Adherence to HAART: Africans Take Medicines More Faithfully than North Americans

In 2001, the chief of the United States Agency for International Development (USAID), Andrew Natsios, gave this justifi cation to the US Congress for why the agency opposed giving antiretroviral therapy (ART) to Africans with HIV:“If we had [HIV medicines for Africa] today, we could not distribute them. We could not administer the program because we do not have the doctors, we do not have the roads, we do not have the cold chain...[Africans] do not know what watches and clocks are. They do not use western means for telling time. They use the sun. These drugs have to be administered during a certain sequence of time during the day and when you say take it at 10:00, people will say what do you mean by 10:00?” [1].Natsios was not the only policy maker to justify withholding ART from Africans on the basis that weak infrastructure, or patients’ inability to take tablets, would stymie adherence. Senior offi cials of the World Bank and Thai government said in