Infrastructure and Support

The successful treatment of HIV/AIDS requires that appropriate infrastructure be in place to ensure the delivery of the drugs to PWHIV/AIDS. The costs of drugs are still too high - but the costs of developing infrastructure and systems to ensure access and monitoring are also a barrier. Here, infrastructure refers to the availability of community-level doctors, healthcare workers, counsellors and social workers trained in the area of HIV/AIDS. It refers to the need for structural mechanisms that ensure access and adherence to treatment. Infrastructure is also needed to ensure the cost effective manufacture and distribution of drugs.

Kevin Frost from the American Foundation for AIDS Research (amfAR) reminded us of a depressing constraint on access. "Even if the number of people accessing ARV were to double (from one to two million) there would not be the manufacturing capacity to meet demand. Ethical issues surrounding clinical trials and STIs also remain an issue but often, prove to be the only means of access to many patients". These trials provide a "wedge" to establish infrastructure for drug delivery systems, even if only for a limited period or limited number of people. "Lack of infrastructure is often used as an excuse to do nothing" said Kevin Frost "However, we shouldn't allow the perfect to get in the way of the good". In response, one of delegates from India highlighted that, in the past clinicians had argued that STIs were problematic in resource poor settings due to drug resistance and had, therefore, warned against access to treatment for short periods of time. She went on to say that STIs were now in vogue and that the same people who had argued against it in the past were now the ones supporting it. A point was also made that, in many places, community values, stigma and discrimination are a potent barrier to establishing effective access and delivery systems, such as clinics or visiting nurses. Also, in many places, the medical system lacked or was not linked to counsellors and community educators who could be effective partners. Health care worker attitudes are a critical part of effective infrastructure. Jintanat Ananworanich from HIV-NAT in Bangkok explained that community doctors are generally underpaid and understaffed - the extra burdens of a complex disease such as HIV may be overwhelming and lead to people with HIV being referred elsewhere or not treated at all. Therefore HCW education is an essential component of any infrastructure development program. The cost of drugs was, not unexpectedly, a critical concern of many workshop participants. A delegate from PNG questioned the value of diagnosis in the absence of readily accessible treatment, or medical staff able to monitor and prescribe OI prophylaxis.