On a never-ending waiting list: Toward equitable access to anti-retroviral treatment? Experiences from Zambia

Health and Human Rights

Volumn 8, Issue 2, 2004, Pages 76-102

  Jones, Peris Sean ^a  

^a Norwegian Centre for Human Rights   (Norway)

Author keywords

[No Author keywords available]

Indexed keywords

HEALTH AND DISEASE; HEALTH CARE; HUMAN IMMUNODEFICIENCY VIRUS; TESTING METHOD;

AFRICA; SOUTHERN AFRICA; SUB-SAHARAN AFRICA; ZAMBIA;

EID: 30444454348     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: 10.2307/4065335     Document Type: Article

References (74)

1. WHO, Treating 3 Million by 2005: Making It Happen (Geneva: 2003): p. 6.
2. E. Cameron, "The Deafening Silence of AIDS," Health and Human Rights 5/1 (2000): pp. 7-24.
3. Article 12(2)(c), International Covenant on Economic, Social and Cultural Rights; see Committee on Economic, Social and Cultural Rights, The Right to the Highest Attainable Standard of Health, General Comment No. 14 (2000), UN Doc. E/C.12/2000/4.
4. WHO, Progress on Global Access to HIV Antiretroviral Therapy - An Update on 3 by 5, UN Doc. A/59/CRP.4.
5. See for example, M. Heywood (ed), From Disaster to Development? Development Update 5/3 (Interfund: Johannesburg, 2004).
6. N. Daniels and J. Sabin, Setting Limits Fairly (New York: Oxford University Press, 2002).
7. Ministry of Foreign Affairs, "Fighting Poverty: The Norwegian Government's Action Plan for Combating Poverty in the South Towards 2015" (Oslo: 2002): pp. 33-36.
8. ESC Committee (see note 3).
9. UNAIDS/WHO, International Guidelines on HIV/AIDS and Human Rights (Geneva: 2002).
10. See for example C. Ngwena, "The Recognition of Access to Health Care As a Human Right in South Africa: Is It Enough?" Health and Human Rights 5/1 (2000): pp. 27-44;
11. M. Heywood and Dennis Altman "Confronting AIDS: Human Rights, Law, and Social Transformation," Health and Human Rights 5/1 (2000): pp. 149-179.
12. Daniels and Sabin (see note 6).
13. More specialist websites such as the Center for HIV Information (www.HIVInsite.ucsf.edu) refer to clinical guidelines based on those of WHO (see below). The Centers for Disease Control and Prevention's AIDS Information website also refers to criteria as "clinical."
14. WHO, Scaling-up Antiretroviral Therapy in Resource Limited Settings: Treatment Guidelines for a Public Health Approach (Geneva: 2004: p. 7.
15. WHO (see note 1), p. 6.
16. WHO, A Public Health Approach to Antiretroviral Treatment: Overcoming Constraints (Geneva: July 2003).
17. WHO (see note 4).
18. UNAIDS, HIV/AIDS, and Human Rights International Guidelines, revised guideline number 6, "Access to Prevention, Treatment, Care and Support" (Geneva: 2002).
19. See background papers for the Consultation on Ethics and Equitable Access to Treatment and Care for HIV/AIDS, Geneva, Switzerland, January 26-27, 2004,
20. R. Macklin, "Ethics and Equity in Access to HIV Treatment"; Pro-Poor Health Policy Team 3 by 5 Initiative; "Priority in Treatment and the Poor";
21. N. Daniels, "How to Achieve Fair Distribution of ARTs in 3 by 5: Fair Process and Legitimacy in Patient Selection." Available at http://www.who.int/ethics/.
22. Macklin (see note 18).
23. WHO, Zambia Summary Country Profile for HIV/AIDS Treatment Scale-up (Geneva: June 2005).
24. Ibid.
25. Relevant questions included: "How would you characterize consultation between government and civil society concerning ARV?," "Which stakeholders have been able to influence process/which haven't?," "What are the existing criteria for a person to receive ARV?," "Do you regard these criteria as adequate?," and "Who is perceived as currently getting access to treatment?"
26. D. Narayan (ed), Can Anyone Hear Us? Voices of the Poor (World Bank Group: Oxford University Press, 2000).
27. Based upon responses of interviews, particularly those of Dr. Senkutu, WHO Deputy Country Representative for Zambia (Interview, Lusaka, September 15, 2004).
28. Mrs. Mataka, Director, Zambian Network on HIVAIDS (Interview, Lusaka, September 8, 2004).
29. C. Mfuzi, Chairperson, Network for Zambian People Living with HIV (Interview, Lusaka, September 7, 2004).
30. Personal communication (Lusaka, September 14, 2004).
31. Senkutu (see note 27).
32. "Scaling Up Antiretroviral Treatment for HIV/AIDS in Zambia: National Implementation Plan 2004-2005," draft, Zambian National AIDS Council (August 2004): pp. 11-12.
33. Such as MSF's geographic coverage of Chiradzulu province, see note 24.
34. Macklin (see note 18).
35. Rosen and Sanne et al., in B. Beresford, "Reflections and Lessons from Frontline Treatment Providers," From Disaster to Development, Development Update 5/3: pp. 265-275 (see note 5).
36. "Consideration of reports submitted by state parties under Articles 16 and 17 of the Covenant: Zambia," Committee on Economic, Social and Cultural Rights, 34th session, UN Doc. E/C.12/1/Add.106 (2005).
37. Ibid.
38. This is also noted in the National implementation Plan (see note 32), which calls for "an enabling policy/legal environment for the scale up of ART."
