Expanding access to antiretroviral therapy in sub-saharan Africa: avoiding the pitfalls and dangers, capitalizing on the opportunities

Am J Public Health. 2005 Jan;95(1):18-22. doi: 10.2105/AJPH.2004.040121.


We describe a number of pitfalls that may occur with the push to rapidly expand access to antiretroviral therapy in sub-Saharan Africa. These include undesirable opportunity costs, the fragmentation of health systems, worsening health care inequities, and poor and unsustained treatment outcomes. On the other hand, AIDS "treatment activism" provides an opportunity to catalyze comprehensive health systems development and reduce health care inequities.However, these positive benefits will only happen if we explicitly set out to achieve them. We call for a greater commitment toward health activism that tackles the broader political and economic constraints to human and health systems development in Africa, as well as toward the resuscitation of inclusive and equitable public health systems.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Acquired Immunodeficiency Syndrome / epidemiology
  • Adult
  • Africa South of the Sahara / epidemiology
  • Anti-Retroviral Agents / therapeutic use*
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / trends
  • Global Health
  • Humans
  • Prevalence
  • Socioeconomic Factors


  • Anti-Retroviral Agents