First Access and then Adherence

The reality for many countries across the region is that treatment access still has not come. The ethical dilemma of short-term therapy, which was addressed in the previous session of the Treatment Access Stream titled "Infrastructure and Support", was revisited. The issue of making therapy available to patients for a short period of time, like three to six months, was the centre of much discussion within the group. In some instances positive people in resource poor settings may have the opportunity, through trials or short-term availability of funds, to access treatments for a limited period of time. Is such access useful? Or does it lead to more harm, due to resistance? There was general agreement by the panel, that individuals, who might have the opportunity to access treatments for a six-month period, and closely follow adherence strategies, would receive short-term benefit from the treatments without developing resistance issues. Also, following on from the earlier session on infrastructure, there seemed to be an understanding that the most valuable resource, or piece of infrastructure, in the case of adherence is people. The need to ensure that a variety of people are skilled and trained to support and assist a person living with HIV to negotiate the territory of treatment uptake and adherence is important. And while resource rich settings often have a team of professionals that can assist an individual during this time, it was recognised that resource poor settings could focus on community participation in this area. But discussion of treatment uptake in resource poor settings was confronted by data presented by panel members. This data focussed on the decline of treatment use in Australia due to longer-term toxicity issues. It was noted that there had been up to a 15 percent decrease in ARV in Australia over the past 12 months. The issue of greater support from resource rich countries to resource poor countries was highlighted, as a means to ensuring there is greater information and education initiatives in developing countries that address treatment adherence, side effects and drug resistance.