Abstract
We applaud the emphasis on free care drugs at the point of service delivery and patient and community participation in Charles Gilks and colleagues article on public health approaches to the scale-up of antiretroviral treatment. The HIV epidemic exploits and exacerbates gender inequities and the move to universal access makes these all the more pertinent. The tried and tested DOTS approach to tuberculosis care and treatment shows that even where drugs are provided free at the point of delivery there are still patients from care: an estimated 52% in Malawi. These missing patients are likely to be from the vulnerable sectors of society and the barriers they face in accessing and adhering to antiretroviral treatment will be even greater than those for antituberculosis drugs because stigma is greater and adherence is for life. Voices from women and men in resource-poor contexts highlight the importance of community-based care strategies to address stigma and creative approaches to the involvement of men in programme design and promotion of womens access to antiretroviral treatment. (excerpt)
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