What Will It Take to Provide HIV Treatment for All?

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We know antiretroviral therapy works at keeping HIV at bay for as long as patients adhere to their meds. We also now know that delaying treatment initiation is not more beneficial than starting as soon as possible. In fact, all five major international HIV treatment guidelines recommend starting treatment immediately.

Moreover, we know that being on treatment and having an undetectable viral load has the added benefit of effectively preventing HIV transmission, as shown in the PARTNER study and HPTN 052.

In particular, for patients who are newly or recently diagnosed with HIV, starting treatment is one of the major first steps in their journey. Despite all the evidence that supports starting treatment for all, many obstacles still exist to treatment access, so we asked some HIV experts and community members what it would take to provide HIV treatment for all those who need it.

Interviews for this slide show were conducted by Naomi Harris, M.P.H.

Credit: Jezperklauzen for iStock via Thinkstock.

Jessica Salzwedel, AVAC, United States

I think it's about policy. It's about changing some of the laws, and some of the patent laws, so that we can get more drugs. More countries need to also invest in HIV treatment. So, there needs to be more country ownership to make that happen, to really get people on treatment, and test and treat, and get them on it.

Joel Goldman, Elizabeth Taylor AIDS Foundation, United States

In the bigger picture, I think all of us, all over the world, from countries that can afford it, need to rally our governments for the replenishment fund. We have all these great, lofty goals, and we can end AIDS. But if we don't hit those numbers, and if the medication isn't there to be put out into the world -- especially in places such as sub-Saharan Africa where the numbers are so high -- we're never going to achieve it. And then all this great talk about 90-90-90 and achieving by 2020 is just talk.

But we need to talk. We need to rally our governments to make sure that we are giving enough. Because, the truth is, if we really focus, if we really focus now on achieving this, it frees so much money for so many other global problems, health and otherwise. It really does.

We have a solution. This isn't like other diseases on the planet that we don't have a solution for; we have the solution. And we take all this money that's going in every year, and going to keep going in, and keep expanding.

Joyce Achola, Uganda

First of all, we need political will from our governments. If our governments are serious, and they're willing, I think governments have money to buy and provide treatment for everyone in our countries. It shouldn't be selective treatment. It should be inclusive for everyone because that is the leeway for our prevention of HIV infection.

Lars Klitgaard, Denmark

The Global Fund is a good way to start. I think it's shameful, coming from Denmark, that Denmark is cutting down on support to the Global Fund. The richer countries, they should not cut it down. They should just give a little more. They don't have to give a lot more, but just a little. If everyone gave a little more then it would be full.

Shirlene Cooper, United States

Universal health care -- meaning that all the nations need to come and sit down together, and everybody needs to put in the resources as a coalition to make sure that everybody receives universal health care. We can't have one country trying to do it because there's not enough money to spread around the world. So, if all the countries came together and had a meeting and said, "You know, we're going to streamline resources here; everybody's going to put money in the pool and then give to those who are in need of medications."

Finn McMurray, Elizabeth Taylor AIDS Foundation, United States

I think breaking down these barriers of social stigmas and discrimination are one of the most important roles that we can take. That's what is holding so many people back, so much. This disease can be eradicated. But, without those issues being addressed, we won't move forward.

Quinn Tivey, Elizabeth Taylor AIDS Foundation, United States

We're really proud and excited to be joining the GenEndIt Coalition. A major component of that is everything under the umbrella -- or, I might say, as you peel back the onion behind HIV and AIDS -- that is social, sexual, racial, injustice, discrimination, inequality, criminalization. It's a huge push of ours. We have been a presenting sponsor of AIDS Watch for the last couple of years, and we will be for this coming year. We'll be pushing that hard in D.C. next year, as well.

These are some of the issues that stand as barriers to treatment, to testing, to winning the fight. There are a number of different components and avenues that all need to be addressed and that all need to be fought. So, I can't give you one specific clear-cut answer. I don't think anybody in the world can. But I think that keeping in mind this larger scope -- I would say this wide, grand scope and being able to act on so many different avenues -- is an important way of addressing the fight.

Silke Klumb, Deutsche AIDS-Hilfe, Germany

First, I think [we need] money, funding -- the engagement of the international society to really be apt to provide treatment needs, their engagement and funding. Second, we need a lot of infrastructure. We cannot accept that people have to walk for two or three hours in rural areas to get their treatment. So, we need other ways of integrating HIV services into the health services in the rural areas, as well.

And third, I think we need a lot of work against stigma and discrimination as long as people are either being HIV positive, or being whatever kind of key population -- either gay, or trans, or a sex worker, or even, being in Southern Africa, young girls, young women, living under sexual violence. So, we have to change a lot concerning homophobia, sexism and racism to end HIV for AIDS, but also to give treatment to all who are in need.

Jane Ng'ang'a, Kenya

There has been a lot of talk about genetics. I'm not sure about how well they will work because sometimes we under-develop the genetics.

The other thing is education, so that people can take HIV seriously. If you look at the research that has been conducted, treatment as prevention is one of the ways of HIV prevention. We also have PrEP [pre-exposure prophylaxis] that has not been rolled out in many of the African countries, simply because of maybe the issues of adherence, costs and all that.

We also need to educate people on stigma and discrimination. As much as it has gone down, I'm not sure that there are not people who are getting discriminated against due to stigma. That is also something that we need to consider.

We also need to engage the community, educate the community, about HIV prevention. There are many prevention emissions that have been put in place. What is happening that we still have new infections? That is a real concern -- that we need to reeducate the community as far as HIV prevention is concerned.

What about you? What do you think it will take to finally have everybody living with HIV on treatment? Share with us in the comments!