Drugs that directly combat HIV - antiretrovirals (ARVs) - have not been available or accessible in most resource-poor communities because of cost and technical difficulties in using them. However, prices of ARVs are coming down and easier ways are being found to use them. Everyone involved in ARV treatment needs to be well informed about the drugs, the services that are needed to support their use, and the risks and benefits of using them. Some NGOs/CBOs/PLWHA groups are already involved in providing ARVs to relatively small numbers of people. Some donors and governments are looking for ways to provide ARVs to larger numbers of people, especially in countries with high HIV/AIDS prevalence.

What are ARVs? There are three types of ARV drugs and each type of drug attacks the virus in a different way. These different types of drugs used in combination work to reduce the amount of virus (viral load) in a person's body. This combination of drugs is referred to as HAART - highly active antiretroviral therapy. Successful HAART helps a person to stay healthy and live longer. However, the drugs must be taken exactly as prescribed and for the rest of a person's life. Many ARVs cause side-effects and some strains of HIV are resistant to some of the drugs, so treatments must be carefully chosen and monitored with regular laboratory tests to ensure that they are effective and safe.

ARVs do not cure HIV/AIDS; they only reduce its effects and prolong life.

In the special case of preventing mother-to-child HIV/AIDS transmission (MTCT), just one type of drug may be used briefly, to protect a child around the time of birth from becoming infected by its HIV-positive mother. This does not change the mother's HIV status. HIV infection can also occur through breastfeeding or, if the mother is receiving HAART, the ARVs may pass on in the mother's milk with possible benefits to the child but also with the risk of side-effects. Treating mothers and babies is therefore especially challenging.

ARVs - antiretrovirals included in the WHO Model list of essential medicines

ARV treatment should always take place within the continuum of care across the following:

The following support the safe and effective use of ARVs:

• good treatment information that is easy to understand - how it is used, the risks and benefits, maintaining and looking after drug supplies and, especially, understanding that not treating HIV/AIDS is a better option than partial treatment that leads to development of resistant viruses and shortening of life;

• strong social support to help people to adhere to the treatment regime, to maintain access to prescribed drugs and to cope with side-effects;

• prevention and reduction of stigma or discrimination so that people are not discouraged from using or helping with ARV treatment;

• integrated health systems that include treatment for TB, for opportunistic and sexually transmitted infections and for other health problems (viral load is increased by the presence of other infections);

• trained counsellors and access to facilities for voluntary counselling and testing - the first important step in making a decision about ARV treatment;

• prescribers and health workers trained in clinical management of HIV/AIDS;

• laboratory services to provide checks on the level of HIV infection, through CD4 or similar tests (viral load tests are very expensive); testing for drug side-effects (such as liver damage) is also important;

• supply services that can maintain adequate and uninterrupted supplies of ARVs and other HIV/AIDS-related drugs, HIV test kits and laboratory materials, which means adequate funding to maintain all the above so that treatments are not interrupted;

• support when ARV treatment cannot be used, and encouragement to follow the various other means of maintaining health and living with HIV/AIDS.