When the World Health Organization released an announcement in Vancouver this month that its updated and highly anticipated HIV treatment guidelines were "moving towards" advising treatment for all people living with HIV, the international agency noted that the recommendations follow scientific evidence from three major clinical research trials showing that immediate access to antiretroviral treatment protects health and prevents HIV transmission. It also noted challenges, that, all the same, may slow worldwide embrace of those recommendations.
Those included barriers still standing between marginalized and criminalized populations and access to HIV treatment under current guidelines, current unmet needs and gaps in delivery of services, and continuing lags in addressing HIV coinfections of tuberculosis and hepatitis.
Now a web portal from the International Association of Providers of AIDS Care provides a picture of how the world has responded so far to existing guidelines, which include treatment access for children, pregnant women, people coinfected with tuberculosis, and for infected individuals whose immune cell -- or CD4 -- count has dropped to 500 or less per cubic millimeter of blood (more or less a drop of blood). The site, HivPolicyWatch.org, which currently incorporates the policies of 149 countries on an interactive map, shows widening inequities, leadership, examples of what countries with a wide range of resources consider possible and necessary, and offers a chance to follow and compare country policies in real time as they continue to evolve.
What countries make antiretroviral treatment available regardless of immune count? The answer is not surprising, with that policy predominately adopted by among some of the world's wealthiest and most developed countries. Some of the lags in adopting current guidelines, on the other hand, are less predictable. While Malawi, one of the world's poorest countries followed the WHO's last recommendations, Botswana, a country with greater resources, has yet to move on from previous guidelines, dating back 5 years and requiring a more damaged immune system, and graver state of health before treatment eligibility begins. The Russian Federation follows a policy based on guidelines issued in 2007. You can go ahead and look up other countries lagging behind, including China. Interesting as well is the number of countries across Africa as well as Eastern Europe that have challenging epidemics but where policies on HIV treatment remain unavailable.
This excerpt was cross-posted with the permission of Science Speaks. Read the full article.