39. +, IRIN, PlusNews (March 28, 2003).
40. Director of ZARAN, Zambia AIDS Law Research & Advocacy Network (Interview, Lusaka, September, 8, 2004).
41. + founder, IRIN, PLUS News (April 1, 2003).
42. +, Ibid.
43. The Post (March 16, 2004).
44. The Times of Zambia (March 11, 2004).
45. (www.kaisernetwork.org, August, 21 2003).
46. Ibid.
47. See also AIDSMAP (2002) stating that partners and infants born with HIV should also be prioritized based on WHO recommendations, similar to Botswana, although the latter is also prioritizing TB patients. See Plus News (2002)
48. C. Sozi, UNAIDS Country Representative, Zambia (Interview, Lusaka, September 14, 2004).
49. Mataka (see note 28).
50. See note 45.
51. T. J. Ngulube, Director, Centre for Health and Social Science Research (CHESSORE) (Interview, Lusaka, September 10, 2004).
52. A respondent suggested, with regard to one of the first treatment projects, at Ndola Central hospital, that they were told by the Managing Director that, of hundreds of patients, not one single patient had been selected who could not afford to buy ARVs on the open market. The justification apparently given was with regard to sustainability issues - in other words, should the hospital run out of drugs, the patient would have the means to purchase medication elsewhere. Goran Carlsson, Advisor, Central Board of Health, Zambia, personal communication (December 20, 2004).
53. Times of Zambia (July 5, 2004).
54. Observation as Kalingalinga clinic (September 15, 2004).
55. "Free Antiretroviral Therapy (ART) Operational Guidelines for Health Facilities in Zambia," Government of the Republic of Zambia, Ministry of Health (Ndeke House, Lusaka: July 18, 2005): pp. 2, emphasis added.
56. Concerns were also raised by two respondents over the "quality" of care provided, with poorly prescribed treatment regimens identified as often having lethal consequences, particularly in unregulated private practices.
57. ESC Committee (see note 3).
58. "Scaling Up Antiretroviral treatment for HIV/AIDS in Zambia (see note 32).
59. Such as K. Attawell and J. Mundy, Provision of Antiretroviral Therapy in Resource-Limited Settings: A Review of Experience Up to August 2003 (Department for International Development: November 2003).
60. B. Toebes, "The Right to Health," in A. Eide, C. Krause, and A. Rosas, (eds), Economic, Social and Cultural Rights (The Hague: Kluwer, 2002): pp. 169-190.
61. ESC Committee, General Comment 14 (see note 3)
62. ESC Committee, consideration of Zambia report (see note 36), respectively.
63. Although Zambia has ratified the ICESCR, it has not incorporated it into domestic law; social and economic rights therefore remain as directive principles. The absence of an equality clause was brought to my attention by ZARAN (see note 40).
64. P. Jones and K. Stoke (eds), Democratising Development: The Politics of Socio-Economic Rights in South Africa (Leiden: Martinus Nijhoff, 2005).
65. Daniels mentions them all as The Publicity Condition, with agreement on the transparent deliberation of priorities, to include, particularly in light of 3 by 5, publicly provided rationale of decisions; The Relevance Condition and Stakeholder participation, to include consensus on rationale to "seek mutually justifiable terms of cooperation," enabled through broad range of stakeholders being involved; Revisability Condition, with scope to change policies in light of new evidence; and, finally, Enforcement Condition, to assure that these points are followed through (see note 18).
66. Daniels (see note 18): p. 17.
67. WHO (see note 16): p. 5.
68. Ibid.
69. Through, for example, DOT-HAART treatment supporters and, critically, support groups. Furthermore, a study of community involvement in ARV in Zambia echoes the observations of many respondents, in that, generally, people do not feel that they are consulted sufficiently: they want to be heard and be better informed about ARV treatment and about the system proposed for handling it. International HIV/AIDS Alliance, Voices from the Community - A Report of a Community Consultation on Antiretroviral Treatment in Zambia (November 2002).
70. D. McCoy, Health Sector Responses to HIV/AIDS and treatment access in Southern Africa: Addressing Equity, Equinet Discussion Paper 10 (October 2003): p. 33. When put to respondents in Zambia, however, interestingly, all unanimously suggested that community selection was inherently problematic and undesirable.
71. B. Cooke and U. Kothari (eds), Participation: The New Tyranny? (London: Zed Books, 2001).
72. Ngulube (see note 51).
73. A. Frankovits, "Introduction," in Empowerment, Participation, Accountability and Non-Discrimination: Operationalising a Human Rights-Based Approach to Development, Human Rights Development Yearbook (Leiden: Martinus Nijhoff, 2002): pp. 3-14.
74. P. Uvin, Human Rights and Development (Bloomfield: Kumarian Press, 2004): p. 176.