Expanding antiretroviral therapy provison in resource-constrained settings: social processes and their policy challenges
Political pressure to provide antiretroviral therapy (ART) in poor countries, alongside falling drug prices, led to a dramatic increase in ART delivery from 2002. Research to inform and evaluate ART expansion in resource-constrained settings has, perhaps inevitably, focused on the impact of different drug combinations and clinical outcomes, related public health questions, and on the effectiveness and costs of different models of delivery. In contrast, this special edition considers several broad areas of enquiry, including: the way in which ART affects the social construction of the disease, people’s identities and stigma; the way in which people are adjusting to a new chance of life, to living with HIV as a chronic condition and the challenges faced in rebuilding their social and economic lives as they return to the harsh realities of poverty; and finally, the way in which ART delivery affects the working and personal lives of health workers and the implications for health systems. This editorial summarizes the themes of the papers including ART and changing identities, ART and living with HIV as well as ART and its effects for health services. Finally, the challenges to long-term success of ART expansion including the further expansion of treatment coverage, the time-limited nature of current funding for ART expansion in Africa, concerns about the feasibility of continued ART roll-out are raised by health systems weaknesses in many countries and finally the question of donor dependency is discussed.