Most people in developing countries who suspect they have a sexually transmitted infection seek care in the private sector because of the stigma attached, and evidence of uncontrolled use is already emerging among largely unregulated private providers, says Ruairi Brugha of the London School of Hygiene and Tropical Medicine.
These treatment practices will accelerate HIV resistance, so it is important to take account of private providers and regulate their behaviour. Unless treatment is properly controlled, these drugs could rapidly become useless.
"The goal of an AIDS-free world is too important to risk failure through ideological disputes over public or private sector approaches at the local or global level. Each can learn from the other, and the state should be the guarantor of quality, wherever people seek care," he concludes.
Three other articles in this week's BMJ explore the issues surrounding HIV. The first recommends a "back to basics" approach to preventing HIV, while in the second, a researcher in child health and former Ugandan government peace minister assess how to make the best use of resources to care for orphans of AIDS in Africa. The final article discusses 10 important lessons from Africa that could limit the spread of HIV in India.
"The behaviour that surrounds implementation of prevention strategies must be overcome," says Arthur Ammann, President of Global Strategies for HIV Prevention, in an accompanying editorial. "We know how to prevent every method of HIV transmission but without more extensive progress, we are deluding ourselves into thinking that the epidemic can be controlled," he concludes.