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Review
. 2005 Jan;95(1):18-22.
doi: 10.2105/AJPH.2004.040121.

Expanding access to antiretroviral therapy in sub-saharan Africa: avoiding the pitfalls and dangers, capitalizing on the opportunities

David McCoy  1 , Mickey Chopra, Rene Loewenson, Jean-Marion Aitken, Thabale Ngulube, Adamson Muula, Sunanda Ray, Tendayi Kureyi, Petrida Ijumba, Mike Rowson
Affiliations
Review

Expanding access to antiretroviral therapy in sub-saharan Africa: avoiding the pitfalls and dangers, capitalizing on the opportunities

David McCoy et al. Am J Public Health. 2005 Jan.

Abstract

We describe a number of pitfalls that may occur with the push to rapidly expand access to antiretroviral therapy in sub-Saharan Africa. These include undesirable opportunity costs, the fragmentation of health systems, worsening health care inequities, and poor and unsustained treatment outcomes. On the other hand, AIDS "treatment activism" provides an opportunity to catalyze comprehensive health systems development and reduce health care inequities.However, these positive benefits will only happen if we explicitly set out to achieve them. We call for a greater commitment toward health activism that tackles the broader political and economic constraints to human and health systems development in Africa, as well as toward the resuscitation of inclusive and equitable public health systems.

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Figures

FIGURE 1—
FIGURE 1—
The virtuous and vicious cycles of rapid ART expansion. Note. ART = antiretroviral therapy; PHC = primary health care.
See this image and copyright information in PMC

References

    1. Treating 3 Million by 2005: Making It Happen. Geneva, Switzerland: World Health Organization; 2003.
    1. Simms C, Rowson M, Peattie S. The Bitterest Pill of All: The Collapse of Africa’s Health Systems. London, England: Save the Children and Medact; 2001.
    1. World Health Report 2004. Geneva, Switzerland: World Health Organization; 2004.
    1. Padarath A, Chamberlain C, McCoy D, Ntuli A, Rowson M, Loewenson R. Health personnel in southern Africa: confronting maldistribution and brain drain. EQUINET Discussion Paper No. 4; 2003. Available at: http://www.equinetafrica.org/bibl/docs/DIS3hres.pdf. Accessed March 6, 2004.
    1. Aitken JM, Kemp J. HIV/AIDS, Equity and health sector personnel in southern Africa. EQUINET discussion paper No. 12; 2003. Available at: http://www.equinetafrica.org/bibl/docs/DISC12aids.pdf. Accessed March 6, 2004.

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