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Chapter 002. Global Issues in Medicine (Part 5)

Chapter 182 provides an overview of the AIDS epidemic in the world today. Here we will limit ourselves to a discussion of AIDS in the developing world. Lessons learned in tackling AIDS in resource-constrained settings are highly relevant to discussions of other chronic diseases, including noncommunicable diseases, for which effective therapies have been developed. We highlight several of these lessons below. In the United States, the availability of highly active antiretroviral therapy (ART) for AIDS has transformed this disease from an inescapably fatal destruction of cell-mediated immunity into a manageable chronic illness. In developing countries, treatment has been offered more broadly only since. | Chapter 002. Global Issues in Medicine Part 5 AIDS Chapter 182 provides an overview of the AIDS epidemic in the world today. Here we will limit ourselves to a discussion of AIDS in the developing world. Lessons learned in tackling AIDS in resource-constrained settings are highly relevant to discussions of other chronic diseases including noncommunicable diseases for which effective therapies have been developed. We highlight several of these lessons below. In the United States the availability of highly active antiretroviral therapy ART for AIDS has transformed this disease from an inescapably fatal destruction of cell-mediated immunity into a manageable chronic illness. In developing countries treatment has been offered more broadly only since 2003 and only in the summer of 2006 did the number of patients receiving treatment exceed 25 of the number who currently need it. It remains to be seen how many of these fortunate few are receiving ART regularly and with the requisite social support. Before 2003 many arguments were raised to justify not moving forward rapidly with ART programs for people living with HIV AIDS in resource-limited settings. The standard litany included the price of therapy compared to the poverty of the patient the complexity of the intervention the lack of infrastructure for laboratory monitoring and the lack of trained health care providers. Narrow cost-effectiveness arguments that created false dichotomies prevention or treatment rather than both too often went unchallenged. The greatest obstacle at the time was the ambivalence if not outright silence of political leaders and experts in public health. The cumulative effect of these factors was to condemn to death tens of millions of poor people in developing countries who had become ill as a result of HIV infection. The inequity between rich and poor countries in access to HIV treatment has rightly given rise to widespread moral indignation. In several middle-income countries including .