Antiretroviral therapy in resource-poor settings: scaling up inequalities?

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Abstract
Since 1996, the increasingly widespread use of potent antiretroviral therapy (ART), a combination of at least three drugs from different classes, has transformed a fatal infection into a chronic disease that is manageable in most patients.1 –3 However, in resource-poor settings in Africa, Asia, and Latin America, where 90% of people with HIV/AIDS live, access to ART has so far been limited to a minority of patients, owing to the high cost of drugs and the lack of an infrastructure capable of delivering ART on a large scale. In recent years, costs of proprietary drugs have fallen and low-cost generic preparations have increasingly become available. Many African countries have qualified for grants from the ‘Global Fund to fight AIDS, Tuberculosis, and Malaria’. Worldwide, the Fund has approved over 1 billion US dollars for programmes against HIV/AIDS.4 On December 1, 2003 (World AIDS Day) WHO launched the ‘3 by 5’ initiative (3 million patients treated by 2005), whose strategy involves simplified, standardized tools for delivering and monitoring antiretroviral therapy.5 The American ‘President's Emergency Plan for AIDS Relief’ (PEPFAR) intends to give 2 million people access to ART.6 The government of South Africa, one of the countries hardest hit by the AIDS epidemic, has recently set up an ‘Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment’ to make antiretroviral drugs widely available in the public health system.7