{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T16:59:27Z","timestamp":1756573167905},"reference-count":43,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2013,5,31]],"date-time":"2013-05-31T00:00:00Z","timestamp":1369958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Developing World Bioethics"],"published-print":{"date-parts":[[2013,8]]},"abstract":"Abstract<\/jats:title>The effectiveness of antiretroviral regimes (ARVs<\/jats:styled-content>) to reduce risk of HIV<\/jats:styled-content> transmission from mother to child and as post\u2010exposure prophylaxis has been known for almost two decades. Recent research indicates ARVs<\/jats:styled-content> can also reduce the risk of HIV<\/jats:styled-content> transmission via sexual intercourse in two other ways. With pre\u2010exposure prophylaxis (PrEP<\/jats:styled-content>), ARVs<\/jats:styled-content> are used to reduce risk of HIV<\/jats:styled-content> acquisition among persons who are HIV<\/jats:styled-content> negative and significantly exposed to the virus. With treatment as prevention (TasP<\/jats:styled-content>), ARVs<\/jats:styled-content> are used to reduce risk of HIV<\/jats:styled-content> transmission from persons who are already HIV<\/jats:styled-content> positive. The development of these new prevention strategies raises a rationing problem: given the chronic shortage of ARVs<\/jats:styled-content> for HIV<\/jats:styled-content>\u2010infected persons in need of treatment, is it ethically justified to allocate ARVs<\/jats:styled-content> for PrEP<\/jats:styled-content> and\/or TasP<\/jats:styled-content>? This article examines the intuitively appealing view that allocation of ARVs<\/jats:styled-content> for treatment should be the highest priority, the use of ARVs<\/jats:styled-content> for TasP<\/jats:styled-content> should be a secondary priority, and that utilizing ARVs<\/jats:styled-content> for PrEP<\/jats:styled-content> would be unethical. I will argue that selective, evidence\u2010based allocation of ARVs<\/jats:styled-content> for prevention in certain cases could be ethically justified even when there is insufficient anti\u2010retroviral access for all those needing it for treatment.<\/jats:p>","DOI":"10.1111\/dewb.12022","type":"journal-article","created":{"date-parts":[[2013,5,31]],"date-time":"2013-05-31T13:48:17Z","timestamp":1370008097000},"page":"79-86","source":"Crossref","is-referenced-by-count":8,"title":["Ethical Use of Antiretroviral Resources for HIV<\/scp> Prevention in Resource Poor Settings"],"prefix":"10.1111","volume":"13","author":[{"given":"Stuart","family":"Rennie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,5,31]]},"reference":[{"key":"e_1_2_4_2_1","volume-title":"Prevention vs. Treatment: what's the right balance?","author":"Faust H.S.","year":"2012"},{"key":"e_1_2_4_3_1","volume-title":"Introduction. In: Prevention vs. Treatment: what's the right balance?","author":"Faust H.S.","year":"2012"},{"key":"e_1_2_4_4_1","first-page":"37","volume-title":"Prevention vs. Treatment: what's the right balance?","author":"Miller G.","year":"2012"},{"key":"e_1_2_4_5_1","doi-asserted-by":"crossref","unstructured":"M.Over.2008.Prevention failure: the ballooning entitlement failure of US Global AIDS treatment funding and what to do about it. Center for Global Development Working Paper #144. Available at:http:\/\/www.cgdev.org\/content\/publications\/detail\/15973\/. [Accessed 25 Jan 2013].","DOI":"10.2139\/ssrn.1131340"},{"key":"e_1_2_4_6_1","unstructured":"World Health Organization.Global HIV\/AIDS Response. Epidemic Update and Health Sector Progress Towards Universal Access. Progress Report. (2011) Available at:http:\/\/apps.who.int\/iris\/bitstream\/10665\/44787\/1\/9789241502986_eng.pdf. [Accessed 25 Jan 2013]."},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02091.x"},{"key":"e_1_2_4_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1758-2652-13-35"},{"key":"e_1_2_4_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0b013e32833860ba"},{"key":"e_1_2_4_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/17441691003796387"},{"key":"e_1_2_4_11_1","unstructured":"The concept \u2018provision of ARVs\u2019 is abstract. Not just the drugs have to be allocated but also the infrastructural material and human resources implicated in the responsible and effective provision of HIV drugs for treatment or prevention purposes. In this paper the term \u2018ARVs\u2019 refers to both the drugs and the health resources enabling their safe and effective delivery. I will be using \u2018ARVs\u2019 and \u2018ARV resources interchangeably."},{"key":"e_1_2_4_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1108524"},{"key":"e_1_2_4_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011205"},{"key":"e_1_2_4_14_1","unstructured":"US Food and Drug Administration.2012.Press Release. FDA approves first drug for reducing risk of sexually acquired HIV infection. Available at:http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm312210.htm. [Accessed 25 Jan 2013]."},{"key":"e_1_2_4_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105243"},{"key":"e_1_2_4_16_1","unstructured":"World Health Organization. Programmatic update.Antiretroviral treatment as prevention (TasP) for HIV and TB.2012:5. Available at:http:\/\/www.who.int\/hiv\/pub\/mtct\/programmatic_update_tasp\/en\/index.html. [Accessed 25 Jan 2013]."