Despite the rapid expansion of public sector highly active antiretroviral (ARV) treatment programs, the private sector continues to be an important source of services and financing for AIDS treatment in Africa. This article reviews currently available information on private sector initiatives, including recent innovations. Private sector providers continue to offer ARV treatment, although adherence problems resulting from high user fees indicate the need for employer, donor, or insurance support. Employer clinics have reported impressive results in patient recruitment and survival. Health insurers are removing AIDS exclusions and expanding AIDS coverage, in some cases with targeted lower cost policies. Public- or donor-funded ARVs have been used to leverage the expansion of populations treated at employer clinics, and attempts are underway to contract for private sector services using public and donor funds. With both funds and clinical resources stretched to meet AIDS treatment goals in countries with a high prevalence of HIV, further efforts are indicated to leverage private sector resources as part of a national treatment plan.
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