hiv as a chronic disease considerations for service planning in resource-poor settings艾滋病作为慢性疾病注意事项服务计划在资源贫乏的环境中.pdfVIP

Reynolds Globalization and Health 2011, 7:35 /content/7/1/35 COMMENTARY Open Access HIV as a chronic disease considerations for service planning in resource-poor settings Lucy Reynolds Abstract This paper reviews the healthcare issues facing nations which have a substantial caseload of chronic HIV cases. It considers the challenges of extending antiretroviral coverage to an expanding caseload as supplier price rises and international trade agreements come into force to reduce the availability of affordable antiretrovirals just as the economic downturn restricts donor funding. It goes on to review the importance in this context of supporting adherence to drug regimens in order to preserve access to affordable antiretrovirals for those already on treatment, and of removing key barriers such as patient fees and supply interruptions. The demands of those with chronic HIV for health services other than antiretroviral therapy are considered in the light of the fearful or discriminatory attitudes of non-specialist healthcare staff due to HIV-related stigma, which is linked with the weakness of infection control measures in many health facilities. The implications for prevention strategies including those involving criminalisation of HIV transmission or exposure are briefly summarised for the current context, in which the caseload of those whose chronic HIV infection must be controlled with antiretrovirals will continue to rise for the foreseeable future. Keywords: HIV, Access to essential medicines, Adherence, Antiretroviral, Fees, Stigma, Infection control, Chronic dis- ease, Intellectual property, Criminalisation Introduction although a number of important medical and social In 2009, an estimated 33.3 million [31.4 million-35.3