Antiretroviral drugs (ARVs) are the main treatment for people living with HIV or AIDS. They are NOT a cure. They are designed to work by decreasing the viral load (ie the amount of HIV in a person’s body), and support the strengthening the immune system. This helps to prolong the life of the person living with HIV. These drugs must be taken around the same time everyday for the rest of the person’s life on order for them to work properly. The medication is quite strong, so patients are encouraged to eat healthy and balanced meals. In many developing countries this reality is unaffordable and unrealistic.

Taking two or more ARVs at the same time is called combined therapy or Antiretroviral Therapy (ART). This makes treatment more effective in the long term. This method is encouraged because if only one drug was taken by people living with HIV, the virus may become immune or resistant to these drugs.

When a person living with HIV is first put on ARVs, they are given the ‘first line’ of treatment or therapy. If, after a while, the virus becomes resistant to these ARVs, then ‘second’ line treatment is usually recommended. Second line treatment is, however, extremely expensive. This means that the majority of people who may need second line treatment cannot afford to pay for it.

First line treatment is, on average, $300-$400 USD per year – that is €220-€290 – (although in some places costs can go as low as $88 USD per year). Second line treatment is three times that amount. And the new third line treatment is 10-15 times more expensive and therefore, way out of reach of the majority of people living with HIV who may need it.

Despite ARVs being ‘free’ for a large number of people, thanks to a number of different funders and government aid, it is the unforeseen costs that people cannot manage, and therefore either do not get any medication at all, or end up defaulting on their medication and thus potentially making the virus resistant to certain ARVs.

The Case of Zambia

Since 2005, Anti-retroviral drugs (ARVs) have been supplied free from clinics and hospitals across Zambia. However, not everyone who is in need of treatment are receiving it. This is because they face ‘accessibility costs’ which can be very high in terms of distance – many people live long distances from clinics or hospitals and are unable to afford the transport and the potential associated food and accommodation costs whilst there, plus the length of time people have to wait (often for days) because there is no doctor, or because the equipment required is unavailable or broken. ARVs are not always readily available from some clinics, especially those in more rural areas. If a person is bedridden or cannot afford to pay, they regularly end up defaulting on their medication. This is detrimental to the patient’s long term treatment and well being. Some clinics do have a network of support teams to help the clients, but unfortunately, this is only the case for a small number of clinics.