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

for health workers who are non-judgmental, non-discriminatory, and able to offerspecialized counseling, physical examinations, and treatment for HIV and STDsfor MSM. As a result of real and perceived discrimination, some sexual minorities,particularly transgendered individuals, delay seeking care and treatment.The situation is similar among the large numbers of Haitians living in theDominican Republic, particularly undocumented workers and those who speak littleSpanish. They are among the poorest and most exploited groups in Dominicansociety. With hundreds of thousands of undocumented workers, there are fewreliable statistics or studies indicating the current HIV prevalence rate (or changesover time) among Haitian migrants living and working in the Dominican Republic.PLWHA at the community level reported that while access to treatment amongthis population has improved, services remain limited and many Haitian migrantscontinue to die in their communities from AIDS and other preventable diseases,without ever obtaining ARV medicines and other needed health services.There still has been no genuine recognition of, or proactive intervention to addressthe growing number of HIV-positive IDUs in the Dominican Republic. Hundreds ifnot thousands of IDUs on the street and in prisons remain at risk for contractingand spreading HIV. They not only face difficulties in accessing treatment for HIV,TB, and hepatitis C, but also rarely have access to vital harm reduction services suchas clean needles and substitution therapy. Persistent obstacles to HIV-positive IDUs’access to ART include assumptions by health care workers that drug users cannotand will not adhere to treatment, and laws and policies that place harsh criminalpenalties on drug use and drug users. Such policies drive users underground, therebyfurther restricting their willingness and ability to access appropriate health care.Access to essential diagnostic testsDOMINICAN REPUBLICDue to a recent massive recall of one defective brand of rapid HIV tests, therehas been a shortage of tests at many sites nationwide in August and September2007. Beyond this hopefully temporary crisis, there is insufficient will on the partof authorities to improve inefficient systems to provide better access to HIV tests.Access to free HIV tests, which the government has been promising for years,remains scattered and insufficient.“Counseling” ironically often serves as a barrier to rapid, anonymous, and free HIVtesting throughout the public sector. Due to inefficient laboratory and counselingsystems, pregnant women are routinely asked to wait hours to be tested and thenmust return several days later for the results of the “rapid” tests, which in theory canbe delivered within an hour. Thousands of pregnant women and others never returnfor their test results and are thus lost to follow-up.18