Scale-ups, scarcity, and selections: the experience of doctors in South Africa.
OBJECTIVE
To present the ethical and clinical experience of public sector physicians during the post-Apartheid period in South Africa, who were faced with poverty, medical scarcity and unexpected government resistance in treating individuals with HIV infection.


METHODS
Oral history interviews with 73 physicians from major cities, mine company clinics, and rural hospitals selected because of their long-standing commitment to treating people with AIDS.


CONCLUSIONS
The onset of the government's 'rollout' of antiretroviral therapy (ART) in 2003, providing drugs to public sector patients, has not put an end to the rationing of care that characterised the pre-ART period. Subsequently, rules were established to guide such rationing in an equitable fashion. But there are occasions when doctors override their own rules, demonstrating the complex interplay between principles of equity and the claims of moral duty to patients, especially in instances of life and death.
Bayer
Ronald
R
Center for the History and Ethics of Public Health, Mailman School of Public Health, Columbia University, New York, New York 10032, USA. rb8@columbia.edu
Oppenheimer
Gerald M
GM
D019380:Anti-HIV Agents / Q000600:supply & distribution*; D023241:Antiretroviral Therapy, Highly Active; D001291:Attitude of Health Personnel; D015658:HIV Infections / Q000188:drug therapy*; D015276:Health Care Rationing / Q000941:ethics / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D018579:Patient Selection / Q000941:ethics; D010820:Physicians / Q000523:psychology*; D013019:South Africa
D019380:Anti-HIV Agents