and adherence. This, therefore, necessitates changes in legislation and health policies to ensure affordability and accessibility of HIV treatment by people with HIV.
History and Current Legislation/Policies
There have been new slogans in the past few years to promote understanding and treatment of HIV. For example, “zero HIV infections,” “closing the gap,” and “one pill per day.” Initially, it was observed that HIV positive persons who had started treatment had a problem with adherence and compliance because the ART drugs were many tablets to take a single moment. Moreover, a significant, number reported adverse effects. This led to policy changes from the pharmaceutical company to the point of administration. Thus, there was the invention of the 3 in 1 or 4 in 1 tablet, which was easier to swallow. The combination tablet/pill reduced inconveniences, had few adverse effects and promoted adherence. Culp-Ressler (2012) indicates that the 4 in 1 pill (Stribild) that was approved by the Food and Drug Administration (FDA) agency is a commendable approach towards improving health outcomes among HIV positive persons. According to British Columbia Centre for Excellence in HIV/AIDS (2013), there have been numerous advances in HIV management that have led to better health outcomes especially after the introduction of ART. However, it indicates that gaps and challenges exist. Some of them include the target beneficiary, adherence, and socioeconomic status.
There is a need to understand people who are HIV positive and are not on treatment and also those who are HIV positive and are on treatment. These groups of persons have unique experiences during the morbidity period. Thus, advances in HIV management have gone ahead to propose the need for comprehensive care of the HIV positive person at a unit that is integrated with all the services. That is, an HIV treatment center, also known as, comprehensive care center (CCC) is currently in place in most regions. Such centers provide preventive, curative, rehabilitative, and palliative services (Bermúdez, and Casal, 2006). Services across the health care disciplines and social welfare are integrated and provided at these centers. Culp-Ressler (2012) also adds that robust clinical research on vaccines, better drugs, and behavior change is ongoing and may yield positive results in the future with respect to HIV management.
Current policies on HIV management probably need to be reviewed to promote adherence and compliance to the HIV treatment plan. Healthcare professionals need to review a couple of things in the patient before initiating antiretroviral therapy. For example, the level of personal organization, nutrition habits, one’s immunity, plans of getting pregnant, any other disease, and socioeconomic activities among other personal factors play a role in prognosis of HIV treatment. British Columbia Centre for Excellence in HIV/AIDS (2013) indicates advanced in policies like the timely commencement of antiretroviral therapy and increasing access to health care have contributed in increasing survival of HIV positive patients in North America.
Increasing and promoting HIV/AIDS testing among the population is another way in which the public and private sectors aim to increase HIV screening. Regular HIV testing at an affordable fee is one way of increasing access to HIV care for those who are positive without their knowledge can get to know their status and commence treatment before it’s too late. Similarly, it is one way of protecting the public from being infected from persons who do not know their HIV status. Culp-Ressler (2012) argues that current policies on HIV in the United States focus on reducing cost of care and increasing accessibility.
Being a chronic disease, HIV/AIDS is now more manageable than before. However, patients should still be informed that despite feeling well, they still continue to take medication for HIV is never completely treated. It should be appreciated that life expectancy among patients on ART has increased over the years since the introduction of the antiretroviral treatment regimes. The available policies need to be reinforced and stricter guidelines should be rolled out to enhance compliance and adherence (Bermúdez, and Casal, 2006). Special policies also need to be formulated for the different socioeconomic status of persons.
According to Public Library of Science (2013), treatment of HIV, could be taken as a preventive measure. This is when the ART is initiated in newly diagnosed individual irrespective of the CD4 count. With continued use of ART, the infectiousness of the individual is significantly reduced, thereby protecting the uninfected while prolonging the life of the patient. According to Nunn, Elize — Bastos, and Gruskin (2010) — increasing the cost of procuring HIV drugs could be a factor contributing to limited access to treatment by some populations. For instance, in 2009, only 40% of people in need of highly active antiretroviral therapy (HAART) developing countries received the drugs.
