AIDS Crisis Control in Uganda: The Use of HAART By Dorothy J. N. ...

individuals when one’s CD4 cell count is 350 or below, a count higher than that of individuals in developing nations (Panel on Antiretroviral Guidelines for Adult and Adolescents [PAGAA], 2008; Sterling et al., 2003; Wood et al., 2003). Asymptomatic HIV-positive individuals in the United States with a CD4 cell count above 350 are discouraged, but not prevented, from starting HAART (Hammer et al., 2006).

Several reasons explain HAART initiation restriction guidelines both in Uganda and the United States. In reference to resource-constrained nations that strictly follow WHO’s HAART access guidelines, restrictions may pertain to forces of demand and supply for highly active antiretroviral drugs. For instance, WHO’s goal at the time this study was conducted was to treat everyone affected by 2010 (WHO, 2004). Millions of those affected who need free drugs live in developing nations. An economic implication in the provision of free HAART is that these drugs do not cure HIV but only suppress its replication, such that they must be administered for life once treatment is initiated (Hammer et al., 2006). WHO’s dilemma is that the demand is high, yet a lifetime supply of these drugs for everyone in need is not possible because of the high cost. Therefore, in order to reach WHO’s goal of free access of anti-HIV drugs to all in a given time frame, it is necessary to restrict availability of these drugs in resource-constrained nations by providing treatment only to those who need it the most.

Several reasons that explain the United States’ DHHS-recommended HAART initiation guidelines also exist. For example, prior to 1998, the DHHS recommended treating anyone in the United States infected with HIV regardless of clinical status or disease progression stage. This policy was referred to as the “hit early and hit hard” strategy, and it was established because it was initially assumed HAART would cure HIV (AIDSinfo, 2008). However, after it was apparent that HIV had no cure and treatment was a life sentence, the “hit early and hit hard” HAART initiation policy was revised (Hammer et al., 2006). This was because the discovery that AIDS remained without a cure was followed by public health concerns pertaining to anti-HIV drug side effects and suboptimal adherence issues. Of major concern was the fact that starting HAART