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Boisseau C, Degui H, Bruneton C, Rey JL. [Poor access to antiretroviral treatment in French-speaking Africa: situation in 2004]. Med Trop (Mars) 2006;66:589-92.
Boisseau and colleagues carried out a survey by questionnaire and interview with persons in charge of purchasing in central structures and AIDS control programs in 18 French-speaking African countries between June and October 2004. Survey data showed that a total of 3300 patients received antiretroviral treatment during the study period. This corresponds to a treatment rate of 0.1 to 9.6% of the number of patients requiring antiretroviral treatment. All countries reported interruptions of the antiretroviral supply for a variety of reasons. The main causes were budgetary issues and procedural complexity involving financial aid. The prices charged to the patients varied greatly in function of national policies. Cost price also varied in function of the negotiating leverage of the purchasing central. The authors conclude that in order to improve general access to antiretroviral treatment and to reduce the number of supply shortages more training will be required in management and distribution of medicines. They conclude that it would also be useful to improve communications between the persons in charge of national purchasing structures.
Editors’ note: Patient access and adherence to treatment are known preoccupations of treatment programmes but antiretroviral drug shortages and financing problems are management concerns at the level of central procurement that have to be urgently addressed for effective supply chain management.
Deng R, Li J, Sringernyuang L, Zhang K. Drug abuse, HIV/AIDS and stigmatisation in a Dai community in Yunnan, China. Soc Sci Med 2007 Jan 23; [Epub ahead of print]
The latest data indicate that between 540,000 and 760,000 people are infected with HIV in China. Although minority nationalities represent 8.1% of China's total population, they account for more than 30% of the reported HIV cases. Deng and colleagues examined stigma and discrimination against drug abusers and people living with HIV in a Dai minority nationality community in Yunnan, China. The authors used qualitative research methods, which included participatory observations, in-depth interviews, focus-group discussions, transect walking and community mapping. A combination of different sampling strategies was used to maximise diversity of the initially selected sample. The data revealed deeply entrenched stigma and overt discrimination against drug abusers and people living with HIV that manifested in familial, work, civil and institutional contexts. The stigma reflected pre-existing cultural, religious sanctions against "deviant behaviours". Intervention programmes that were insensitive to the local culture and religion may have also contributed in part to the stigmatisation of drug abusers and people living with HIV. The major impact of stigma was that it created a vicious cycle of social isolation, marginalisation and thus addiction relapse. This in turn reinforced the stigmatisation and discrimination against drug abusers and thus hindered efforts towards prevention and control of HIV.
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