The question facing African governments and societies, say Rosen and colleagues, is not whether to ration such therapy, but how to do so in a way that maximizes social welfare.
Heineken Breweries launched a workplace HIV/AIDS program at its Rwanda subsidiary in September 2001. By January 25, 2005, 736/2,595 eligible individuals had reported for counseling and HIV testing: 380/521 employees (72.9%), 254/412 spouses (61.7%), 99/1,517 children (6.5%), and 3/145 retired (2.0%). As a result, 109 HIV+ individuals were identified: 62 employees, 34 spouses, 12 children, and 1 retired. In September 2003 an anonymous HIV seroprevalence survey was performed with participation rates of 69.4% for employees, 58.2% for spouses, and 79.7% for adolescents. Using the survey result, the expected number of HIV+ employees was 71, which implies a program uptake of 87.1% (62/71) in this group. Of the identified 109 HIV+ beneficiaries, 42 were on highly active antiretroviral treatment (HAART). In November 2003 a qualitative study of awareness and health-seeking behavior of the Heineken Rwanda beneficiaries identified key principles contributing to the success of this program.
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