| Chapter 1: | Introduction |
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were tens of thousands of marginalized Ugandans able to gain free access to these drugs through public programs funded by international organizations such as the WHO, World Bank, Global Fund, and the U.S.-based President’s Emergency Plan for AIDS (PEPFAR) (Mugyenyi et al., 2006). Around the time this study was conducted, there were about 175 centers that provided free HAART to about 75,000 of the hundreds of thousands of individuals nationwide who had a diagnosis of full-blown AIDS and were on the brink of death (AVERTing, 2008; Hardon et al., 2006; WHO, 2006c). Of the 175 centers providing HAART in 2007, three centers located around Uganda’s capital city were selected for this study. Two of those that participated in the study served about 3,200 civilians; the third center served about 1,000 soldiers and civilians. Although a few clients choose to travel from remote areas to access services at any of the centers under study, each of these centers serves individuals in the immediate surroundings of about a 75-kilometer radius.
HAART-providing centers in Uganda generally mimic those in the United States. However, several differences pertaining to the provision of services exist, basically as dictated by financial expense. To illustrate these differences, I will compare the three HAART-providing centers in Uganda under study with three centers in the United States: namely, the AIDS Services of North Texas (ASNT) in Denton, Texas; 360: Positive Care Center (PCC) in San Francisco, California; and the HIV Center at Northwestern Memorial Hospital in Chicago, Illinois.
The first difference is that free HAART in Uganda only became accessible to those who could not afford it at a cost in 2004. In contrast, the United States has been providing HAART to everyone who meets the access criterion (described later) since around 1996 (Hammer et al., 2006; The AIDS Support Organization [TASO], 2006). Additionally, HAART-providing centers in Uganda and the United States differ in terms of the recommended time to initiate taking anti-HIV drugs. Before discussing these differences, it is important to understand that the exact time at which to start anti-HIV drug treatment is not clear. It is also necessary to mention that study results associating HAART initiation time