World Bank Satellite Meeting Discusses Models of National HIV/AIDS Treatment Programs in India, Thailand, South Africa
This is a "fortunate time" in the history of the HIV/AIDS epidemic because antiretroviral drug therapy is more widely available and as the cost of treatment has dropped, Emmanuel Jimenez, World Bank director for human development in East Asia and the Pacific, said on Sunday at a satellite meeting on the sidelines of the XV International AIDS Conference in Bangkok, Thailand. Jimenez, who chaired the meeting, said that the world is discussing how to deliver antiretroviral therapy, and he introduced three presenters who discussed treatment case studies from India, Thailand and South Africa.
Mead Over, a senior economist in the World Bank's Development Research Group, presented several models of HIV treatment in India, where the government recently has implemented a nationwide antiretroviral treatment program. Over said that treatment can affect HIV prevention by slowing HIV transmission by reducing viral load; motivating people to get tested for the virus; and promote solidarity. However, he added that the provision of treatment also could speed HIV transmission by lengthening the duration of the disease; creating drug-resistant HIV strains; and reducing the perceived threat of high-risk behavior. Although treatment can be cost-effective, Over said that prevention is a "key parameter" of successful treatment programs, particularly condom use. Over warned that if treatment availability caused complacency, the cost-benefit of the program would be lost. He also urged the Indian government to proceed with caution in rolling out its program to avoid the development of resistant HIV strains and complacency and enhance the synergy of treatment and prevention programs.
World Bank Lead Economist Ana Revenga and Wiwat Peerapatanapokin of the East-West Center in Bangkok presented preliminary data on a joint study of the Thailand Ministry of Public Health and the World Bank examining the country's antiretroviral treatment program. The study aims to assess the impact of treatment on the epidemic; help design policies to make the program more effective by increasing testing and adherence; and highlight the needs of the program in order to scale it up. Thailand's treatment program, known as National Access to Antiretrovirals for People With HIV and AIDS, consists of programs included entirely within the public health system; public system programs augmented by non-governmental or AIDS advocacy groups; and hospitals and doctors within the private health care system.
South Africa's national antiretroviral treatment program, which the government decided to implement in August 2003 under pressure, aims to ensure that HIV-negative people remain uninfected; slow the progression of HIV disease in HIV-positive people; and effectively manage HIV-positive people who already have developed AIDS, according to Siyabonga Jikwana of the South African Department of Health. Jikwana presented year-old data that was presented to the South African Cabinet before they made their decision to begin the program. The session also included a panel discussion of treatment access, with questions from the audience (Alyson Browett, Kaiser Daily HIV/AIDS Report, 7/11).
A webcast of the complete session is available online from kaisernetwork.org.