AJPH
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (17)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by McCoy, D.
Right arrow Articles by Rowson, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by McCoy, D.
Right arrow Articles by Rowson, M.
Related Collections
Right arrow Global Health
Right arrow Health Policy
Right arrow Access to Care
Right arrow HIV/AIDS
January 2005, Vol 95, No. 1 | American Journal of Public Health 18-22
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2004.040121

GLOBAL HEALTH CONCERNS

Expanding Access to Antiretroviral Therapy in Sub-Saharan Africa: Avoiding the Pitfalls and Dangers, Capitalizing on the Opportunities

David McCoy, DrPH, BMed, Mickey Chopra, MSc, BMed, Rene Loewenson, PhD, Jean-Marion Aitken, MA, Thabale Ngulube, PhD, MBChB, Adamson Muula, MPH, MBBS, Sunanda Ray, MPH, MBBS, Tendayi Kureyi, MPhil, Petrida Ijumba, MPH and Mike Rowson, MSc

Petrida Ijumba is with the Health Systems Trust, Durban, South Africa. Mickey Chopra is with the University of Western Cape School of Public Health, Cape Town, South Africa. Rene Loewenson is with the Training and Research Support Centre, Harare, Zimbabwe. Thabale Ngulube is with the Centre for Health, Science & Social Research, Lusaka, Zambia. Adamson Muula is with the University of Malawi, Lilongwe. Sunanda Ray and Tendayi Kureyi are with the Southern Africa AIDS Network in Harare, Zimbabwe. Mike Rowson is with Medact, London, United Kingdom. At the time of writing, David McCoy was with the Health Systems Trust, Durban South Africa; Sunanda Ray was with the Southern Africa AIDS network, Harare, Zimbabwe, and Jean-Marion Aitken was an independent consultant in Lilongwe, Malawi.

Correspondence: Requests for reprints should be sent to Petrida Ijumba, Health Systems Trust, PO Box 808, Durban 4000, South Africa (e-mail: petrida{at}hst.org.za).

We describe a number of pitfalls that may occur with the push to rapidly expand access to antiretroviral therapy in sub-Saharan Africa. These include undesirable opportunity costs, the fragmentation of health systems, worsening health care inequities, and poor and unsustained treatment outcomes. On the other hand, AIDS "treatment activism" provides an opportunity to catalyze comprehensive health systems development and reduce health care inequities.

However, these positive benefits will only happen if we explicitly set out to achieve them. We call for a greater commitment toward health activism that tackles the broader political and economic constraints to human and health systems development in Africa, as well as toward the resuscitation of inclusive and equitable public health systems.




This article has been cited by other articles:


Home page
 Arch. Dis. Child.Home page
A Riordan and T Bugembe
Update on antiretroviral therapy
Arch. Dis. Child., January 1, 2009; 94(1): 70 - 74.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Public HealthHome page
S. R. Benatar and R. E. G. Upshur
Dual Loyalty of Physicians in the Military and in Civilian Life
Am J Public Health, December 1, 2008; 98(12): 2161 - 2167.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Public HealthHome page
J. Pfeiffer, W. Johnson, M. Fort, A. Shakow, A. Hagopian, S. Gloyd, and K. Gimbel-Sherr
Strengthening Health Systems in Poor Countries: A Code of Conduct for Nongovernmental Organizations
Am J Public Health, December 1, 2008; 98(12): 2134 - 2140.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
A Boulle and N Ford
Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges?
Postgrad. Med. J., May 1, 2008; 84(991): 225 - 227.
[Full Text] [PDF]

Home page
 Sex. Transm. Infect.Home page
A Boulle and N Ford
Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges?
Sex Transm Inf, December 1, 2007; 83(7): 503 - 505.
[Full Text] [PDF]

Home page
 Scand J Public HealthHome page
D. Posel, K. Kahn, and L. Walker
Living with death in a time of AIDS: A rural South African case study
Scand J Public Health, August 1, 2007; 35(69_suppl): 138 - 146.
[Abstract] [PDF]

Home page
 BMJHome page
N. Malangu
Human health resources are key to HIV treatment in Africa
BMJ, July 8, 2006; 333(7558): 98 - 98.
[Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2005 by the American Public Health Association