One of the factors that lead to limited access to HIV/AIDS treatment is the cost the national budget has to incur in the procurement of the drugs. This could also be due to reduced donor funding or change in public health priorities. Hence leading to reduced supply of antiretroviral drugs to the HIV positive population. This is a challenge that governments can fight by coming up with innovative ways and public drug production policies to acquire the drugs including manufacturing generic products for its population. Nunn et al. (2010) argues that countries like Brazil have been forced to enter into global price negotiations and dialogue so as to realize accessible and affordable HIV care to their populations.
Intervention Areas
Nunn, Elize, Bastos, and Gruskin (2010) recommend the introduction of policies on HIV education and prevention among all the developmental cohorts. This especially evidenced by the success of countries like Brazil, United States and Canada. Awareness and prevention campaigns including HIV testing should be encouraged through policy formulation.
Another area of policy intervention is strategizing on how to acquire HIV/AIDS drugs and allowing free access by the members of the public who are ailing. Distribution of such drugs to the facilities should be well regulated so that the right amount of drugs is delivered to the right/intended persons. Moreover, strict measures should be put in place to ensure total adherence and compliance once a patient has been started on ART (Culp-Ressler, 2012).
According to Public Library of Science, (2013) and Nunn et al. (2010), governments should have sound public health policies that are not discriminatory on distribution of AIDS drugs. In fact, they should have “a right to ART” policy so that all members of the population are given a chance to access the HIV treatment available for them.
Use of ART should also be integrated into guidelines and protocols in all HIV treatment centers. Countries could also consider the local production of generic ART drugs that can be cheaper than the originals imported from other countries. However, Nunn et al. (2010) indicates that this is more successful in regions with flexible or no policies and laws on intellectual property rights for pharmaceutical products. Governments can also explore other funding sources, for example, international donors and lenders.
Lastly, countries should formulate favorable laws and policies for research of HIV cure. Governments and their agencies, as well as like-minded partners, could support an AIDS vaccine initiative through funding, infrastructure development, fair policies and laws, shunning politics and encouraging public support. However, robust clinical research for HIV/AIDS vaccine and drugs has constantly been hindered by stringent policies and legislation on intellectual property rights. Bermúdez and Casal (2006) argue that numerous HIV drugs are in development, but often subjected to the disputes surrounding intellectual property rights. Thus, national governments could consider developing policies and legislation to provide guidance on the research and development surrounding HIV/AIDS drugs with special emphasis on intellectual property rights.
References
Bermúdez, M, and Casal, G (2006). Recent advances in HIV infection research. New York: Nova Biomedical Books.
British Columbia Centre for Excellence in HIV/AIDS (2013) Advances in HIV treatment dramatically increases life expectancy. Retrieved on 3/3/2014 from http://www.cfenet.ubc.ca/news/releases/advances-hiv-treatment-dramatically-increase-life-expectancy
Culp-Ressler, T (2012). On World AIDS day, here are five huge advances we’ve made to combat the global HIV/AIDS epidemic. Think Progress. Retrieved 4/3/2014 from < http://thinkprogress.org/health/2012/12/01/1265581/world-aids-day-2012/#>
Nunn, AS, Elize, M, Bastos, F, and Gruskin, S. (2010). AIDS treatment in Brazil: Impacts and challenges. Bethesda: PMC, DOI: 10.1377/hlthaff.28.4.1103
Public Library of Science (2013) HIV elimination in South Africa could be achieved by the current treatment policy. Science Daily Retrieved 3/4/2014 from <http://www.sciencedaily.com/releases/2013/10/131022183242.htm>
United Nations (2013) Goal 6: Combat HIV/AIDS, Malaria and other diseases Retrieved 4/3/2014 from <http://www.un.org/millenniumgoals/aids.shtml>
WHO (2014) MDG 6: Combat HIV/AIDS, malaria and other diseases. Retrieved on 3/3/2014 from <http: //www.who.int/topics/millennium_development_goals/diseases/en/>
