Home Institution

Washington University in St Louis

Publication Date

Spring 2008

Program Name

Kenya: Development, Health, and Society


When I first learned that the eligibility criteria for Antiretroviral Drugs (ARVs) in Uganda is to have a CD4 cell count of 200 or below, I was shocked. Actually, I think my exact response was, “So patients must have full-blown AIDS, severely weakened immune systems, and may be on their deathbeds before they can receive the drugs?” I knew little of the subject, other than that in the United States HIV-positive patients who are on drugs may avoid many of the opportunistic infections and complications that come from delaying treatment until the CD4 count is low. My initial confusion over a policy that appeared to have its priorities reversed served as the spark that propelled this project. My goal was to understand the issues that surround eligibility for antiretroviral drugs. I wanted to learn everything I could about ARVs and how they are delivered. But I was especially curious as to who was able to receive ARVs, how and why. I felt that an understanding of the cultural, economic, political, and medical factors that influence eligibility guidelines would illustrate the rationale behind such policies and the barriers that exist to scaling up treatment for HIV/AIDS patients. A thorough understanding of HIV testing, counseling, care and treatment was necessary to put ARVs into context. Assuming that the CD4 count eligibility guidelines should be higher than 200, my initial intention was to determine why this is not currently the policy in Uganda. While researching the topic, several crucial barriers to access of ARVs became obvious. These barriers, as will be outlined below, are multi-dimensional and require a multi-faceted approach to address them. However, the key concern is not whether the CD4 eligibility guidelines should be raised or whether barriers to access need to be overcome to improve treatment of HIV/AIDS, but rather how these two improvements may be integrated with one another. The government of Uganda is currently re-evaluating its HIV/AIDS treatment guidelines, including CD4 cell count eligibility. Enormously relevant to this re-evaluation is consideration of Uganda’s ability to care for a larger population of eligible individuals when so many already face significant barriers to accessing care and treatment.


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