A suggestion on anti-retrovirals
Dec 18, 2003
SIR— While health minister Jim Muhwezi’s statement that more Ugandans would be put on anti-retrovirals beginning January 2004 is laudable, the criteria he has chosen for determining those who are eligible are questionable
SIR— While health minister Jim Muhwezi’s statement that more Ugandans would be put on anti-retrovirals beginning January 2004 is laudable, the criteria he has chosen for determining those who are eligible are questionable.
Even though pregnant mothers, orphans and marginalised groups are vulnerable, not everybody who is HIV-positive, regardless of gender or social status, actually needs anti-retrovirals.
The experience from countries like South Africa which have been struggling with this question shows that the best criteria for choosing who gets ARV treatment ahead of others is solely how damaged one’s immune system is.
As a result, the practice by Medicins Sans Frontiers, which has pioneered ARV therapy in South Africa, is to pick people whose CD4 cell count has fallen below the 200 mark.
Other criteria may be prospects of compliance with the strict drug regimen but not just being orphaned or widowed. Can Muhwezi pick lessons here?
Michael Wakabi
Cape Town, South Africa
Even though pregnant mothers, orphans and marginalised groups are vulnerable, not everybody who is HIV-positive, regardless of gender or social status, actually needs anti-retrovirals.
The experience from countries like South Africa which have been struggling with this question shows that the best criteria for choosing who gets ARV treatment ahead of others is solely how damaged one’s immune system is.
As a result, the practice by Medicins Sans Frontiers, which has pioneered ARV therapy in South Africa, is to pick people whose CD4 cell count has fallen below the 200 mark.
Other criteria may be prospects of compliance with the strict drug regimen but not just being orphaned or widowed. Can Muhwezi pick lessons here?
Michael Wakabi
Cape Town, South Africa