Provision of antiretroviral therapy in South Africa: unique challenges and remaining obstacles

From 2003 to 2006, the number of human immunodeficiency virus-infected people in sub-Saharan Africa able to access antiretroviral therapy (ART) has increased from 100,000 to >1 million. The World Health Organization estimates that >3.5 million patients are still in need. The challenges to more expeditious provision of ART in Africa are many. This article is an analysis of the barriers to ART scale-up that are unique to South Africa. With 5.3 million people infected and 1 million needing ART, this country carries nearly one-quarter of the treatment burden of the continent. Although South Africa is undeniably a middle-income nation, inequities born of apartheid, lack of political commitment, poverty, and cultural barriers have significantly slowed efforts to provide universal access to ART to South African citizens.