- © 2007 Canadian Medical Association or its licensors
Unfortunately, William Cameron is correct to claim that the next milestone to be attained in HIV management is unlikely to be the delivery of medical care to the poorest people.1 I recently saw 2 patients in Ottawa who had been exposed to HIV outside an occupational setting. Both patients sought medical care in a timely manner and were eligible for postexposure prophylaxis for HIV infection. When they learned that the cost of the 4-week regimen was Can$50 to Can$100 per day, both patients declined the therapy.
With appropriate treatment, HIV infection can now be considered to be a chronic disease. The cost of hundreds of courses of postexposure prophylaxis to prevent 1 seroconversion is not trivial, but neither is the cost of decades of care for people infected with HIV because of a lack of access to prophylactic medicines.
Even in countries that are far from the poorest in the world or the hardest hit by HIV, access to essential medicines is hardly universal. Certainly, the injustices concerning access to HIV medicines in Canada pale in comparison to those in Africa. However, my 2 Canadian patients felt the same despair as patients in Africa do. This despair comes with the realization that their wallets are too thin to give their families the best chance to live free of HIV infection. Eliminating the financial barrier to medicines, thereby reducing the burden of disease, is paramount and is a milestone that is well within our reach.
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