Prisca, 36, was diagnosed with HIV three years ago, but as an unemployed mother of two, she is more concerned about feeding her children than getting HIV treatment.

In fact, Prisca, who lives in the Ivory Coast, has only been to the clinic to get her CD4 count tested once, even though this test is important for people living with HIV, as it measures the level of infection-fighting white blood cells in a patient’s blood.

“I have to be very careful with my resources,” Prisca says. “I do petty jobs for my daily income. And I cannot afford such exams. I rely on providence.”

In contrast, Marietta, 27, also from the Ivory Coast and living with HIV, does not worry about paying for the CD4 test, is very observant and has her count checked on a regular basis. As a manager in a business company she can afford such exams. She says: “I travel abroad for my monitoring tests and I get my drugs from there.”

Addressing the dramatic inequalities between those who can afford access to health care and those who can’t is one of the biggest challenges of this century. HIV infection represents a very clear example of these inequalities: AIDS is a disease that the rich can treat and the poor cannot.

Disconnect in access to treatment

Though HIV treatment tends to be provided free of charge, the vast majority of people living with HIV in developing countries cannot afford treatment for related opportunistic infections, such as tuberculosis. Adam, who is HIV positive and lives in Abidjan, says: “We have to pay a lot of money to be treated for opportunistic infections. These drugs are not free. Moreover routine tests are also not free. And people living with HIV with minimum or low resources cannot afford them.”

When someone is diagnosed as HIV positive, they need to take routine tests to assess the evolution of the virus in their body. Unfortunately accessing such tests is still challenging for many.

A medical doctor from Treichville Teaching Hospital in Abidjan, who did not want to be identified, said: “Routine tests such as viral load tests are necessary in the monitoring of HIV patients. These tests help determine when a patient has to switch from one treatment to another. Unfortunately less than 10 per cent of people living with HIV in limited resource settings have access to these tests because they are expensive and only available in laboratories in capital cities.

“Rich patients just go to private clinics or travel abroad to have these exams while those who are not that rich rely on providence. Another exam necessary for HIV patients is testing for drug resistance which tells a patient if he needs to make a switch. Unfortunately we do not have this test in our country.”

The state of public health infrastructure is just one more issue that people living with HIV in places with poor resources often have to face. Mariama, who lives in Guinea, says: “Here there is only one public facility where we can do our CD4 test. And sometimes the machine goes down. When we face such a situation, we just have to go back home and wait for the machine to be repaired. If you have money you can go to a private facility to have your test done.”

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