How many people should be on antiretroviral therapy for HIV/AIDS?

This paper, from HLSP, asks whether the number of people needing access to antiretroviral therapy (ART) has been grossly underestimated, and explores the implications of scaling up ART programmes. The author estimates that the number of people living with HIV who require ART is approximately 30 per cent according to World Health Organisation standards and 43 per cent according to American Department of Health and Human Services standards. This means that 12 – 17 million people require ART globally. Moreover, the global initiative of extending ART to 3 million people by 2005 is struggling.

The author argues that, as the public sector is currently incapable of delivering these services on the scale needed, cooperation with the private sector is necessary. This is not large institutional providers but the many thousands of individual nurses, doctors, community health workers, drug shops and traditional carers who are already providing most of the care in poorer countries. The challenge is to enable these providers to network in ways that will improve the quality of their services. Suggestions include supplying private providers with drugs, and building treatment plans for tuberculosis, other opportunistic infections and HIV and AIDS into existing reproductive health and primary care services.