While access to medicines is extremely important, the needs of people with HIV/AIDS extend far beyond drugs and health care. HIV/AIDS care strategies therefore need to be more encompassing.

Comprehensive care and support rests on several pillars, and need to include voluntary HIV counselling and testing so that people can know their HIV status and deal effectively with it. Comprehensive care must include psychological support to help people cope with the implications of having a life-threatening disease. It requires social support to help HIV-positive people, their families and their communities cope with the economic and social consequences of sickness and death due to AIDS.

The role of communities and community organisations - especially those involving people living with HIV/AIDS - is especially important. Their work promotes social solidarity with HIV-affected individuals and their families, provides them with emotional support, and helps protect them against discrimination and violations of their rights. Often their activism helps prompt governments to devote more resources to the AIDS response and spurs companies to lower drug prices.

Comprehensive care and support depends upon improved health systems to boost access to comprehensive care and support services, including the life-saving drugs people living with the virus need. In Africa, where two-thirds of the world's HIV-positive people live, health care systems were already weak and under-financed before the advent of AIDS. They are now buckling under the added strain of millions of new patients. In many places, facilities for diagnosis are inadequate and drug supplies are erratic, even for HIV-related conditions that are easy to diagnose and inexpensive to treat. Access will remain uneven and compromised until countries are able to afford AIDS-related drugs and diagnostic equipment and equip their health systems with the necessary infrastructure and adequately trained staff.

Many developing countries, however, struggle to allocate sufficient portions of their national budgets to the health sector. In Africa, governments are spending considerably more on servicing foreign debts than they spend on health and education. Increased debt relief and international development assistance can help countries invest more in poverty alleviation and AIDS prevention and care.

In places unable to mobilise sufficient resources (health staff, infrastructure and funding), people living with HIV/AIDS must have access to basic pain relief and treatment for "simpler" opportunistic infections such as pneumonia and tuberculosis.

Care and support for people living with HIV can help to protect the health of the public at large by making prevention more effective. The vast majority of people living with HIV do not know their HIV status. Greater use of voluntary counselling and HIV testing is an important key to encouraging changes in risky behaviour and, in turn, to more effective prevention. The availability of HIV care and treatment, a source of hope, can be a powerful incentive for people to come forward and find out their HIV status.

People who know they are infected and have access to care can break through the denial about HIV that so often impedes prevention efforts. Care providers who look after HIV-positive people demonstrate to others that there is no need to fear being infected through everyday contact and thus help dispel misguided beliefs about HIV transmission.

Providing diagnosis and treatment for tuberculosis and sexually transmitted infections, common among people with HIV, also helps decrease the spread of infections among people who are HIV-negative.

For these reasons, AIDS-related care is increasingly recognised as a good investment that directly benefits people with HIV/AIDS, while also boosting AIDS prevention.

Launched in May 2000, the Accelerating Access Initiative (AAI) represents a redoubling of efforts by the UNAIDS Secretariat and Co-sponsors to assist countries in implementing comprehensive packages of care for people living with HIV/AIDS. The initiative proceeds along two tracks. The first involves dialogue with the pharmaceutical industry to make quality drugs more affordable in developing countries. The second entails technical collaboration with countries as they set about boosting their capacity to deliver care, treatment and support (including the introduction of antiretroviral therapy).

The support is tailored to each country's situation. Upon request, support is provided for the preparation of national action plans on care that form part of wider HIV/AIDS strategies in countries. Information from other countries on the prices of drugs (including generics) and diagnostics is made available to the responsible national authorities that are engaged in negotiations with companies supplying drugs and equipment.

So far, 36 countries in Africa, Europe, Asia, the Caribbean, and Latin America have decided to take advantage of the initiative. Ten of these countries (all in Africa) have reached agreements with manufacturers on significantly reduced drug prices.

The prices of a number of important drugs for people living with HIV/AIDS, including a number of antiretrovirals, have decreased dramatically in recent months. Price reductions have been achieved through a combination of efforts. They have included advocacy (to draw attention to the enormous impact of the epidemic and the treatment gap in developing countries), pressure from activists and civil society and competition from generic drug manufacturers. Also important have been differential (discounted) prices from pharmaceutical companies for use exclusively in developing countries, as well as ventures like the Accelerating Access Initiative. Some companies have also offered donations of drugs, for example, an antiretroviral to prevent mother-to-child transmission and an antifungal to treat certain opportunistic infections.

Price has been an obstacle to expanding access to treatment. But other important conditions for expanding access to drugs include mobilising sustainable financing for bringing medicines and equipment to developing countries, and strengthening health facilities and personnel so that the drugs can be prescribed and used safely. Proper prescription and monitoring of compliance with drug regimes is essential for the benefit of patients and for avoiding the serious potential of drug resistance.

Even with greatly reduced drug prices, however, drugs of importance to people living with HIV remain out of reach of the vast majority of people who need them. For example, current prices being offered in developing countries to treat one patient for a year are still much higher than the annual per capita GDP of many of the hardest hit countries.

In addition to advocating the pricing of HIV medicines in line with the purchasing power of countries, other avenues are being pursued. They include reducing or eliminating import duties and taxes; encouraging patent-holder companies to grant voluntary licenses that allow other manufacturers to produce their products at lower cost; the use of safeguards in international trade agreements that can help governments expand access to medicines and protect public health; and promoting South-South and North-South cooperation. New funding mechanisms are also being devised to channel more private and public sector resources towards care and support programmes.

In this section:

• Comprehensive care
• Care and treatment boosts prevention
• Accelerating access
• Drug prices

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