HIV/AIDS in an established market economy: the case of Italy

At the beginning of the HIV/AIDS epidemic in Italy, needle sharing among Intravenous Drug Users (IVDUs) was the principal mechanism of transmission of HIV. After an initial burst of the epidemic, the incidence declined sharply but transmission continues to occur mainly via homo and heterosexual intercourse. A significant number of cases were reported in last year amongst the immigrant population. The Italian Government has responded aggressively to the epidemic: a special commission composed of relevant AIDS clinicians, researchers and persons from NGOs, was set up in 1987 to give technical advice to the Ministry of Health. The first recommendations of the commission were enacted into a law (135/1990) which represents the main frame of the fight against AIDS in Italy. Initially, effective treatment not available, care of AIDS patients mainly involved treating Opportunistic Infections. Innovative care systems (Day care and Hospice Treatment Services) were implemented. The availability since 1996 of highly active antiretroviral treatment changed the life expectancy and care needs of the HIV affected patients. Different priorities have since had to be met: compliance to the treatment, emergence of drug resistant virus strains, management of side effects and treatment of co-morbidities such as chronic Hepatitis C are now the main challenges to be tackled by caregivers. The main drawback of the fight against HIV/AIDS in Italy was the lack of an effective Health Education plan targeted to the reduction of HIV transmission through sexual intercourse. This fact, coupled with unrealistic hopes for the effectiveness of antiretroviral treatment, produced a second wave of the epidemic among the hetero- and homosexual populations that, though less severe than that involving IVDUs, is maintaining the HIV epidemic alive in Italy.