This publication looks at issues around access to antiretroviral therapy (ART) in Africa, focusing on lessons learned and highlighting the main challenges facing the delivery of ART. In addition, the document touches on some of the advocacy campaigns around ART and includes an interview with South African treatment campaigner Zackie Achmat.

According to the report, what it takes to deliver ART is already well understood as a result of the pioneering work of Medecins Sans Frontieres (MSF) in South Africa and Malawi. It involves standardised treatment protocols and simplified clinical monitoring; the delegation of aspects of care and follow-up to more junior healthcare workers and the community; the involvement of community members and people living with AIDS in programme design; and ensuring a reliable supply of affordable medicines and diagnostics.

The report states that the delivery of national programmes is limited by the overburdened and under-resourced public health system, whose decline has been accelerated by the toll of HIV/AIDS. However, the issue of resources remains politically charged, with activists demanding that the Global Fund to Fight AIDS, Tuberculosis and Malaria be the primary financing mechanism, to avoid duplication with bilateral initiatives such as the United States President’s Emergency Fund for AIDS Relief.

The report also states that where ART is available, stigma, seemingly inexplicably, still influences people’s response to treatment. ART should be part of a continuum of care: a comprehensive approach that includes voluntary counselling and testing, prevention of mother-to-child transmission, and other prevention and social support services. A regular supply of drugs, treatment preparedness and literacy are important factors in achieving high and sustained adherence rates.