This week's issue of The Lancet carries a study from Uganda that shows that, in a well-supported trial at least, home-based carers providing antiretroviral therapy and co-trimoxazole prophylaxis can reduce mortality among those living with HIV by 95%. This may seem obvious, but what is important about this study is that the treatment programme was not dependent on doctors. None of the study participants visited clinics - and it is the requirement for clinic visits that is one of the most important factors in the relative failure of antiretroviral programmes in Africa. Few have the money, the energy or the time to make the long trip to a clinic - and so they simply die. And it is not only the person with HIV who dies. The children of those who die also die - even if they do not have HIV. So, for each HIV positive person who dies as a result of not receiving treatment, at least one child under the age of 10 will die too - and the children who do survive are orphaned. The ramifications are enormous. The most recent estimate shows that there are seven million people world-wide who need antiretroviral treatment - most of them in sub-Saharan Africa. The same estimate shows that around two million actually are receving treatment - that is only 28% of those in need. And this is with scaled up intervention and funding, both international and in-country. This still isn't enough. The remaining five million people who are not receiving antiretroviral treatment will die - and with them another whole generation of children. The survivors will be orphans. Something to think about while you cook your child's supper tonight.
Bridget Farham Editor https://www.bizcommunity.com