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Targets and results - High-income countries
United Kingdom
United States of America
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Access to ARVs in high-income countries has been less of an issue
than in other parts of the world, as funds have been available to
purchase and distribute the drugs. These countries are not included
in 3 by 5 statistics.
The epidemic has been established in many
high-income countries since the 1980s, including the USA and Western
Europe. These countries had already established medical and care
facilities so that people living with HIV could immediately access
care and treatment. Providing ARVs has not been without its
problems, though. The price of the drugs is very high; at US$20,000
per person per year, the cost of the new fusion inhibitor T20 are by
far the highest for any ARV ever produced, and it was announced in
January 2004 that the price of Ritonavir was to be increased by 500%
in the USA.
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It is estimated that 49,500 people are living with
HIV in the UK, one third of whom are undiagnosed. The year 2003 saw
the highest ever annual number of diagnoses. The introduction of
combination therapy in 1996 led to a big decrease in the number of
AIDS-related deaths. It also meant higher costs for treatment and
care, as everyone who is HIV+ and legally entitled to reside in the
UK is entitled to free healthcare. The combination of more people
living longer and needing treatment and increasing numbers of new
infections meant that costs were ever increasing to cover the costs
of ARVs. In 2000, it was estimated that the average lifetime
treatment cost for someone living with HIV would be between £135,000
and £181,000.18 This figure is for all treatment, including hospital
costs, not just the price of the drugs.
According to the National Association of NHS
Providers of AIDS Care and Treatment (PACT), the cost of managing a
patient with HIV is £15,000 per year. The total cost of treatment
and care in 2002-03 was £345 million.19 According to SOPHID data,
there were 23,031 people accessing anti-retroviral therapy in
England, Wales and Northern Ireland in 2003.
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The first AIDS drugs were developed in 1987, four
years after HIV was first identified. Since the mid-1990s, when
combination therapy was introduced, US AIDS deaths have dropped
about 70%. In 2003, the number of people living with AIDS in the USA
was 384,906.
Most people in the US access their care and
treatment through privately bought health insurance, as there is no
country-wide state provision of healthcare. However, not all people
can afford insurance. Instead they use Medicaid or Medicare,
programs that pay for medical assistance for certain individuals and
families with low incomes and resources. These programs provide
medical long-term care assistance to people who meet certain
eligibility criteria.
Since 1987, AIDS Drug Assistance Programs (ADAPs),
which are federally and state-funded and state-run, have made
treatments available primarily to low-income HIV patients who do not
qualify for Medicaid. Currently, ADAPs buy around 20 percent of the
HIV drugs prescribed in the United States, enough for 92,000
people.21 So far, 11 states have been forced to close ADAP enrolment
for new patients. Others have tightened income-eligibility criteria.
In April 2004, 1,263 people nationwide were waiting to access any
kind of treatment through ADAPs.22 There are, even in America,
people who die for want of AIDS drugs.
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