The evaluation of the HIV/AIDS Drug Access Initiatives in Côte DʼIvoire, Senegal and Uganda

Abstract

Effective antiretroviral treatment of AIDS in resource-limited settings particularly sub-Saharan Africa has become a bellwether issue for patients physicians and policy-makers. The immense tragedy and enormous challenge of global AIDS raises fundamental questions in ethics and human rights accompanied by key logistic and technical issues in medicine immunology virology public health macroeconomics and social development. The successes of science and public health interventions in wealthy nations must be translated into a sustainable response for the 90% of people with HIV and AIDS in resource- limited settings. In the first two decades of the HIV epidemic the parallel efforts of activists scientists and clinicians resulted in a largely successful paradigm that included prevention of HIV infection and treatment of AIDS. In resource-rich countries these two key modalities reduced the growth of the epidemic and mortality morbidity and health care costs the latter most dramatically in the late 1990s with widespread (although not universal) access to highly active antiretroviral therapy (HAART). By contrast for the vast majority of HIV-infected people that live in sub-Saharan Africa surveillance education and information and (potential) vaccines strategies were thought to be the only possible modalities to combat the epidemic. Although the efficacy of antiretroviral therapy was evident from results presented at the 11th World Aids Conference in 1996 in Vancouver access to antiretroviral treatment (ART) was not considered feasible in developing countries by most experts in the field. (excerpt)