WHAT ARE ARVs?
In a healthy person, helper T cells stimulate or activate the immune system to attack infections. HIV particularly targets these helper T cells. It uses the cells to replicate itself, weakening and destroying helper T cells until the immune system is seriously compromised. Antiretroviral drugs [ARVs] disrupt this replication process.
Currently, four main types of ARVs are administered. NUCLEOSIDE ANALOGUES and NON-NUCLEOSIDE ANALOGUES prevent HIV from copying itself onto a person’s DNA. PROTEASE INHIBITORS block a specific protease enzyme in infected cells from reconstructing the virus and producing more HIV. FUSION INHIBITORS aim to prevent HIV from entering cells. By suppressing HIV replication, ARVs can slow the progression from HIV infection to AIDS, dubbed the most severe clinical form of HIV disease
ARV therapy is widely administered in high-income countries. However, the World Health Organization (WHO) estimates that in some developing lands, only 5 percent of those who need ARV therapy have access to the drugs.
United Nations envoys have gone so far as to describe this imbalance as “a serious injustice” and “the grotesque obscenity of the modern world.”
Unequal access to therapy can also exist among citizens of the same country. The Globe and Mail reports that 1 in 3 Canadians who die of AIDS has never been treated with ARVs. Even though the drugs are available free of charge in Canada, certain groups have been overlooked. “Those missing out proper treatment,” says the Globe, “are those in most desperate need: aboriginals, women and the poor.”
The Guardian quoted one African mother who is HIV- positive as saying: “I don’t understand it. Why do these white men who have sex with men get to live and I have to die?” The answer to her question lies in the economics of drug production and distribution.
The average price of a three-drug ARV regimen in the United States and Europe is between $10,000 and $15,000 a year. Even though generic copies of these drug combinations are now being offered in some developing countries at a yearly rate of $300 or less, this is still far beyond the reach of many who have HIV and live where ARVs are needed the most. Dr. Stine sums up the situation this way: “AIDS IS A DISEASE OF POVERTY.”
THE BUSINESS OF MAKING DRUGS
Developing generic versions of patented drugs and selling them at reduced price has not been easy. Strict patent laws in many countries prohibit the unauthorized reproduction of brand-name drugs. “This is an economic war,” says the head of one large pharmaceutical company.
Producing generic drugs and selling them to developing countries for a profit, he says, isn’t fair to people who have discovered those drugs.” Brand-name drug companies also argue that diminishing profits could result in reducing funding for medical research-and-development programs. Others worry that low-cost ARVs destined for developing countries could actually end up on the black market in developed lands.
Proponents of low-cost ARV drugs counter that new drugs can be produced at between 5 and 10 percent of the costs suggested by the pharmaceutical industry. They also say that research and development by private pharmaceutical companies have tended to neglect diseases afflicting poorer countries.
Thus, Daniel Berman, coordinator of the Access to Essential Medicines project, states: “For new drugs, there needs to be an internationally-supported enforceable system that reduces prices to affordable levels in developing countries.”
In response to this global need for ARV therapy, WHO has developed what is described as the three-by-five plan to provide ARVs to three million people living with HIV/AIDS by the end of 2015. “The three-by five targets must not become another unmet UN target,” warned Nathan Ford of Medecins Sans Frontieres. “It is only half the number of people with HIV/AIDS estimated to need treatment today and this number will be much greater [by 2020].”
ASSUMPTIONS ABOUT HIV/AIDS
1. HIV-INFECTED PEOPLE LOOK SICK: On average, it takes about 10 to 12 years for someone infected with HIV to develop AIDS,” says Dr. Gerald J. Stine. During this time, the HIV-infected will show few if any recognizable symptoms, but they are able to infect other people.
2. AIDS IS A HOMOSEXUAL DISEASE. In the early 1980’s, AIDS was initially identified as a homosexual disease. Today, however, heterosexual intercourse is the primary mode of HIV transmission in much of the world.
