The Political Economy of HIV/AIDS in Developing Countries
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The Political Economy of HIV/AIDS in Developing Countries

TRIPS, Public Health Systems and Free Access

Edited by Benjamin Coriat

The book is based on original data and field studies from Brazil, Thailand, India and Sub-Saharan Africa. Focusing on the issue of universal and free access to treatment (a goal now taken to heart by the international community), it assesses the progress made and presents a rigorous diagnosis of the obstacles that remain, especially the constraints imposed by TRIPS and the poor state of most public health systems in Southern countries. In so doing, the book renews our understanding of the political economy of HIV/AIDS in these vast regions, where it continues to spread with devastating social and economic consequences.
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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


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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