Saturday, May 30, 2009

Imbalance Access To Anti-Retroviral Therapy: A Shameful Medical Injustice!

Mark was four when his parents died of Acquired Immune Deficiency Syndrome (AIDS). He was forced to live with his 80-year old grandmother but things were not as easy as he thought for the grandmother was too poor to take adequate care of him. He was disappointed but that was just the beginning of the agony.

At 12 when his Human Immunodeficiency Virus (HIV) metamorphosized into AIDS, the last resort became the government hospital which became a hell he never expected. He was ostracised and dehumanised by patients and health workers. They felt very uncomfortable with him and told him that to his face. He lived in isolation broken-hearted.

Meanwhile the only life-saving drug that could keep him going is beyond his reach. He is poor and his grandmother died two years earlier. The government, the last resort in this battle cannot cope anymore with the increasing number of victims whose last resort relies on the drug. That was the last straw that broke the camel’s back. Mark died few months later, even though he could have lived as long as he wanted if the drug and care was there for him.

Mark’s case is not strange but just a fragment of what numerous others with the virus go through to prolong their life. The Anti-retroviral drugs are not there and when they are, they are beyond their reach. Poverty and poor healthcare system are the two main reasons for this injustice especially in developing worlds with the sub-Saharan Africa as the worst hit.

In Sub-Saharan Africa the anti-retroviral is still eluding vast majority of the people living with the virus. In the early 1990s when the drug became available, HIV/AIDS was transformed from a death sentence to a manageable disease but only for some. The cost of the drugs coupled with unequal distribution pattern prevented about 95 percent of those living with the virus from getting access to them.

The worldwide fury that millions were dying because of income inequality in accessing the drugs resulted in its price reduction and the 2002 foundation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Through the Fund and the US President’s Emergency Program for AIDS Relief, the world saw a massive production and distribution of antiretroviral treatment in many developing countries. Since then healthcare workers have adapted to settings where people often could not access even the most basic care. At the moment millions of lives which otherwise might have been lost are being saved. Equally important, providing treatment is becoming a focal point of the efforts to prevent further spread of the disease.

Presently more than three million more people around the world are alive due to the drugs. This is a big jump from 350,000 just about five years ago. If this trend continues, by 2010 more than five million people are likely to have access to these drugs.

However we still have a long way to go before the victims who need them can access them. Presently the need is for about 10 million people, but until we can control the growth in new infections, that number will continue to grow. Africa is obviously the place this attention needs to be shifted as a result of the havoc the virus is causing there and the inability of the victims to access the drugs. Poverty remains the main reason for this. Poor health care system and corruption are other major reasons.

Six years ago at the opening of the 11th International Conference for People Living with HIV/AIDS in Uganda, Ben Plumley, Chief Executive Officer at the UNAIDS decried that it is a, “serious injustice to see that only one percent of the 4.1 million people in sub-Saharan Africa who need anti-retroviral therapy have access to it”. He charged the conference to look for ways to close this vast gap opining that they are under a moral obligation to do so and tackle the intolerance, corruption, fear and inequalities that prevents people from accessing the services they need. Sadly the situation still remains the same.

For more than 25 years, HIV/AIDS have been ravaging the lives of millions of people. Since the outbreak, nearly 30 million people have died. But over the past few years, a quiet global revolution has enabled millions infected by the virus to live healthily. However more are still to be done! For instance in Haiti with a population of 9.6 million, 115,000 people are living with the virus while only 13,586 are on anti-retroviral treatment. India has a population of about 1.13 billion with 2.5 million living with the virus while only 126,400 are on the treatment. Mali with a population of 12.2 million has 130,000 living with the virus with only 15,450 on the treatment.

In Peru with a population of 27.9 million, 10,400 are on the treatment out of 93,000 living with the virus. Russia has 31,000 on the treatment out of 940,000 living with the virus in a population of 143.2 million. In Rwanda out of 150,300 living with the virus only 44,400 are on the treatment in a population of 9.2 million. South Africa has a population of 47.4 million out of which 5.5 million are living with the virus but it is only 488,739 that are receiving the treatment. In the neighbouring Swaziland with a population of 1 million, about 20,610 are on treatment out of 220,000 living with the virus while in Vietnam with a population of 84.2 million, 132,628 are living with the virus while 14,180 receives the treatment. Nigeria with a population of 145 million has about 3.5 million infected with the virus with only 124,572 on the treatment. What happens to the rest of the population that could not be placed under this therapy? Pain, agony and sorrowful death become the only way out!

The good news is that free antiretroviral treatment is saving millions of lives today and that is enough reason to continue widening access to it. However, the main challenge is preventing new infections and confronting the injustices in accessing the drugs especially for millions in the third world. Worldwide three people are infected by HIV for every person that begins treatment. To stem the tide, we must reverse those numbers. In doing so, fear and stigma is reduced, more people will dare to be tested and it will become easier to talk openly about how it spreads and how to protect against infection.

But there are still other challenges. Even where those infected have access to antiretroviral treatment and their immune systems begin to recover, infections and illnesses they have already developed because of HIV may take their lives. Tuberculosis continues to be the leading cause of death likewise Hepatitis, liver diseases, Pneumonia and HIV-related cancer. Nonetheless Anti-retroviral treatment is generally successful. After six months on the treatment, eight out of every ten people who started are still alive.

The success in rolling out antiretroviral treatment against terrifying obstacles should inspire us to go for the test and since there is no cure yet, testing remains the only way to nip it on the bud.

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