They call it "patient selection" in Khayelitsha: the experience of Médecins Sans Frontières-South Africa in enrolling patients to receive antiretroviral treatment for HIV/AIDS

This article explores some of the medical and ethical issues that surround the selection of persons to receive anti-retroviral therapy (ARV) for HIV-AIDS. It is empirically grounded in the experiences of the project to prevent and treat AIDS conducted by Médecins Sans Frontières (MSF) in Khayelitsha, a densely populated, highly disadvantaged, urban township on the periphery of Cape Town, South Africa. The article describes and analyzes the so-called “selection process” that the project’s staff uses to determine which patients to start on ARV therapy; the medical, social, and adherence criteria on which they try to base their decisions; the emotional and moral strains that this entails for them; and their overall reluctance to refuse anyone for treatment. It depicts the evolution that the process has undergone as it has moved progressively toward becoming a system to prepare patients for treatment and help them to adhere to the drug regimen, rather than to select or de-select them. The article ends with brief reflections on the macro-implications of the Khayelitsha project’s experiences in grappling with these issues for dealing with them nationally, in South Africa, the country with the world’s largest number of HIV-positive persons.