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APHA Scientific Session and Event Listing

Recorded presentation

William J. Bicknell, MD, MPH, Departments of International Health and Family Medicine, Boston University, School of Public Health, 715 Albany St., T4W, Boston, MA 02118-2526, 617-283-5775, wbicknel@bu.edu and Brian William Jack, MD, Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Dowling 5, Boston, MA 02118.

Lesotho, a proxy for other high prevalence, low-income countries, faces a national catastrophe with 40% of 30-39 year olds HIV+. Scaling-up prevention, testing and treatment is vigorous. Clinton Foundation drug prices make treatment more affordable. ARVs are being provided on a first-come, first-served basis. It is axiomatic that all who need treatment, merit treatment. As numbers under treatment approach 10,000, the hope is international donor funding will meet a growing need. However, if this is not the case, resources will frame the policy debate. Specifically, the need, cost of drugs and funds available suggest Lesotho can only afford to buy ARVs for ~15% of patients needing care between 2008 and 2010. Who should decide who gets ARVs and who does not? What are the criteria? How should national good and national survival be balanced against individual need and good? Should certain groups get priority for treatment? Children? Teachers? Mothers? Skilled maintenance technicians? Health workers? Farmers? Rationing of this severity is new to richer countries and expatriate advisers. Thus, advice should be leavened with humility as the consequences are born by the country and its people. We will explore the policy and program implications of whose rights are right.

Content for this presentation is informed by the authors' extensive policy and program work in Lesotho since 2002.

Learning Objectives:

• Participants will be able to discuss, analyze and articulate human rights conflicts facing lower income countries with a very high HIV prevalence that arise from prevention, testing and treatment choices.

Keywords: Policy/Policy Development, HIV/AIDS

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation