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Universal access to treatment: who sets the agenda? Whose voice is heard?

Date: Poster sessions
Source: Forum 11
Authors: Anushree Mishra, Consultant, Panos Global AIDS Programme, India


Access to treatment and specifically antiretroviral (ARV) drugs across the developing world is currently one of the major donor priorities in the fight against HIV. The Panos Global AIDS Programme conducted research in Haiti, Ethiopia, India, Nepal and Zambia. The objectives were to: analyse the way in which treatment roll-out is designed and implemented; identify the obstacles to achieving universal access; and, to establish the extent to which the most affected communities are involved in the current treatment roll-out. The study incorporated the voices of people living with HIV (PLHIV), vulnerable groups, health professionals, public health experts, government officials, industry representatives and others concerned with the programme.

The following themes emerged from the findings: 1) a programme that is poorly conceived, and monitored; 2) a public health infrastructure unprepared to take on this intensive programme; 3) insufficient funding; 4) a lack of transparency at all levels; 5) limited access for marginalised and vulnerable groups such as women, people from rural areas, sex workers and men having sex with men; 6) limited information on treatment literacy and a lack of involvement of community organizations, especially organizations of PLHIV. Issues around patenting and the cost of drugs are also major challenges to ensure universal access.

On the basis of the analysis the study came up with a set of recommendations that will enable effective and inclusive treatment roll-out around the world. These include commitment from leadership and recognition of local circumstances. The study argues that national strategies on treatment can be effective only with meaningful involvement of PLHIV and vulnerable groups and increased communication among groups of people receiving treatment. Advocacy on the need to increase access to treatment and the issues that need to be resolved in order to achieve universal access are essential elements in communication. Dissemination of adequate and appropriate information to all stakeholders is essential to support an environment of increased communication. The role of the media is vital to provide clear and accurate information, and to hold policy-makers and politicians designing national responses to HIV to account.