Scale-ups, scarcity, and selections: the experience of doctors in South Africa

Objectives: To present the ethical and clinical experience of public sector physicians during the post-Apartheid period in South Africa, who were faced with poverty, medical scarcity and unexpected government resistance in treating individuals with HIV infection. Methods: Oral history interviews with 73 physicians from major cities, mine company clinics, and rural hospitals selected because of their long-standing commitment to treating people with AIDS. Conclusion: The onset of the government's 'rollout' of antiretroviral therapy (ART) in 2003, providing drugs to public sector patients, has not put an end to the rationing of care that characterised the pre-ART period. Subsequently, rules were established to guide such rationing in an equitable fashion. But there are occasions when doctors override their own rules, demonstrating the complex interplay between principles of equity and the claims of moral duty to patients, especially in instances of life and death. (c) 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins.