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HIV as a chronic disease considerations for service planning in resource-poor settings

DOI: 10.1186/1744-8603-7-35

Keywords: HIV, Access to essential medicines, Adherence, Antiretroviral, Fees, Stigma, Infection control, Chronic disease, Intellectual property, Criminalisation

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In 2009, an estimated 33.3 million [31.4 million-35.3 million] people were living with HIV, according to UNAIDS[1]. With successful antiretroviral treatment, life expectancy for people living with HIV (PLHIV) can be restored to near normal: thus HIV has latterly been transformed into a manageable chronic illness, compatible with fairly good health, lifestyle and economic participation. Most countries now have from a few to many thousands of their population maintained with chronic HIV infection on antiretroviral treatment (ART). This situation already causes some significant challenges, which will increase as the ongoing spread of HIV adds to the caseload. Much has been written about the need to introduce and scale-up antiretroviral treatment to prevent deaths from AIDS. Much less has been said about planning for the situation when PLHIV have been stabilised on treatment so that their immunity is largely restored and they can resume familial and social roles, although a number of important medical and social issues emerge at this stage. This paper aims to raise awareness of some of the key questions for health ministries and governments.As HIV prevalence continues to rise through the roll-out of highly active antiretroviral therapy (HAART) to minimise mortality, there will be escalating stress on health provision. Once HAART has transformed HIV from an acute to a chronic illness, patients must be supported in adhering to treatment so that they do not accumulate resistant virus which can once again impair immunity and result in acute illness from opportunistic infections. Further, because chronic HIV infection results in various forms of organ damage, and because PLHIV are as vulnerable to unconnected illnesses as other people, it is also essential to ensure their access to general health facilities. The main barrier is the attitude of health workers: they may be afraid of HIV infection, and may stigmatise patients known or thought to carry it. Irrational fears and d


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