We began publishing HIV & AIDS Treatment in Practice five years ago this week. The original stated aim of the newsletter was to reflect the evolving practice of HIV treatment in resource-limited settings at a time when many physicians were just getting to grips with the possibility of providing antiretroviral therapy.

Within six months the World Health Organization had declared a global health emergency and issued guidelines recommending the use of fixed dose combination ARVs in resource-limited settings. WHO also set an ambitious target of 3 million on treatment by the end of 2005 – 3x5 – that catalysed activity worldwide.

Since then, numbers on treatment have expanded – but the 3x5 target wasn’t reached. By December 2006 only 2.1 million people in developing countries were receiving treatment, even though the leaders of the world’s wealthiest nations had agreed in 2005 that universal access to HIV treatment, prevention and care by 2010 should be the aim of the global community, a commitment reaffirmed by a UN General Assmebly Special Session in June 2006.

Since 2003 HATIP has covered a wide range of subjects, but we keep coming back to a number of areas as practice continues to evolve (follow links to an index of articles on each subject):

• Prevention of mother to child transmission: since 2003 the messages have become increasingly complex, and it’s become clear that the operational implementation of new findings is challenging. There’s still a big need to share best practice in this area.
• Retention in care: Now that people are in care, what do we do to retain them and keep them on treatment — hopefully to live into old age? Bringing treatment as close to where they live as possible, addressing their needs holistically and supporting their care through community-based mechanisms will be crucial. We expect to keep reporting on best practices that keep people living with HIV in care for some time to come.
• Treatment failure: how to define it, how to spot it and what to do about it remains controversial.
• Palliative care: pain relief, symptom management and quality of life remain neglected or poorly supported. Our series of clinical reviews, supported by the Diana, Princess of Wales Memorial Fund, aims to incorporate palliative care into the basic package of care received by people with HIV – and to give community organisations the facts to advocate for it.
• Tuberculosis: integrating HIV and TB care is one of the great challenges faced today. HATIP has covered TB/HIV issues extensively over the past two years, and will continue to do so in collaboration with WHO’s Stop TB Networks and a growing network of experts in HIV and TB care.

HATIP has just under 29,000 subscribers in over 100 countries.

Around 45% of HATIP’s readership is in sub-Saharan Africa, and 61% of the total readership is in resource-limited settings. Although we cannot quantify it, we suspect from analysis of email addresses that a high proportion of the North American, UK and European readers are either directly involved in HIV care in resource-limited settings or working in research and policy roles.

Excluding the UK and the United States, the top 15 countries represented in HATIP’s readership are, in order of subscribers: South Africa (almost 10% of all subscribers), India, Kenya, Nigeria, Uganda, Zambia, Zimbabwe, Tanzania, Ethiopia, Brazil, Malawi, Thailand, Mozambique and Ghana.

The English-language bias of our readership is clear, which is why we are currently seeking funding for a francophone edition of HATIP.

We would also like to recruit more clinical advisers from India – if you are an experienced HIV physician with a large clinic population and able to provide comment and input on articles, we’d love to hear from you!