3. ORAL SEX IS “SAFE SEX.” According to the Centers for Disease Control and Prevention, “numerous studies have demonstrated that oral sex can result in the transmission of HIV and other sexually transmitted diseases.” The risk of HIV transmission through oral sex is not as high as through other sexual practices. Nevertheless, the practice has become so prevalent that some doctors expect it to become a significant route for transmitting HIV.
4. THERE IS A CURE FOR AIDS. Although antiretroviral therapy can, in some patients, slow the progression from HIV to AIDS, there is currently NO VACCINE or CURE
Even if enough ARVs were supplied to developing lands, other obstacles would have to be overcome. Some drugs need to be taken with food and clean water, but hundreds of thousands of people in some land can eat only every other day.
ARVs (often 20 or more pills daily) need to be taken at a certain time each day, but many patients do not own a timepiece. Drug combinations need to be adjusted according to a patient’s condition. But there is a critical shortage of physicians in many lands. Clearly, providing ARV therapy to developing countries will be a difficult hurdle to surmount.
Even patients in developed lands face challenges in using combination therapy. Research reveals that failure to take all prescribed drugs at scheduled times is alarmingly common. This may lead to drug resistance. Such drug-resistant strains of HIV can be transmitted to others.
Dr. Stine points to another challenge faced by HIV patients. “The paradox of HIV treatment,” he says, “is that sometimes the cure feels worse than the disease, especially when treatment begins before symptoms arise.”
HIV patients on ARVs commonly suffer from side effects including DIABETES, FAT REDISTRIBUTION, HIGH CHOLESTEROL, and DECREASED BONE density. Some side effects are life-threatening.
How successful have preventing efforts been in slowing the spread of AIDS and changing high-risk behaviors? Extensive AIDS education campaigns in Uganda during the 2000’s cut HIV prevalence rates in that country from an estimated 14 percent to approximately 5 percent in 2010.
Similarly, Senegal’s efforts to inform its citizens about the risk of HIV infection have helped that country to maintain HIV prevalence rates below 1 percent among the adult population. Such results are encouraging.
On the other hand, AIDS education has not been so successful in other countries. A 2012 survey of 11,000 young Canadians revealed that half the students in their first year of high school believed that AIDS can be cured.
According to a British study conducted the same year , 42 percent of boys between 10 and 11 years of age had never heard of HIV or AIDS. Yet, even youths who are aware of HIV and AIDS and the lack of a cure have grown complacent.
“For many young people,” says one doctor, “HIV has become just one of the many problems in their lives, like if they are going to get a good meal, who they are going to live with, whether they are going to school.”
Not surprisingly, then, WHO states that “focusing on young people is likely to be the most effective approach to confronting the epidemic, particularly in high prevalence countries.” How can youths be helped to act on warnings they have received regarding AIDS? And it is realistic to hope for a cure?
WOMEN AND AIDS
In 1982, when women were diagnosed with AIDS, it was thought that they must have been infected through intravenous drug use. Soon, it was realized that women could become infected through normal sexual intercourse and that they are at special risk of contracting HIV.
Worldwide, women now make up 50 percent of adults living with HIV/AIDS. “The epidemic disproportionately affects women and adolescent girls who are socially, culturally, biologically and economically more vulnerable, and who shoulder the burden of caring for the sick and dying,” reports UNAIDS.
Why is the growth of the disease among women a special concern to AIDS workers? HIV-infected women often face more discrimination than men, especially in some developing lands. If a woman is pregnant, the health of her child is endangered; if she already has children, caring for them becomes a challenge, particularly for a single mother. Further, comparatively little is known about the unique characteristics of HIV-infected women and their clinical care.
Certain cultural factors make the situation especially dangerous for women. In many countries women are not expected to discuss sexuality, and they risk abuse if they refuse sex. The men commonly have many sexual partners and unknowingly transmit HIV to them.
Some African men have sexual relations with younger women to avoid HIV or in the false belief that sex with virgins can cure AIDS. No wonder WHO state: “INTERVENTIONS MUST BE AIMED AT MEN (as well as women) if women are to be protected.”