Ethical and programmatic challenges in antiretroviral scaling-up in Malawi: challenges in meeting the World Health Organization's "Treating 3 million by 2005" initiative goals.
The Fifty-seventh World Health Assembly's (WHA's) resolution on the "scaling up of treatment and care within a coordinated and comprehensive response to HIV/AIDS' is welcomed globally, and even more so in Sub-Saharan Africa, where the majority of the people currently in need of antiretroviral therapy do not have access to it. The WHA identified, among others, the following areas which should be pursued by member states and the World Health Organization (WHO): trained human resources, equity in access to treatment, development of health systems, and the integration of nutrition into the comprehensive response to HIV/AIDS. The WHO Director-General was requested to "provide a progress report on the implementation of this resolution to the Fifty-eighth World Health Assembly.' Much of what happens between now and that time depends on the actions of the WHO and the member states and also on the contribution of the international community to the fight against HIV/AIDS. Much of what is to be done will be based on what is available now in terms of practice, human resources, and programs. This paper explores the WHA's resolution, especially regarding the scaling up of antiretroviral therapy, taking Malawi as the case study, to identify the challenges that a Southern African country may be facing which will eventually influence whether the initiative to "Treat 3 Million by 2005' ("3 by 5') will be achieved or not. The challenges southern countries may be facing are presented in this paper not in order to undermine the initiative but to create an awareness of these factors and initiate the appropriate action which would surmount the challenges and achieve the goals set.
Department of Community Health, University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi. amuula@medcol.mw
Adamson S
AS
Muula
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D044966:Anti-Retroviral Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D003906:Developing Countries; D004608:Eligibility Determination; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006297:Health Services Accessibility / Q000941:ethics; D006280:Health Workforce; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D016730:Program Development; D014944:World Health Organization
D044966:Anti-Retroviral Agents