Access to HIV/AIDS-related treatment is affected by many factors, including the following.
1. Types of health systems
Drugs and other forms of treatment are generally used within the various health systems of a country. Health systems can be defined as public (meaning that they are provided and funded by the government) or private (meaning that they are provided and funded by commercial means or NGOs). Traditional health systems also often function alongside other systems or, in some cases, provide an important source of care that is easily available and accessible.
Public health systems are a way that governments fulfil their duty to provide for the well-being of their people. Each country has a different method of doing this; one common way is by providing funds from the national budget to spend on health. The public health system may provide care and treatment without charge, or user fees may be charged, with the person paying all or part of the costs. Services are usually supported by national policies to control costs and to ensure safe and effective use of treatments.
Private health systems are not funded by the government and they may or may not participate in government health policies or guidelines on the use of treatments. This depends on the laws about health care in a particular country. Examples include:
• doctors, care providers, hospitals and clinics that charge for their services and drugs;
• licensed pharmacies, wholesalers and general stores that sell drugs and medical supplies;
• insurance schemes that pay for health care in return for a regular payment from the client;
• NGOs/CBOs that may or may not charge for their services;
• informal providers such as market traders and unlicensed treatment providers.
Traditional health systems involve traditional healers and the use of traditional medicines. They are common in many countries and are important because:
• in some places, they may be the main source of health care that is available locally and easily accessible;
• they provide alternatives if medical treatment causes side-effects or other problems; and
• they often provide socially or culturally acceptable ways to deal with illness.
In some countries, traditional healers also have a working relationship with medical practitioners in the public and private health systems. Where this happens, it can be possible to encourage traditional healers to:
• provide care and symptom relief for HIV/AIDS-related illness;
• teach people about harmful practices;
• dispel myths about HIV/AIDS;
• teach people about HIV prevention; and
• refer people to health facilities.
2. Economic and political factors
The economic and political situation of a country also affects access to HIV/AIDS-related treatment. The poorest countries have the heaviest burdens of illness and HIV/AIDS can make existing difficulties even worse. It is much harder for people to resist infections if they do not have adequate physical and financial security, food and education. If there is an overall lack of money - both nationally and individually - there are fewer funds for care and treatment.
Political will, which involves leaders deciding to make HIV/AIDS a priority, can drive action on access to HIV/AIDS-related treatment. This often depends on commitment from the most senior people in power - from presidents to community leaders. Political will can change official priorities for health care and is also important for reducing stigma and discrimination.
3. Stage of the epidemic
The stage of the HIV/AIDS epidemic in a country affects how many people need treatment. In turn, this affects the demands on local health systems.
Early stages of HIV/AIDS epidemic
Later stages of HIV/AIDS epidemic
At this stage, most people living with HIV/AIDS are not yet sick and only a small number need treatment. Therefore, the needs are likely to be:
At this stage, more people living with HIV/AIDS are visibly sick or dying, and more need treatment. Therefore, the needs are likely to be:
• HIV prevention, including diagnosisand treatment of sexually transmittedinfections and tuberculosis
• HIV/AIDS information, diagnosis, counselling and support to help peopleto cope psychologically
• preparation to help people to cope in the future when more people will become sick
• training and sensitization of health- care workers
• sensitization and education of communities
• support and information for peoplewho are living with HIV/AIDS but arenot yet sick
• HIV/AIDS-related treatment and careand support for people with varyingdegrees of illness
• support for people who care for othersin their family or community
• support for adults and children whohave lost family members
• HIV prevention to reduce both the number of new infections and the extent of illness in those with HIV/AIDS
• balancing needs relating to HIV/AIDS with the community's overall health and social needs