15th International AIDS Conference Bangkok, Thailand — July 11-July 16, 2004

Int Conf AIDS. 2004 Jul 11-16;15:Abstract No. LbOrE34

C Chanfreau, S Bennett
Abt Associates, Bethesda, MD, United States

Despite a growing global commitment to the provision of antiretroviral treatments (ART), the availability of ART is still likely to be less than the need. This imbalance raises ethical dilemmas about who should be granted access to publicly-subsidized antiretroviral treatment programs. This paper reviews the eligibility and targeting criteria used by a few case study countries in their national ARV programs or major pilot projects, with the aim of drawing lessons regarding ethical approaches to rationing antiretroviral therapy. Mexico, Senegal and Uganda have each made an explicit policy commitment to provide antiretrovirals to all those in need, but are achieving this goal in steps - beginning with explicit rationing of access to care. Categories of explicit rationing criteria identified include biomedical factors, prospects for adherence to treatment, prevention-driven factors, social and economic benefits, social and political empowerment, financial factors and factors driven by moral arguments. Initial criteria for determining eligibility are typically clinical criteria and assessment of adherence prospects, followed by the other factors listed. Rationing mechanisms reflect multiple underlying ethical theories and the ethical underpinnings of explicit rationing criteria should reflect societal values. In order to ensure this alignment, widespread consultation and dialogue with a variety of stakeholders, and not just policy makers or physicians, is critical. Without such explicit debate, more rationing will occur implicitly and this may be more inequitable. The effects of rationing mechanisms upon equity depend considerably upon implementation processes. As antiretroviral programs are implemented, it is critical to monitor who gains access to these programs.

040711
LbOrE34

Copyright © 2004 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.