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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 | Journal Article / Commentary | MSF Science Portal
Journal Article
|Commentary

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

Fox RC, Goemaere E
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Abstract
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.

Countries

South Africa

Subject Area

HIV/AIDS

Languages

English
DOI
10.1017/s0963180106060403
Published Date
02 May 2006
PubMed ID
16862934
Journal
Cambridge Quarterly of Healthcare Ethics
Volume | Issue | Pages
Volume 15, Issue 3, Pages 301-312
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