Elements of HIV Care in Resource- Poor Settings: Policy Challenges

More than 40 million people are now living with HIV infection around the world, and another 20 million have already died from the disease.1 First recognized in developed countries in the early 1980s, HIV is now an unprecedented global pandemic. The burden of disease is felt most severely in sub-Saharan Africa and other economically disadvantaged countries, where more than 7,000 people die each day from HIV and AIDS. The sheer scale of statistics such as these does, in fact, tell much of the story. The case fatality rate (the percentage of people who die if left untreated) for HIV approaches 95%. Most past and recent pandemics like influenza, or SARS, have had much lower case fatality rates: 5% for annual influenza, 15% for SARS. (Only bubonic plague, with a 90% case fatality rate, compares to HIV.) However, unlike these other infectious diseases, disability and death from HIV occur during the chronic phase of the illness – some 8 to 10 years after the infection is contracted. Moreover, unlike influenza and SARS, HIV typically affects otherwise healthy, economically productive adults. These facts, combined with the relative success in controlling the spread of HIV in the US since the mid1990s, means that the devastation of HIV