I n countries with rapidly growing economies, such as Thailand, Brazil, Malaysia, and South Africa, public spending on health has increased both in relative and absolute terms. It is hardly surprising that in these expanding markets new expensive medical technologies are being promoted as well. While this offers promises for people living with HIV, the mere availability of these technologies poses the challenge of how to optimise their use. As in industrialised countries, the debate on new medical technology is often centred around the potential benefits for individual patients and ignores the societal and family consequences, the feasibility of equitable and widespread application, the conditions under which optimal efficacy may be obtained, and the budgetary constraints under which priorities need to be set.
Antiretroviral therapy is a good example.
In order to realise a sizeable benefit from the use of antiretroviral drugs, these drugs must be started early and used regularly for a long time. Simple as this may sound, it means that potential beneficiaries must be identified at a time when the drugs are still effective, not when the patient is terminally ill, as is often the case. HIV tests must therefore be widely available and properly used, and counselling services and social support mechanisms must be up and running to inform patients of their test results in confidence and to enable them to decide whether to start treatment. The drugs must be available and affordable, and it must be possible to monitor their efficacy and toxicity. Finally, there must be the will to continue long term treatment, which requires qualified and motivated staff and continuous counselling and peer support within or close to the home environment.