(Not) achieving antiretroviral treatment – while millions infected with HIV still suffer

by Sarah Chown

With only nine months before one of the targets set under the United Nations Millennium Development Goals (MDGs) is supposed to be achieved, there is still a long way to go.

In 2000, the United Nations agreed on eight MDGs to be achieved by 2015: eradicate poverty and extreme hunger, achieve universal primary education, promote gender equality, reduce child mortality, improve maternal health, ensure environmental sustainability, create a global partnership for development, and combat HIV/AIDS, malaria, and other diseases. These are ambitious goals andby sharing expertise and funds, leaders hope to improve quality of life for people worldwide.

Specific targets were set for each goal. One such target is to achieve universal access to treatment for HIV/AIDS for all those who need it by 2010. Providing antiretroviral (ARV) treatment is brilliant: like most MDGs, it means improvements in more than one area. ARV treatment means more people suffering from illness will be able to work, take care of their children, and live long enough to become professionals and train others. Antiretrovirals work by reducing the reproduction rate of the virus.  Although they slow the progress of the infection, they are not a cure. These are severely expensive drugs, costing between $10,000 and $15,000, primarily as a result of pharmaceutical patents. There is, however, adherence to ARVs in the Global North where individuals and governments, such as Canada, many states in America, all of Western Europe, and other countries are able to afford the drugs. These countries also have extensive health care networks, with medical professionals available to diagnose and treat patients. In many developing countries, these resources simply do not exist. This can be attributed to a number of factors, including the legacy of loan agreements with the International Monetary Fund, an international financial institution, that required governments to make drastic cuts to social spending.

Clearly, when these goals were set, those involved knew they were ambitious. But “ambitious” should not be conflated with “impossible”. there are examples of countries that have overcome the barriers people so often accept: absent health infrastructures, illiterate patients unaccustomed to regimented prescriptions, growing numbers of HIV+ patients in need of drug treatment, and the legal framework of UN intellectual property rights that protect these medications and make them impossible for governments and individuals in the world’s poorest countries to purchase on a widespread basis.

Brazil is one country that has reduced the cost of drugs to an average of $3,000 and is widely acknowledged as the model for achieving ARV adherence. This is not a new development. Since the late 1990s, Brazil has provided ARV treatment to all those who needed it. This program was possible because of political commitment in Brazil itself and international partners such as the World Bank that financed the initiative, as well as the willingness to challenge the power pharmaceutical companies wield.

Less than one third of those in need of treatment receive ARVs according to The Millennium Development Goals Report from the United Nations. Although more and more people are able to access drugs through innovative programs provided by governments and civil society organizations like Médécins sans Frontières (MSF), new infections are outpacing gains in treatment.

What is worse is that with nine months left to meet the goal, it is being overlooked by the media,  parliaments, and the UN Assembly. Meanwhile, 9.7 million people in need of HIV treatment will die young, leaving their countries struggling to staff work places and their children without parents.

The UN, governments, civil society organizations, corporations, and individuals should be doing all they can to say to people living with HIV worldwide that they will not be left to die in a world that has the treatment they need.  Until people are able to get treatment to prolong their lives, HIV will continue to be a perpetuating factor in issues of poverty, hunger, mortality, unemployment, and access to education. It will also place disproportionate burdens on women who most often end up caring for patients. Letting the promise of MDGs slip away from possibility is impossible to justify or rationalize. It is merely another indicator of the ambivalence towards the international assistance programs that are the subject of so much rhetoric.  It is a missed chance to stop yet another generation from dying slow, lonely deaths.

Sarah Chown is a fourth-year public affairs and policy management student at Carleton.