Treating AIDS: Dilemmas of unequal access in Uganda
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Treating AIDS : Dilemmas of unequal access in Uganda. / Whyte, Susan Reynolds; Whyte, Michael A.; Meinert, Lotte; Kyaddondo, Betty.
In: SAHARA-J: Journal of Social Aspects of HIV/AIDS, Vol. 1, No. 1, 2004, p. 14-26.Research output: Contribution to journal › Journal article › Research
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TY - JOUR
T1 - Treating AIDS
T2 - Dilemmas of unequal access in Uganda
AU - Whyte, Susan Reynolds
AU - Whyte, Michael A.
AU - Meinert, Lotte
AU - Kyaddondo, Betty
PY - 2004
Y1 - 2004
N2 - The price of antiretroviral (ARV) medicines in Uganda has fallen dramatically in recent years and more people are under treatment. By mid-2003 it was estimated that 10 000 people were taking ARVs. Drawing on participant observation, qualitative interviews, work with key informants and document reviews, we seek to map out the channels through which ARVs are being made available to people and to describe and assess the social implications of the present system of distribution. Four channels of access to ARV medicines were common in mid-2003: (i) Medicines were provided free in structured research and treatment programmes funded by donors, but only to those who lived in a defined catchment area and met inclusion criteria. (ii) Gazetted treatment centres provided drugs on a fee-for-service basis; these urban-based institutions account for the largest number of drugs dispensed. (iii) Private practitioners, mainly based in Kampala, provided discrete treatment for those who could afford it. (iv) Finally, medicines were ‘facilitated' along informal networks, supplying friends and relatives on a less regular basis, sometimes for free, sometimes for cash. However, access to ARVs remains highly uneven. We argue that cheaper drugs make possible different kinds of access, different qualities of care, and a growing awareness of inequity. Because the price of drugs has fallen drastically, middle-class families now have the possibility of buying them. But this requires tough prioritising and many cannot follow the regimen regularly. Health workers must consider whether patients will be able to purchase the drugs or not. In a kind of popular social pharmacy, people assess who can and should and does get access to ARVs. Further research should examine the whole range of ARV access channels in different countries and the associated patterns of social differentiation and exclusions.
AB - The price of antiretroviral (ARV) medicines in Uganda has fallen dramatically in recent years and more people are under treatment. By mid-2003 it was estimated that 10 000 people were taking ARVs. Drawing on participant observation, qualitative interviews, work with key informants and document reviews, we seek to map out the channels through which ARVs are being made available to people and to describe and assess the social implications of the present system of distribution. Four channels of access to ARV medicines were common in mid-2003: (i) Medicines were provided free in structured research and treatment programmes funded by donors, but only to those who lived in a defined catchment area and met inclusion criteria. (ii) Gazetted treatment centres provided drugs on a fee-for-service basis; these urban-based institutions account for the largest number of drugs dispensed. (iii) Private practitioners, mainly based in Kampala, provided discrete treatment for those who could afford it. (iv) Finally, medicines were ‘facilitated' along informal networks, supplying friends and relatives on a less regular basis, sometimes for free, sometimes for cash. However, access to ARVs remains highly uneven. We argue that cheaper drugs make possible different kinds of access, different qualities of care, and a growing awareness of inequity. Because the price of drugs has fallen drastically, middle-class families now have the possibility of buying them. But this requires tough prioritising and many cannot follow the regimen regularly. Health workers must consider whether patients will be able to purchase the drugs or not. In a kind of popular social pharmacy, people assess who can and should and does get access to ARVs. Further research should examine the whole range of ARV access channels in different countries and the associated patterns of social differentiation and exclusions.
KW - Faculty of Social Sciences
KW - Antropologi
KW - International sundhed
KW - AIDS
KW - Antiretroviral adgang
KW - Ulighed
KW - Uganda
KW - Afrika
M3 - Journal article
VL - 1
SP - 14
EP - 26
JO - Sahara J
JF - Sahara J
SN - 1729-0376
IS - 1
ER -
ID: 1092876