[afro-nets] No ARV roll-out is better than a bad ARV roll-out (3)

[Wendy Holmes <holmes@burnet.edu.au>]

No ARV roll-out is better than a bad ARV roll-out (3)
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When so many people are dying it is understandable that people
get upset and frustrated about the inequality of access to anti-
retroviral drugs. But it is important not to be blindly critical
of the analysis of others with experience who are trying to
alert policy makers to potential dangers.

Peter Barron is not a fool, and is certainly not arguing against
provision of ARVs. In fact he concludes: "We have to have a na-
tional ARV programme, but we have to do it the right way and
with the right level of commitment and capacity." He is on the
same side - so there is no need to fight him. He is not forget-
ting how many are dying - but he's arguing for those who need
treatment for HIV to be able to access effective treatment into
the future; he's arguing to try to prevent more people becoming
infected with HIV as a result of diversion of prevention re-
sources to pay for antiretroviral drugs; and he's arguing that
more people should not die from other preventable and treatable
conditions because resources have been diverted from primary
health care.

When countries have an adequately resourced health care service
it becomes possible to treat people effectively with antiretro-
viral drugs - without it there are dangers for individuals and
the community of rapid spread of availability of antiretroviral
drugs. This is not a simple argument that people in poor set-
tings can't take drugs properly - they are just as motivated as
people with HIV anywhere to take life-saving medication - (and
it is as difficult for them as for people anywhere to sustain
the motivation over many months). But in poor settings people
are more likely to suffer interrupted supplies of medicines,
unless there are strong drug ordering, storage and supply sys-
tems in place. These are needed for malaria medication and for
antibiotics for respiratory infections, as well as for antiret-
roviral drugs. If they get severe side-effects or treatment
fails they need functioning referral networks to be in place.

There are dangers from the urgency of the current push to expand
access to antiretrovirals. These need to be pointed out so that
we can try to avoid them. In pointing them out we are not sug-
gesting that the international public health community should
not be working towards increasing access to antiretrovirals -
but that we need to be careful how we go about it in order to
avoid greater numbers of premature deaths, and more misery.

Advocacy has brought the cost of drugs down - but continued ad-
vocacy is needed to get sufficient resources allocated (by the
US, by multi-nationals, and by national governments) to build
the necessary capacity to enable effective management of people
with HIV into the future. It is dangerous to pretend that people
with HIV can have equitable access to life-saving treatment
without governments allocating considerably more resources to
the health care sector.

Wendy Holmes
Centre for International Health
Macfarlane Burnet Institute for Medical Research and Public
Health
Melbourne, Victoria, Australia
mailto:holmes@burnet.edu.au