Looking back at HIV

by Dr Dahlia McDaniel

I've met many persons living with HIV as pharmacy clients. The early days were sad. The truth is that if treatment was as available and financially accessible then as it is today, most of my clients would still be alive.

The wonder drug azidothymidine (AZT) of 1987, which we thought was the magic bullet, turned out to be only minimally effective on its own against the virus. In 1987, it was discovered that latex condoms were effective in preventing the transmission of the virus, a major advancement. By 1991, similar drugs to AZT, like didanosine, were discovered and released. Three more drugs were released by 1995. They were all from the same class of drugs nucleoside reverse transcriptase inhibitors, or "nukes".

Then 1996 brought other treatments called protease inhibitors, which proved very different from previous anti-retrovirals, and much more effective; but they were pricy. Most of the clients I met in the first eight years could not afford the $40,000 per month it cost then to buy the medications for HIV. They passed away fairly soon after diagnosis. Three of my clients lost their jobs because their HIV-positive status was discovered. They could not continue to buy the drugs either and died within a year. Others tried to buy the medicines for a few years but couldn't maintain this expensive demand. They, too, passed away.

We've come a long way

The Ministry of Health Jamaica, in collaboration with the World Bank, The Clinton Foundation and others, significantly improved the financial accessibility of HIV drugs (antiretrovirals) to the Jamaican population. The average cost of the monthly supply of antiretrovirals is around $1,200 today.

So, these days are not as sad as they used to be. I have attended weddings of my clients, and a number of the babies born to my HIV-positive clients are now in high school. Some clients who were in high school when we met are now graduates of local and international universities. Many of my clients are productive and healthy, making their contribution to society.

The beginning of the end

Looking back at those years, 1996 was phenomenal in terms of advancement in understanding of the virus and the development of treatment against it. With protease inhibitors' entry into the armamentarium, experts felt like the end of HIV/AIDS had come. But now we know it was only the beginning of the end of HIV/AIDS.

Along those lines, World AIDS Day 2011-2015 is about 'Getting to Zero', in terms of new HIV infections, discrimination and AIDS-related deaths.

There are now at least 25 different effective drugs used to treat HIV, some years producing more than two new ones. Most of my clients take either three or four of these drugs daily. The anti-retrovirals prevent the virus from growing and reproducing itself in the body. The drugs are classified into seven different groups. Based on the stage in the life-cycle of the virus, the drug works to kill.

Dr Dahlia McDaniel is a pharmacist with a doctorate in public health. She is the chief executive officer of two pharmacies and a medical practice in Kingston; email:yourhealth@gleanerjm.com.