Treatment and vulnerability

Poverty and high levels of inequality may influence adherence to treatment with ARVs as well as access to drugs. Adherence to ARVs is critical in the treatment process. However, this is threatened if those receiving treatment do not have regular access to enough food. Also, the cost of travel to clinics and the ability to take the time to make regular clinic visits may threaten adherence to ARVs. Treatment programmes need to consider broader issues that affect people living with HV and AIDS. Even when treatment is made freely available, competing priorities, such as taking care of other family members, investing in education or immediate food needs may mean that patients may not follow the ARV treatment regime and have incentives to sell drugs. How can programmes and longer term treatment strategies deal with these issues? Both micro and macro determinants of vulnerability need to be considered. A better understanding of structural determinants, as well as the political will, is needed to provide an environment in which sustained and real access is possible.