Confronting the deadly pandemic
Nearly 38 million people were living with the human immunodeficiency virus (HIV) at the end of 2018, the majority of them in sub-Saharan Africa. While there is no cure for HIV, a combination of drugs, known as antiretrovirals (ARVs), enable people to live longer, healthier lives if taken regularly. The cost of first-line drugs is now cheaper than ever, but efforts are still needed to ensure everyone who is living with HIV receives treatment. Nearly 13 million people were missing out on receiving treatment as of June 2019.
Worldwide, more than 20 per cent of people currently infected with the virus don't know their HIV status. In West and Central Africa, only around two-thirds of people living with HIV know their status. Once someone is diagnosed with the disease, viral load monitoring - measuring the levels of HIV virus in the blood - is essential to measure whether treatment is working. While annual viral load tests are standard in wealthy countries, access in developing countries still lags far behind.
There is no cure for HIV, although life-long treatment using combinations of drugs known as antiretrovirals (ARVs) helps manage the virus and enables people to live longer, healthier lives if taken regularly. While nearly 10 million more people are on treatment today than in 2014, deadly treatment gaps exist, especially in West and Central Africa, and the Middle East and North Africa, where barely a quarter of people living with HIV receive ARVs.
While most people living with HIV can stay healthy on first-line drugs - which cost around US$65 per person per year - a significant number develop resistance to this regimen and have to switch to second-line regimens. But the price of doing so is high - literally. Second-line regimens are nearly four times the price of first-line regimens. To switch from second- to third-line regimens is up to eight times more expensive, as much as $2,200 per person per year. This is in large part because pharmaceutical corporations maintain monopolies that block price-lowering generic competition. On top of overcoming pricing barriers, adequate medical follow up must ensure a timely identification of resistance and a switch of regimens when needed.
Low HIV prevalence rates - ranging from two to 10 per cent across West and Central African countries, and less than one per cent across the Middle East and North Africa - have left these regions in a blind spot in the global HIV response. These regions continue to lag behind in attention and investment in tackling the epidemic, resulting in low access to testing and treatment. In West and Central Africa, just over half of people living with HIV are on treatment. It is unacceptable to witness people dying of AIDS within hours of being admitted to our hospitals in Democratic Republic of Congo (DRC), Guinea, Kenya and Malawi.
In conflict settings and when people are displaced, ensuring the continuity of care for people with HIV - including long-term supply of drugs - can be difficult. Logistical and security issues are barriers for both our teams and patients in ensuring that people living with HIV can access the care and treatment they need to stay healthy. In Yemen, providing uninterrupted treatment during more than five years of war has proved logistically challenging - and dangerous to patients and staff.
So called ‘key populations’ include vulnerable people who are disproportionately affected by HIV, including sex workers, people who use drugs, men who have sex with men, and prisoners. Despite their higher risk of acquiring HIV, key populations are often excluded from accessing HIV treatment and prevention as well as comprehensive health services. Stigma, discrimination, social exclusion, violence and criminalisation are part of their daily struggles. In Mozambique and Malawi, MSF provides packages of HIV and sexual and reproductive healthcare services for sex workers and men who have sex with men in key sites along main transport routes.
HIV lowers the body's immune response, and without effective treatment, leaves people living with the disease much more vulnerable to deadly opportunistic infections like tuberculosis (TB). TB is the single biggest killer of people living with HIV, accounting for one in three AIDS-related deaths. However, according to WHO, only one in four people living with HIV estimated to have developed TB in 2016 had access to ARV treatment.
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Stopping Senseless Deaths: Overcoming access barriers to affordable, lifesaving diagnostics and treatments for HIV and opportunistic infections
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Untangling the Web of Antiretroviral Price Reductions 18th Edition
Fight against HIV doomed to fail without urgent focus on West and Central Africa
HIV: Antiretroviral drugs fail to consistently reach patients in countries most affected by HIV/AIDS
MSF HIV/AIDS Researchfieldresearch.msf.org
We produce important research based on our field experience. So far, we have published articles in over 100 peer-reviewed journals. These articles have often changed clinical practice and have been used for humanitarian advocacy. Read all our HIV/AIDS-related articles on our dedicated Field Research website.