Health Policy 99 (2011) 261–266 Contents lists available at ScienceDirect Health Policy journal homepage: www.elsevier.com/locate/healthpol Equity in the use of antiretroviral treatment in the public health care system in urban South Africa Susan Cleary a,* , Sheetal Silal a , Stephen Birch a,b,f , Henri Carrara c , Victoria Pillay-van Wyk d , Thomas Rehle c,e , Helen Schneider e a Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, 7925, Observatory Cape Town, South Africa b Centre for Health Economics and Policy Analysis, McMaster University, Canada c Department of Social Aspects of HIV/AIDS and Health, Human Sciences Research Council, South Africa d Burden of Disease Research Unit, Medical Research Council, Cape Town, South Africa e Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa f School of Community Based Medicine, University of Manchester, UK article info Keywords: Antiretroviral treatment HIV/AIDS Socioeconomic inequalities in use Health care access abstract Objectives: The scaling up of antiretroviral treatment (ART) for HIV-infected adults requires a sizeable investment of resources in the South African public health care system. It is important that these resources are used productively and in ways that reach those in need, irrespective of social status or personal characteristics. In this study we evaluate whether the distribution of ART services in the public system reflects the distribution of need among adults in the urban population. Methods: Data from a 2008 national survey were used to estimate the distribution of socioe- conomic status (SES) and sex in HIV-positive adults in urban areas. These findings were compared to SES and sex distributions in 635 ART users within 6 urban public ART facilities. Results: Close to 40% of those with HIV are in the lowest SES quintile, while 67% are women. The distributions in users of ART are similar to these distributions in HIV-positive people. Conclusions: Patterns of ART use in study settings correspond to patterns of HIV in the urban population at the national level. This suggests that the South African ART programme is on track to ensure equitable delivery of treatment services in urban settings. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Sub-Saharan Africa has only 10% of the world’s pop- ulation, but has more than two-thirds of the world’s HIV-infected people and bore more than three-quarters of the HIV-related deaths in 2007. Southern Africa is the most affected region with more than 35% of the world’s HIV-infected people, half of whom live in South Africa [1]. Extensive circular migration between other Southern * Corresponding author. Tel.: +27 21 406 6755; fax: +27 21 448 8152. E-mail addresses: Susan.Cleary@uct.ac.za, Susan.Cleary@gmail.com (S. Cleary). African countries and South Africa is also likely to con- tribute to these epidemics [2]. In the recent “HIV&AIDS and STI National Strategic Plan” [3] the South African government committed to providing “an appropriate package of treatment, care and support ser- vices to 80% of people living with HIV... by 2011” (p. 64). The 2004 National Antiretroviral Treatment Guidelines [4] recommend that antiretroviral treatment (ART) for adults should be started when an individual’s CD4 count falls below 200 cells/l and/or the individual has an AIDS diag- nosis, hence providing an evidence-based measure of ART need. Allocating resources according to need, irrespective of sex, socio-economic status (SES) or any other character- istic of individuals would represent the most productive use of these resources. Such an approach would also be con- 0168-8510/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2010.10.016