HIV and AIDS
Antiretroviral therapy in resource-poor settings: scaling up inequalities?
More research is needed to improve implementation of ART programmes in resource-poor settings
Authors:
M. Egger; A. Boulle; M. Schechter; P. Miotti
Publisher:
International Journal of Epidemiology, 2005
This editorial from the International Journal of Epidemiology questions the effect in equity of scaling up antiretroviral therapy (ART) in resource poor settings. In Africa, Asia, and Latin America, where 90 percent of people with HIV/AIDS live, access to ART has so far been limited to a minority of patients, due to the high cost of drugs and lack of infrastructure capable of delivering ART on a large scale. However, the debate in developing countries has moved from the question of whether the introduction of ART is feasible, to questions of how effective ART and care can best be delivered.
An important concern is whether it is possible to reduce AIDS deaths without reinforcing socioeconomic inequalities in health, and the differences in ART provision between genders, urban and rural populations, and between affluent and poor or marginalised populations, or geographical areas? Experiences from Brazil, South Africa, Malawi and Thailand are considered in the context of the ‘inverse equity hypothesis’, which states that health inequities get worse as new public health interventions reach those of higher socioeconomic status first and the poor later.
The authors conclude that despite the lack research or of models for implementing ART programmes in resource poor settings, this should not constrain efforts to scale up ART programmes; research and evaluation efforts are urgently needed and must be synchronised so that treatment programmes can be modified and improved over time.
[adapted from author]
