Reconciling the science and policy divide: The reality of scaling up antiretroviral therapy in South Africa

Alan Whiteside, Jamie Cohen, Michael Strauss
Southern African Journal of HIV Medicine | Vol 16, No 1 | a355 | DOI: | © 2015 Alan Whiteside, Jamie Cohen, Michael Strauss | This work is licensed under CC Attribution 4.0
Submitted: 27 January 2015 | Published: 02 July 2015

About the author(s)

Alan Whiteside, Balsillie School of International Affairs, Waterloo, Canada; College of Law and Management Studies, University of KwaZulu-Natal, South Africa
Jamie Cohen, Harvard School of Public Health, Boston, United States
Michael Strauss, Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, South Africa


With the world’s largest national treatment programme and over 340 000 incident casesannually, the response to HIV in South Africa is hotly contested and there is sometimes adissonance between activism, science and policy. Too often, policy, whilst well intentioned, isinformed only by epidemiological data. The state of the healthcare system and socioculturalfactors drive and shape the epidemic and its response. By analysis of the financial,infrastructural, human resources for health, and governance landscape in South Africa,we assess the feasibility and associated costs of implementing a universal test and treatprogramme. We situate a universal test and treat strategy within the governance, fiscal,human resources for health, and infrastructural landscape in South Africa. We argue that theresponse to the epidemic must be forward thinking, progressive and make the most of thebenefits from treatment as prevention. However, the logistics of implementing a universaltest and treat strategy mean that this option is problematic in the short term. We recommenda health systems strengthening HIV treatment and prevention approach that includes scalingup treatment (for treatment and prevention) along with a range of other prevention strategies.


HIV; Health; Treatment; Health Policy; South Africa


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