Intended for healthcare professionals

Rapid response to:


Rising rates of HIV infection

BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:320

Rapid Response:

Global Management of HIV/AIDS: Disparities in Prevalence and Treatment Access

According to World Health Report 2004, AIDS has killed more than 20 million people and is now the leading cause of death and lost years of productive life for adults worldwide. The AIDS epidemic takes on different prevalence patterns and epidemiological profiles in different parts of the world. The continent of Africa, particularly the southern region, continues to have the highest HIV/AIDS incidence and prevalence rates globally. It is estimated that 34-46 million people are infected with HIV around the world; about 30 million of them live in Africa. Many of the highly industrialized countries of the Western Hemisphere, including the United States, report declining epidemiological trends in AIDS overall, however, their incidence rates in certain subpopulations are rising. In the Eastern Hemisphere, countries that once formed the Soviet Union confront a fast growing epidemic. Latin America and the Caribbean also face a growing threat, while East and Southeast Asia, which include countries like China and India that contain some of the world’s largest populations, may eventually exceed Africa in terms of their absolute number of cases if their current escalating rates of HIV/AIDS go unchecked.

The socioeconomic disparities that factored into the original disparities in disease prevalence in different parts of the world also are associated with disparities in treatment access, and hence continue to fuel the spread of the epidemic. Ironically, those that are the hardest hit in developing countries find it the most difficult to get appropriate treatment. The exact cost of antiretroviral therapy in a particular geographical location varies and is determined by a complex set of factors including global politics, the existence of donor funds, public and private insurance and/or entitlement programs, and the policies and drug- testing activities of large pharmaceutical firms. The high cost of antiretroviral drugs places therapy beyond the range of many individuals living with the virus. The World Health Organization estimates about six million people infected with HIV in the developing world need access to antiretroviral therapy to survive, but only 400,000 have access to treatment. These people will die in the next two years if they do not receive antiretroviral treatment. In sub-Saharan Africa, an estimated 4.3 million people need AIDS home-based care but only about 12 percent receive it and in South Asia, coverage drops to 2 percent.

Developing countries cannot afford the expensive drug therapies for HIV; the costs run approximately $10,000-12,000 per year and need to be taken on an ongoing basis according to precise protocols with ongoing immune monitoring. Although a number of global programs are facilitating or providing treatment, the demand throughout the world far exceeds the numbers to be served. There is an urgent need to step up the efforts to make available the required therapies to those who need it. Millions of lives could be saved with today's knowledge and resources. Failure to address this crisis would be a moral failure.

Competing interests: None declared

Competing interests: No competing interests

18 February 2005
Memoona Hasnain
Director of Research & Assistant Professor of Public Health in Family Medicine
Dept of Family Medicine, College of Medicine, University of Illinois at Chicago, IL 60612 USA