The Current State of the Epidemic:
Why We Need to Step Up Our Efforts

2. Too many people with HIV are not receiving, or are resistant to, treatment; and too many are dying

with the advent of highly active antiretroviral therapy (HAART), people with HIV are living much longer than they did in the 1980s and early 1990s, when the time between diagnosis and death was measured in months. But living for many years with a fatal infectious disease takes an immense toll on people's health, quality of life, finances, independence and self-esteem.

Despite the progress that has been made in treating HIV, many people -- particularly those living in small, rural and remote communities, but also many living in large urban centres -- continue to have problems accessing care and treatment. This problem is exacerbated by the national shortage of physicians and other health care providers and the increasingly complex care needs of people with HIV.

Although antiretroviral therapies for HIV are effective for many people, they are not benign. In fact, these therapies are associated with a range of serious side effects, such as cancer, heart disease, peripheral neuropathy, lipodystrophy and neurocognitive impairments. The longer people are on HAART, the more likely they are to develop heart, kidney and liver diseases. 3

A significant proportion of people with HIV also have other illnesses that threaten their health and complicate care. For example, as of December 1999, about 11,194 people living with HIV in Canada -- or more than 20% of the total -- were co-infected with hepatitis C,4 and that number has since increased to close to 14,000. According to the Canadian AIDS Treatment Information Exchange (CATIE), the most frequently asked HAART-related questions are about liver failure and how to preserve liver function with HIV/hepatitis C co-infection; about the metabolic changes caused by HAART, particularly to cholesterol, lipid and blood sugar levels; and about lipodystrophy.5

Many people living with HIV are also coping with complex issues, such as addiction or mental illness. Between 40% and 60% of people with HIV suffer from depression, which can lead to a weakening of the immune system, faster disease progression, lack of adherence to treatment regimens (which, in turn, can lead to treatment failure and the development of drug-resistant HIV), greater risk of suicide and less ability to maintain safer sex and drug use practices.6, 7, 8

Because of their complex health needs, people living with HIV often face high prescription drug costs as well as costs associated with complementary therapies (e.g., vitamins, massage) that are not covered by government or private health plans. The financial impact of HIV is often exacerbated by the lack of flexible employment opportunities or disability plans that can accommodate the needs of people who will go through periods of ill health when they cannot work. As a result, a growing number of people with HIV in Canada are trapped in poverty and do not have adequate housing.9

Many people living with HIV/AIDS also struggle to manage sexual relationships in the context of a life-threatening STI. People with HIV/AIDS have the right to enjoy a healthy active sex life, yet little has been done to help PHA share a healthy, affirming sexuality, which would also contribute toward lifelong prevention strategies to protect both their partners and themselves (i.e., from re-infection) and help define broader HIV responses.

Footnotes

3
Palella Jr FJ, Baker R, Moorman AC, Chmeil J, Wood K, Holmberg SD, and the HOPS Investigators. Mortality and Morbidity in the HAART Era: Changing Causes of Death and Disease in the HIV Outpatient Study. Northwestern Univ., Chicago, IL, USA; Cerner Corp., Herndon, VA, USA; and CDC, Atlanta, GA, USA.

4
Remis R. Final Report: Estimating the Number of Persons Co-infected with Hepatitis C Virus and Human Immunodeficiency Virus in Canada. Department of Public Health Sciences, University of Toronto. (March 31, 2001).

5
Electronic communication from CATIE (June 2004).

6
Ciesla JA. "Meta-analysis of the relationship between HIV infection and risk for depressive disorders," Amer J Psychiatry, 158, 725-30 (2001).

7
Cohen M et al., "Prevalence of distress in persons with HIV," Psychosomatics, 43, 10-5 (2002).

8
Ickovics JR et al., "Mortality, CD4 cell count decline and depressive symptoms among HIV-seropositive women," JAMA, 285, 1466-74 (2001).

9
AIDS Bureau. AIDS in Ontario 2002. Ontario Ministry of Health and Long-Term Care.

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