Scaling Up Treatment — Why We Can't Wait

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Abstract
Many arguments have been raised over the years to justify not moving rapidly forward with antiretroviral treatment programs for people living with the human immunodeficiency virus (HIV) and AIDS in settings with limited resources. The standard litany included the price of therapy as compared with the poverty of the patient, the complexity of the intervention, the lack of infrastructure for laboratory monitoring, and the staggering lack of trained health care providers. Narrow cost-effectiveness arguments have been commonplace. False dichotomies — prevention or treatment, rather than both — have too often gone unchallenged. Perhaps of greatest concern several years ago was the ambivalence — if not the silence — of political leaders and experts in public health. The cumulative effect was to allow the death of tens of millions of poor people in developing countries who are living with and becoming ill as a result of HIV infection. Meanwhile, in countries rich in resources, HIV infection has largely become a manageable, chronic condition because of the availability of combination-drug antiretroviral treatment.