As in many other countries around the world, HIV infection has been epidemic in Taiwan since the mid-1980s. In 1989, a national infection control system was put in place and, in April 1997, the government of Taiwan has adopted a policy to provide highly active antiretroviral therapy (HAART) to all citizens infected with HIV through the public health insurance system.

As you know, the use of HAART in people infected with HIV leads to suppression of the infection, increases life expectancy and reduces the frequency of transmission of HIV from mother to child and in heterosexual couples. Fang C.T. et al. (Taiwan) An observational study was conducted with elements of mathematical modeling and statistical analysis to determine whether the widespread use of HAART could lead to a reduction in HIV infection at the population level. Based on data from the health system, an exponential model for the development of the HIV epidemic was created before (January 1990 - April 1997) and after (May 1997 - December 2002) the implementation of the free access to HAART.

The expected average HIV prevalence was found to be 0.391 new cases per year for each case existing before the introduction of free antiretroviral therapy, compared to 0.184 thereafter. Thus, the model showed that the estimated prevalence of HIV infection decreased by 53% (95% confidence interval 31-65%) with the introduction of the new policy.

To exclude foreign influences on the data obtained, the importance of other factors, including changes in sexual behavior, was assessed. The absence of marked changes in the incidence of syphilis (a marker for this factor) led us to conclude that the role of changes in sexual behavior in reducing the frequency of HIV infection is unlikely.

Thus, the introduction of a HAART open access policy effectively reduces the spread of HIV infection in countries where the incidence of HIV is relatively low. However, it should be noted that in countries with high morbidity, this policy may be unacceptable due to the high cost of therapy, as well as the lack of a pronounced and rapid effect, due to the long lifespan of people already infected. The researchers also point out that the introduction of such a program is not enough to eliminate the HIV epidemic, it should be accompanied by other measures, such as educating the public about safe sex and the use of preventive measures.