HIV/AIDS prevention, treatment and care: Present status, future needs and some possible solutions

At the close of 2006, according to UNAIDS (2007) 33.2 million persons were estimated to be living with HIV, with 2.5 million new infections and 2.1 million deaths being registered that year (see Figure 32.1 for global AIDS death regional data). These numbers point to the profound impact HIV/AIDS is having on the most affected countries. Economies are being decimated, and the number of children orphaned by AIDS continues to rise (see Figure 32.2). Despite billions of dollars invested in international cooperation on HIV/AIDS prevention, treatment and care, viral transmission appears still out of control in too many communities and countries. Deaths continue to mount even as rapid scale-up of life-saving treatments are rolled out in some of the poorest nations on earth, especially in hard-hit Sub-Saharan Africa. In upper-income countries such as the U.S., Canada, Australia and Western Europe, the death rate attributed to HIV has plummeted due to widespread availability of antiretroviral treatments, sparing lives but adding to a rising HIV prevalence and an aging AIDS population with multiple chronic challenges to well-being. The cost of combination antiretroviral treatments have declined precipitously, from over USD 15,000/per patient per year to as low as USD 150/year today in some low and middle income countries. Concerns regarding the optimal allocation of scare resources have been noted in many settings where there are insufficient public resources to cover all patients requiring treatment.