Patients' readiness to start highly active antiretroviral treatment for HIV.

al. The San Francisco men's health study: continued decline in HIV sero-conversion rates among homosexual/bisexual men. A. The influence of women's changing roles and status in Bangladesh's fertility transition: evidence from a study of credit programmes and contraceptive use. (Development policy and practice working paper 41.) 21 Ahmed SM. Intimate partner violence against women: experiences from a woman-focused development programme in Matlab, Bangladesh. A. The impact of social, economic and sexual empowerment: commercial sex workers [abstract 447D]. X international conference on AIDS, Yokohama, 1994. 26 Communication Initiative. Programme experiences: Rusape girls empower-ment village, Zimbabwe. The intervention with microfinance for AIDS and gender equity study Assessing whether patients are ready to start antiretroviral treatment may improve HIV prevention and treatment outcomes Initiatives to increase access to antiretroviral treatment in resource constrained settings are growing, but the scale and magnitude of the HIV epidemic in these settings raises a number of operational and ethical challenges. Most people infected with HIV are unaware of their status, and people who are aware of their status fear stigmatisation and discrimination. Key themes about access to treatment include who gets treatment, when is the best time to start treatment, and how to ensure therapeutic success. Numerous guidelines for treatment have been developed nationally and internationally. One concern is how initiation of antiretroviral treatment should relate to patients' readiness and commitment. Although patients' readiness is emphasised as a requirement for starting treatment in several guidelines, 1–4 the guidelines are neither clear nor in consensus about what constitutes readiness and how this readiness should be assessed. Given this ambiguity, readiness may be used to ration resources, particularly in resource poor settings, in which access to antiretrovirals is currently gaining support. The potential of using readiness to improve HIV prevention and care outcomes, however, mandates that we closely examine the use of readiness for starting highly active antiretroviral treatment (HAART). Studies about assessing patients' readiness for starting HAART or the impact of this on therapeutic success are few. One small study found that lack of readiness resulted in interrupted treatment and risky sexual behaviour; therefore, readiness for treatment may help care givers to make decisions about when to start treatment with antiretrovirals for each patient. 5 The potential importance of treatment readiness for therapeutic success is why a more structured and systematic approach to evaluating readiness is needed. In addition, a systematic evaluation of the use of treatment readiness …