title: Access to antiretroviral treatment, issues of well-being and public health governance in Chad: what justifies the limited success of the universal access policy?
abstract: Universal access to antiretroviral treatment (ART) in Chad was officially declared in December 2006. This presidential initiative was and is still funded 100% by the country's budget and external donors' financial support. Many factors have triggered the spread of AIDS. Some of these factors include the existence of norms and beliefs that create or increase exposure, the low-level education that precludes access to health information, social unrest, and population migration to areas of high economic opportunities and gender-based discrimination. Social forces that influence the distribution of dimensions of well-being and shape risks for infection also determine the persistence of access barriers to ART. The universal access policy is quite revolutionary but should be informed by the systemic barriers to access so as to promote equity. It is not enough to distribute ARVs and provide health services when health systems are poorly organized and managed. Comprehensive access to ART raises many organizational, ethical and policy problems that need to be solved to achieve equity in access. This paper argues that the persistence of access barriers is due to weak health systems and a poor public health leadership. AIDS has challenged health systems in a manner that is essentially different from other health problems.
authors.affiliation: Département de Santé Publique, Faculté des Sciences de la Santé de l'Université de N'djaména, Avenue Mobutu, BP, 1117 N'djaména, Tchad. maishaze@yahoo.com
authors.forename: Jacquineau
authors.initials: J
authors.lastname: Azétsop
authors.forename: Blondin A
authors.initials: BA
authors.lastname: Diop
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002596:Chad / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006291:Health Policy; D006297:Health Services Accessibility / Q000941:ethics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010549:Personal Satisfaction; D011635:Public Health Administration
chemical_list: D044966:Anti-Retroviral Agents
references.citation: Bull World Health Organ. 2001;79(12):1145-51
references.pmid: 11799447
references.citation: BMJ. 2008 Dec 10;337:a2900
references.pmid: 19073663
references.citation: Hum Resour Health. 2010 Mar 31;8:8
references.pmid: 20356363
references.citation: Lancet. 2009 Dec 19;374(9707):2080-2089
references.pmid: 19939445
references.citation: J Epidemiol Community Health. 2003 Apr;57(4):254-8
references.pmid: 12646539
references.citation: BMC Health Serv Res. 2009 Jan 09;9:5
references.pmid: 19134202
references.citation: Hum Resour Health. 2009 Aug 23;7:76
references.pmid: 19698146
references.citation: Int J Health Serv. 1992;22(3):429-45
references.pmid: 1644507
references.citation: Reprod Health Matters. 2006 May;14(27):12-23
references.pmid: 16713875
references.citation: Stud Hastings Cent. 1973;1(3):77-88
references.pmid: 4607284