BMJ  2003;326:1382-1384 (21 June), doi:10.1136/bmj.326.7403.1382

Education and debate

Antiretroviral treatment in developing countries: the peril of neglecting private providers

Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT ruairi.brugha@lshtm.ac.uk

Increased access to antiretroviral drugs is vital to maintain developing countries with high rates of HIV infection. But unless treatment is properly controlled, these drugs could rapidly become useless

The first 150 words of the full text of this article appear below.

Only 5% of the 5.5 million people in developing countries who need antiretroviral treatment currently receive it.¹ New initiatives and global partnerships are trying to increase access to antiretroviral drugs— for example, the International HIV Treatment Access Coalition,¹ guidelines for scaling up antiretroviral treatment,² and employee programmes under the umbrella of the Global Business Coalition on HIV/AIDS. However, these initiatives largely ignore the fact that most poor people who suspect they have a sexually transmitted infection seek care in the private sector because of the stigma attached.^{3 4} The main care providers for HIV disease in the poorest countries are therefore likely to be private medical practitioners, pharmacists, and traditional and informal providers, such as drug vendors, who are often unregulated and dispense drugs illegally.^{4 5} Improper use of antiretroviral drugs may result in development of resistant HIV, so it is important to take account of private providers and regulate their behaviour.

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