Treatment and care

In addition to prevention of HIV transmission, treatment and care for people living with HIV (PLHIV) has to be an integral part of a comprehensive and appropriate response to the epidemic.

Treatment and care for PLHIV, including antiretroviral treatment (ART), delays the progression of the disease, reduces disability, improves quality of life and increases life expectancy; thereby making HIV/AIDS a chronic disease rather than a death sentence. Above and beyond the advantages for individuals, access to ART also has a public health dimension. As part of a prevention plan, it can significantly reduce HIV transmission and affect the epidemic’s development.

At the 2001 meeting of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS), countries made a unanimous commitment to address the question of access to evidence-based treatment for those in need, primarily highly active antiretroviral treatment (HAART). European countries continue to make significant progress in scaling up access to HIV/AIDS treatment and care and ART is now available in 52 of the 53 Member States in the WHO European Region.

There is an increasing trend in the extent of ART coverage among PLHIV in need of care: from 53% in 2004 to 63% in 2008 in 47 reporting countries. There are substantial differences in proportions of people on ART between sub-regions. Observing the five year period from 2004 to 2008, in the west 73%, 80%, 85%, 89% and 88% were receiving ART at the end of each year among those seen for care, while in the east the proportions were 3%, 5%, 8%, 15% and 24%, respectively. In central Europe, a stable proportion of PLHIV on ART among those seen for care is observed: 73%, 71%, 76%, 82% and 75% respectively. The divergence might be explained by timely differences in the epidemic onset within the Region, as well as by other factors, like low access to treatment for IDUs in the eastern part of the Region, etc. Inequity of access to treatment for this particular population group in eastern Europe presents a serious barrier for public health interventions.

As part of the global commitment to provide universal access to HIV/AIDS treatment and care, WHO/Europe assists the Member States in moving towards this goal, by supporting Member States in policy making, planning and implementing effective and evidence-based interventions WHO/Europe promotes a comprehensive approach in treatment and care for PLHIV. This includes not only specific ART, but addressing other health needs of PLHIV including: management of other infections and morbidities (TB, hepatitis B and hepatitis C), management of drug dependence, treatment of opportunistic infections, palliative care, sexual and reproductive health, prevention of HIV mother-to-child transmission, immunization of PLHIV and post-exposure prophylaxis.