Cost and supply considerations

The high cost and demanding clinical requirements of the antiretroviral drugs discussed in this module may put them out of reach of the vast majority of people with HIV, particularly in developing countries, where HIV-infection rates are high and resources are scarce.

Governments of developing countries are under increasing pressure to supply these drugs in an effort to curb the spread and effects of the infection (and these therapies may continue to become more affordable to these countries through special pricing schemes, bulk-purchase arrangements, or partnerships between international agencies, countries, and drug companies). However, many argue that public funding of antiretroviral therapy consumes too many resources and is of a lower priority than other concerns—such as preventing HIV transmission, treating or preventing other infections, or improving educational systems and other infrastructure issues—and that the consequences of funding this treatment in favor of other pressing needs could have unintended social and economic effects that could actually result in an increase in the spread of the infection.   

The challenges involved in using antiretroviral drugs in low-resource settings include not only the cost of drugs, but also the infrastructure required for their correct application. Aside from cost issues, some antiretroviral drugs have strict storage requirements (refrigeration, for example), or require precautions to avoid severe side effects (such as drinking liters of clean water to prevent kidney stones). Such requirements may not be accessible to or possible for clients in low-resource settings.

These obstacles should not be used as a justification to delay or discourage efforts to increase access to antiretroviral drugs for developing countries. Many PLHA and nongovermental organizations have been pressuring major international manufacturers of these drugs to lower prices for developing countries and allow the production of generic brands by manufacturers in developing countries. International organizations,such as UNAIDS and the World Health Organization (WHO), have also been working with manufacturers and governments to achieve similar aims. Recently, WHO compiled an index of approved manufacturers of generic brands from which developing countries can buy antiretroviral drugs at lower costs (see Making It Work for the link to the WHO site to access this index). However, the level of resources needed to make antiretroviral drugs and combination therapy available to all those who need them are still well beyond the capability of most developing countries.

Preventing and Treating Opportunistic Infections

Where available, preventive therapies and treatment of opportunistic infections can help prevent opportunistic infections, reduce mortality, slow the progress of HIV infection, and ease painful symptoms.

Therapies to prevent some of the most common opportunistic infections are shown in the following table:

Unfortunately, in many low-resource settings facilities for diagnosis are inadequate and drug supplies are erratic, even for those opportunistic infections that are easy to diagnose and less costly to treat. Access to treatment for clients in these settings will remain compromised until drugs and diagnostic equipment are accessible and countries can afford to equip their health systems with the necessary infrastructure and well-trained staff.

Preventive therapies for and treatment of opportunistic infections are important elements of the continuum of care that can be more realistically achieved in developing countries in the short and medium term than antiretroviral-drug therapy. Recently, there has been renewed international action to curb tuberculosis and malaria, two of the most devastating opportunistic infections, especially in Sub-Saharan Africa. Making It Work provides links to relevant Web sites on these topics.

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