Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

limitations in most of the treatment sites visited. However, many health facilitieslacked essential medicines for OIs and other basic supplies. For example, at thelargest children’s hospital in the country, where hundreds of HIV-positive childrenreceive care, health workers acknowledged that they lacked cotrimoxazole, animportant and inexpensive drug for preventing and treating some OIs.The government has not prioritized public sector treatment access in highprevalence areas with considerable resources and massive development fromtourism. For example, the public hospital in Boca Chica, a tourist resort located halfan hour from Santo Domingo, lacked in-patient care of any kind. The hospital’snew “comprehensive care” outpatient unit for HIV/AIDS lacked supplies of test kitsand was unable to offer free HIV testing, including for pregnant women and TBpatients. ARVs were also unavailable and PLWHA had to travel to Santo Domingo toobtain CD4 tests. Only a few medicines for treating OIs were observed in a nearlyempty storage cabinet.Meanwhile, PLWHA in Puerto Plata, another resort area, are able to access ARVsbut must travel several hours to larger cities for CD4 and viral load tests, makingit difficult to access appropriate care. Those who cannot afford transportation oftenforgo or delay these important monitoring tests. A similar situation limits access todiagnostics and proper care in other areas of the country as well.Effective coordination is not always visible between the public and nongovernmentalsectors. For instance, NGO clinics (many of which are providingART to significantly greater numbers of PLWHA than the public sector) still mustrefer PLWHA who are sick (such as those with TB and other OIs or significanthealth problems) back to the public sector (or to expensive private facilities) forhospitalization and specialized care. Anecdotal reports from several doctors,activists, and patients indicated that specialized care is often impossible to access.Cases were reported of PLWHA being denied essential medical procedures,including surgery, hospitalization, lab tests, and kidney dialysis—often because theywere HIV-positive and unable to pay for potentially lifesaving procedures in theprivate sector.HIV treatment for childrenDOMINICAN REPUBLICIn several areas of the country, the Clinton Foundation has been focusing, oftenwith the support of religious and community-based groups, on providing ARVs forchildren. The Foundation’s initiative is important, because it has offered training,pediatric treatment combinations, and increased access to testing and specializedcare for children with HIV, particularly in areas where the MoH had been slow to act.However, there are already real concerns about the sustainability and the needfor better coordination with some of these programs. In one project implementedat the Maternidad de Los Mina in Santo Domingo, HIV-positive children were able16