When to start antiretroviral therapy in resource-limited settings: a human rights analysis

<p>Abstract</p> <p>Background</p> <p>Recent evidence from developed and developing countries shows clear clinical and public health benefit to starting antiretroviral therapy (ART) earlier. While discussions about when to start ART have often focused on the clinical risks and benefits, the main issue is one of fair limit-setting. We applied a human rights framework to assess a policy of early treatment initiation according to the following criteria: public-health purpose; likely effectiveness; specificity; human rights burdens and benefits; potential for less restrictive approaches; and fair administration.</p> <p>Discussion</p> <p>According to our analysis, a policy of earlier ART initiation would better serve both public health and human rights objectives. We highlight a number of policy approaches that could be taken to help meet this aim, including increased international financial support, alternative models of care, and policies to secure the most affordable sources of appropriate antiretroviral drugs.</p> <p>Summary</p> <p>Widespread implementation of earlier ART initiation is challenging in resource-limited settings. Nevertheless, rationing of essential medicines is a restriction of human rights, and the principle of least restriction serves to focus attention on alternative measures such as adapting health service models to increase capacity, decreasing costs, and seeking additional international funding. Progressive realisation using well-defined steps will be necessary to allow for a phased implementation as part of a framework of short-term targets towards nationwide policy adoption, and will require international technical and financial support.</p

Walking in Jozi: Guided Tours, Insecurity and Urban Regeneration in Inner City Johannesburg

This article explores how the emerging tourism sector in Johannesburg is intertwined with current processes of urban regeneration and development. Using walking tours as a case study, I illustrate how tour operators navigate insecure urban spaces and contribute to their (re-)development by performing (in)security, by offering ‘authentic’ experiences and by actively engaging in social and economic activities. I argue that walking tours promote a particular kind of urban development that aims to appeal to a new urban middle class and is in line with the vision pursued by big private investors and new urban entrepreneurs. Similar to other global gentrification processes, this vision draws on Western notions of hip urban lifestyles and aesthetics in order to foster an image of the city as pan-African and cool. While making new spaces accessible, this approach to urban development also affects and threatens other inner city users, including African migrants living or working in precarious conditions. I contend that these side effects of the currently promoted urban regeneration have so far been overlooked. In order to create a social and sustainable urban development that supersedes apartheid-era spatial segregation, these effects should be taken into account by the tourism sector, by private investors and policy makers alike