},{"key":"e_1_2_4_17_1","unstructured":"World Health Organization. Programmatic update.Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in children(2012). Available at:http:\/\/www.who.int\/hiv\/PMTCT_update.pdf. [Accessed 25 Jan 2013]."},{"key":"e_1_2_4_18_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.0071"},{"key":"e_1_2_4_19_1","unstructured":"Ibid: 1537."},{"key":"e_1_2_4_20_1","unstructured":"Ibid: 1542."},{"key":"e_1_2_4_21_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.28.6.1591"},{"key":"e_1_2_4_22_1","unstructured":"Macklin and Cowan's use of the word \u2018divert\u2019 gives the unfortunate impression of a fixed finite pool of ARVs where the use of resources for treatment or prevention is a zero\u2010sum game. This is descriptively false. While finite the limits of the resources are dynamic and depend on macro\u2010level decisions regarding other social commitments such as military expenditures. ARVs for a prevention intervention (e.g. an intermittently used vaginal gel) is not physically the same or demand the same supportive health system resources as ARVs for treatment (e.g. a daily oral regime)."},{"key":"e_1_2_4_23_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.28.6.1666"},{"key":"e_1_2_4_24_1","first-page":"77","volume-title":"Utilitarianism: For and Against","author":"Williams B.","year":"1973"},{"key":"e_1_2_4_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1202614"},{"key":"e_1_2_4_26_1","unstructured":"Microbicide Trials Network.2011.MTN Statement on Decision to Discontinue Use of Tenofovir Gel in VOICE a Major HIV Prevention Study in Women. Available at:http:\/\/www.mtnstopshiv.org\/node\/3909. [Accessed 25 Jan 2013]."},{"key":"e_1_2_4_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283522272"},{"key":"e_1_2_4_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001231"},{"key":"e_1_2_4_29_1","unstructured":"J.Birungiet\u2009al.2012.Lack of effectiveness of antiretroviral therapy (ART) as an HIV prevention tool for serodiscordant couples in a rural ART program without viral load testing in Uganda. Washington D.C. Nineteenth International AIDS Conference. Abstract TUAC0103."},{"key":"e_1_2_4_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001232"},{"key":"e_1_2_4_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283543e83"},{"key":"e_1_2_4_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7541.605"},{"key":"e_1_2_4_33_1","unstructured":"B.G.Williamset\u2009al.Pre\u2010exposure prophylaxis (PrEP) versus treatment\u2010as\u2010prevention (TasP) for the control of HIV: Where does the balance lie? arXiv:1209.0364 [q\u2010bio.PE]. Available at:http:\/\/arxiv.org\/abs\/1209.0364. [Accessed 25 Jan2013]."},{"key":"e_1_2_4_34_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1975"},{"key":"e_1_2_4_35_1","unstructured":"UNAIDS.2012.UNAIDS Report on the Global AIDS Epidemic. Available at:http:\/\/www.unaids.org\/globalreport\/Global_report.htm. [Accessed 25 Jan 2013]."},{"key":"e_1_2_4_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61053-8"},{"key":"e_1_2_4_37_1","unstructured":"Option B+ will be ethically controversial because it may be regarded as exclusionary: pregnant women may have better access to HIV testing and ARVs for treatment\/prevention relative to non\u2010pregnant HIV\u2010positive women unless the latter are embraced by another policy (such as \u2018test and treat\u2019 of all HIV\u2010positive persons)."},{"key":"e_1_2_4_38_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0020303"},{"key":"e_1_2_4_39_1","volume-title":"Equity and ethics in access to HIV treatment \u2013 3 by 5 initiative","author":"Macklin R.","year":"2004"},{"key":"e_1_2_4_40_1","volume-title":"How to achieve fair distribution of ARTs in 3 by 5: fair process and legitimacy in patient selection","author":"Daniels N.","year":"2004"},{"key":"e_1_2_4_41_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511809514"},{"key":"e_1_2_4_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/phe\/phn004"},{"key":"e_1_2_4_43_1","first-page":"541","article-title":"Approaches to rationing antiretroviral treatment: ethical and equity implications","volume":"83","author":"Bennett S.","year":"2005","journal-title":"Bull World Health Org"},{"key":"e_1_2_4_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283402c3e"}],"container-title":["Developing World Bioethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdewb.12022","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dewb.12022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T19:21:28Z","timestamp":1694632888000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dewb.12022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,31]]},"references-count":43,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2013,8]]}},"alternative-id":["10.1111\/dewb.12022"],"URL":"https:\/\/doi.org\/10.1111\/dewb.12022","archive":["Portico"],"relation":{},"ISSN":["1471-8731","1471-8847"],"issn-type":[{"value":"1471-8731","type":"print"},{"value":"1471-8847","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,5,31]]}}}