When I write this editorial, I often scratch my head about whether there’s a theme or issue that unites the different articles we have in each edition of HTU. This spring, what we have may look like a particularly disparate bunch. What unites the complexities of the English NHS reforms (Overhauling health: NHS reform, HIV and patient power), the hectic pace of research into hepatitis C drugs (Full speed ahead to curing hepatitis C), and the concerns about financial security for people who are just trying to have a normal life (Rest assured: life insurance for people with HIV)? 

This variety of topic was also a feature of the 19th Conference on Retroviruses and Opportunistic Infections (CROI) last month, which we cover extensively in News from CROI 2012 and in Eliminating HIV: latest progress, as well as in the hepatitis C article. There wasn’t one big topic or result that dominated the news; further research into prevention, hepatitis C drugs, new HIV drugs and basic research into a cure all jostled for attention.

In fact, it hasn’t been difficult to find a theme, and that theme can be summed up in one word: access. We are at a particularly crucial point in the way the world treats HIV. US funding for HIV is no longer growing, and the Global Fund, in disarray after accusations of mismanagement – partly fed by politicians who never liked it – has had to cancel its 2012 round of grant giving. UNAIDS estimates that the total amount donated towards HIV treatment and care went down last year – for the first time ever, from $7.6 to $6.9 billion. 

One study at CROI showed that in eight African countries, one in six of the general population might now be dead had it not been for treatment and care paid for by the US President’s Emergency Plan for AIDS Relief (PEPFAR) programme: an extraordinary figure, but one imperilled by the global financial situation and the deprioritisation of HIV as a topic.

The same theme can be seen in our features. Will the high cost of the treatments bar access to the new generation of hepatitis C drugs for the people who might best respond to them? Will the NHS reforms be used as an excuse to erode the standard of care patients, particularly those with chronic or complex conditions, can expect? How can we persuade a reluctant insurance industry that we are as entitled to financial security as anyone with any other long-term condition?   

There is more hope among scientists about the possibility of ending HIV than there has ever been, whether by extending treatment and effective prevention methods to as many people as possible, or by finding a cure or vaccine. All this takes money, though. It would be bitterly ironic if, at a point when we could end the epidemic, the means to do so were snatched away.