Barriers to better care for people with AIDS in developing countries

This British Medical Journal article examines the challenges faced in the World Health Organization’s (WHO) “3 by 5” initiative, which aims to deliver anti-retrovirals (ARVs) to 3 million people by 2005. It highlights that the focus on delivering ARVs distracts resources and attention from a broader model of health care. They argue that the initiative must develop a chronic disease model of care through a strengthened public health infrastructure. The authors also point out the exclusionary power of stigma and outline the need for training programmes for health care workers on medical ethics and human rights.

Other key issues identified include the need for cooperation with existing essential programmes to manage scarce health care staff and that access to treatment needs to be based on rights rather than the ability to pay. The authors conclude that a constructive dialogue between stakeholders with different agendas, including health care workers, public health managers, community and faith based organisations and people living with HIV/AIDS, is essential for the initiative to succeed. Moreover, social context needs to be considered when setting up programmes and working relationships in order to build on, and not undermine, the existing social order. [adapted from author]