Specific challenges include:

1. Encouraging people to come forward for testing and counseling and, if appropriate, treatment
    
   Even where treatment is free or affordable, patients may not be accessing ART due to barriers such as stigma or travel costs.
    
   
2. Encouraging HIV-positive pregnant women to accept and complete the full course of preventive therapy, including treatment of the newborn, to prevent HIV transmission
    
   Even when pregnant women know they are HIV positive, they may not give birth in a setting where preventive therapy is available. In addition, newborns may not receive or complete preventive therapy because of cultural barriers, stigma, or other constraints
    
   
3. Encouraging patients on ART to consistently adhere to the treatment regimen
    
   Lack of adherence to prescribed ART has been demonstrated to be associated with complex treatment regimens that require multiple doses and that are subject to stigmatization (e.g., when drugs have to be collected or administered in a public setting), drug side effects, and simple forgetfulness.
    
   Recent studies suggest that at a minimum, ART adherence levels of 95% may be necessary to achieve and sustain suppression of viral load.
    
   Studies in regions of the world where ART has been available for longer periods of time (e.g., United States, Europe) have also shown that significantly large percentages (one-tenth to one-half) of individuals infected with HIV harbor a strain that is resistant to at least one antiretroviral drug. It is therefore essential that, where patients are accessing ART, mechanisms are put in place to promote patient adherence to complex multidrug regimens both for the patients' own welfare and for the sake of slowing the emergence of ART-resistant strains.