TRIPS, Public Health Systems and Free Access
Edited by Benjamin Coriat
Chapter 13: The Cost of Universal Free Access for Treating HIV/AIDS in Low-Income Countries: The Case of Senegal
Bernard Taverne, Karim Diop and Philippe Vinard INTRODUCTION Since 2004, access to medical treatment for people living with HIV, including antiretroviral drugs (ARVs), has seen tremendous growth in southern countries, through the impetus of the WHO’s ‘3 by 5’ programme. By the end of 2006, unanimous consensus was reached on the need to expand therapeutic treatment and prevention, using a complementary and simultaneous approach to limit the spread and impact of the HIV/AIDS epidemic in countries with limited resources (WHO, 2006). Research completed with the ﬁrst cohorts of patients treated with ARVs showed very early on that the fees for care charged to patients constituted a major obstacle to eﬀective therapeutic treatment (Whiteside and Lee, 2005; Braitstein et al., 2006). In 2005, this observation led the WHO ‘to advise countries to adopt a policy of free access at the point of service delivery for an “essential packet” of HIV care and treatment, including antiretroviral treatment’ (WHO, 2005). Since 2006, the abolition of user fees at the point of service delivery for care and drugs is one of the pillars of the public health approach proposed by the WHO, within the framework of universal free access to treatment (Gilks et al., 2006). Numerous African countries are involved in free ARV-drug distribution; very few, however, have taken the plunge in providing complete free medical treatment. Most oﬃcials who shape health policies in Africa have doubts about the feasibility of complete free access, fearing that such a decision will lead to...
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