In Sub-Saharan Africa about 27 million adults are currently living with HIV/Aids. Yet according to the World Health Organisation, just 1% of HIV positive people in the region have access to treatment - 50,000 out of 4.1 million who need it.
In Africa, the WHO will face a massive challenge to reach the target of its 'three by five' campaign, which aims to get treatment for 3m people by 2005. Even if the prices of drugs can be brought sufficiently low, health delivery systems need to be expanded. In most rural areas, there are simply no clinics with the equipment, staff and facilities necessary to do the vital work of prescribing, testing and counseling and even in urban areas, demand far outstrips supply.
So it is inevitable that for years to come, even as access to treatment is scaled up, many fewer will get the drugs than need them.
In the meantime, who should get the treatment that is available? How should access to the drugs be allocated? Is there any way to deliver such desperately sought-after drugs fairly? Would a lottery in which patients eligible for ARVs compete to win their treatment by random selection - as in some Latin American countries like Chile and Guatemala - be fair, if brutal? Or would that be an abdication of responsibility?
For some it is obvious that skilled medical personnel should be the ones to decide who should get the drugs. Even though this would mean accepting an uneven and chance access to treatment, essentially decided by a patient's luck in being near clinics with competent personnel and drugs to supply, many would say this has to be the safest option.
For others, priorities need to be set. According to the World Bank, half of Malawi's professional workforce could die of AIDS by 2005. Health technicians and teachers are worst affected, along with the army and police. Life expectancy in the country is down to 36. Without prioritising strategically important members of society for treatment, a country could simply reach a point beyond which it is unable to run its own affairs, opening the way to a collapse of the state.
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There may be another case for prioritisation. Without support, weaker members of society unable to fight their corner will fail to get treatment. In both Nigeria and Burundi, rights activists have pointed out that hardly any children are being treated under subsidised ARV programmes.
Many would argue that allowing any specific group to move to the front of the line would constitute social engineering, and would, in any case, be abused or subverted. They may have a point: Even with the existing treatment programs, there are reports of wealthy people siphoning drugs out of the public health system for their own use, witness the reports of some Zambian nurses accepting bribes to advance names up the waiting list for treatment.
Tell us your views. Whether you are doctor, nurse or health adviser in Africa, a person living with HIV/Aids or a relative of someone who is ill, share your thoughts on treatment policies. Perhaps you are involved in policy-making and trying to plan for a future in which HIV is decimating your country's skills base or working to advance human rights in Africa; whatever the case - Join allAfrica.com's debate
