Which patients first? Setting priorities for antiretroviral therapy where resources are limited

Am J Public Health. 2005 Jul;95(7):1173-80. doi: 10.2105/AJPH.2004.052738.


The availability of limited funds from international agencies for the purchase of antiretroviral (ARV) treatment in developing countries presents challenges, especially in prioritizing who should receive therapy. Public input and the protection of human rights are crucial in making treatment programs equitable and accountable. By examining historical precedents of resource allocation, we aim to provoke and inform debate about current ARV programs. Through a critical review of the published literature, we evaluate 4 precedents for key lessons: the discovery of insulin for diabetes in 1922, the release of penicillin for civilian use in 1943, the development of chronic hemodialysis programs in 1961, and current allocation of liver transplants. We then describe current rationing mechanisms for ARVs.

Publication types

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

MeSH terms

  • Adolescent
  • Anti-Retroviral Agents / therapeutic use*
  • Child
  • Developing Countries*
  • Diabetes Mellitus, Type 1 / drug therapy
  • HIV Infections / drug therapy*
  • Health Care Rationing / methods*
  • Health Care Rationing / statistics & numerical data
  • Health Priorities*
  • Humans
  • Insulin
  • Liver Transplantation
  • Patient Selection*
  • Penicillins / therapeutic use
  • Public Health
  • Renal Dialysis


  • Anti-Retroviral Agents
  • Insulin
  • Penicillins