Abstract in English:In this day and age, public policies that aim to improve equity cannot limit themselves to seeking greater access for all to the job market; the lack of equity is also reflected in unequal access to health services, to education, and to political representation. In order to understand and attempt to correct this unequal access, an approach is needed that takes into account all the sociodemographic factors that shape inequality in the Region of the Americas, most notably sex, ethnic origin, and race. This paper is the product of a request by the Member States of the Pan American Health Organization for PAHO to make known the influence that race, ethnic origin, and sex have on the state of health and on access to health care services. The paper examines how racial discrimination and other forms of intolerance, the low socioeconomic and educational level of certain ethnic and racial groups, and cultural beliefs exert a decisive influence on individuals' search for health care and their possibilities of enjoying good health. This subject is particularly important this year, when the United Nations is holding its World Conference against Racism, Racial Discrimination, Xenophobia and Related Intolerance.
Abstract in English:This document presents the most recent update of recommendations from the Department of Health and Human Services of the United States of America concerning the antiretroviral treatment of adolescents and adults who are infected with human immunodeficiency virus (HIV). Among the subjects covered in the document are assessment tests for the viral load, the CD4+ T cell count, and resistance to antiretrovirals; when to begin treatment and with which drugs; when to change treatment and the therapeutic options in that situation; aspects of treating adolescents and pregnant women; treatment adherence; and the drugs' principal side effects. Treatment is indicated for all patients with acute HIV infection, in those who have seroconverted in the preceding 6 months, and in symptomatic patients. With asymptomatic patients, the need for treatment depends on several real or potential risks and benefits. Treatment is usually indicated for asymptomatic individuals with CD4+ T cell counts of < 350/mm³ or with plasma HIV RNA > 55 000 copies/mL with the reverse transcriptase polymerase chain reaction test. Once treatment has begun, goals should include a maximum and durable suppression of the viral load, restoring or maintaining immune function, improving the quality of life, and reducing HIV-related morbidity and mortality. Treatment results are assessed mainly in terms of the plasma HIV RNA level, which should be undetectable (< 50 copies/mL) after 4 to 6 months of treatment. Treatment failure after that period of time can be due to poor treatment adherence, drugs being incompletely suppressive, viral resistance, or other poorly known factors. Treatment should be changed if it fails despite good adherence. This change should be based on a complete analysis of the patient's therapeutic history and on the results of resistance tests.