Impact of the global economic crisis on antiretroviral treatment programs

In many HIV prevalent countries in sub-Saha¬ran Africa death among HIV-infected moth¬ers and their children is a major obstacle to achieving the millennium development goals (MDGs) for maternal and child mortality. In South Africa HIV/AIDS is the leading cause of maternal and child mortality and with HIV incidence estimated at 5% (per year) in 2006 life expectancy has decreased by more than 20 years since 1994. From 1990 onwards infant mortality has increased and maternal mortality has remained unchanged so with¬out drastic action it is unlikely South Africa will achieve the two-thirds reduction in infant mortality or three-quarters reduction in mater¬nal mortality required to reach MDGs 3 and 4 by 2015. As we make our way through the third decade of the AIDS epidemic we now have affordable antiretroviral combinations capable of adding years to the lives of people living with HIV. In many cases these are the productive years of teachers nurses and doctors in high prevalence countries. We need to adapt to the realities of the diverse mosaic of countries and delivery systems. The laboratory monitoring regarded as the standard of care in Europe and North America is unfeasible in large parts of Africa that lack the human resources and laboratory capacities to implement it. However life-saving therapies can still be provided through evidence-based clinical protocols that balance technical quality with an availability of resources. Although the economic recovery is expected to be slow global economic conditions have improved quicker than expected mainly due to public intervention. While many countries may be questioning whether they can maintain the measures needed to support people living with HIV and AIDS the world cannot afford to have a shortfall in antiretroviral treatment programs which are so essential to the lives of millions of people around the world. (excerpt)