Basic health care package without antiretroviral therapy?

Background Antiretroviral therapy (ART) for HIV/AIDS patients has become a standard in developed countries and a generally accepted objective in developing countries. Major funding agencies, such as USAID and the Global Fund to Fight AIDS, Tuberculosis and Malaria, are supporting ART programmes in developing countries as a non-negotiable element of a basic health care package. Aim Recently a few papers have challenged whether this investment is rational as ART is expensive and the long-term consequences of resistance cannot be neglected. This paper intends to contribute to this discussion from a health economic perspective. It analyses the opportunity costs, the sustainability and the ethics of ART as well as the absorption capacity of existing health care services in developing countries. Results There is no justification for the so-called “exceptionality” of HIV/AIDS. Conclusion ART might be an essential element of a basic health care package, but it should pass the same procedure as any other intervention to be included into the basic package. Financing a comprehensive health care package would require more international input—an important vision of a “Global Fund to Promote Health” as the offspring of the existing Global Fund.