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WHO’s poor consultation with patients on HIV guidance has denied women choice in drug treatment

BMJ 2014; 348 doi: (Published 07 February 2014) Cite this as: BMJ 2014;348:f7601
  1. Alice Welbourn, founding director, Salamander Trust, London
  1. alice{at}

Criticisms abound among HIV activists about World Health Organization guidelines, which include antiretroviral treatment for all children aged under 5 with HIV. Why does WHO not consult properly with those affected by the disease, asks Alice Welbourn

I write as someone who has spent 12 of the 22 years since my HIV diagnosis trying to uphold women’s rights at a global level and on behalf of many international colleagues who sense a profound disquiet about recently launched treatment guidelines from WHO’s HIV Department.1 These guidelines promote lifelong treatment with antiretroviral drugs for all of us with HIV with a CD4 count below 500; all pregnant or breastfeeding women with HIV; and all children with HIV under 5 years. The guidelines promote integration with other services (including for antenatal care and tuberculosis), decentralisation, and task shifting (where prescriptions of antiretrovirals are initiated and maintained by trained non-physician health workers and dispensed by community health workers). All these have merits but also present huge challenges.1

The concerns about promoting lifelong treatment for women (called “option B+”) and children are echoed by some clinicians in Africa, Europe, and the United States.2 3 4 We all believe firmly in antiretrovirals. Without them we would be long dead, as many of our former sister activists are. Yet we also believe firmly that treatment is a choice not a compulsion.

Option B+ …

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