Since 1996 Uganda has pioneered the use of ART in sub-Saharan Africa. The ARVs were initially imported and distributed to those patients who could afford to buy them. Joint initiatives between international organizations such as UNAIDS and private organizations such as the Joint Clinical Research Centre (JCRC) helped to reduce the cost of ARVs, making them accessible to many more people. The importation of cheaper generic drugs into the country by private institutions such as JCRC has caused pharmaceutical companies to significantly reduce the price of some patented ARVs (Mugyenyi, 2001).
As AIDS became the second highest cause of death in Uganda after malaria, the JCRC was established in 1991, with support from the Government, as the country's first AIDS treatment research centre. However, since ART was very expensive only a few government officials and other high-income people could access the medicines. Even after securing permission to import generic ARVs, prices were still prohibitively high for the general population.
ARV medications became more widely available in Uganda in 2004 when the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the US President's Emergency Plan for AIDS Relief (PEPFAR) came in to support the provision of ART for people with AIDS. These two agencies provided unprecedented multilateral support and enabled the scaling up of access to ART (Gill et al., 2005).
In June 2004, the Government of Uganda implemented an ARV programme in one national referral hospital (Mulago), in all 11 regional referral hospitals and 11 district hospitals, providing ARVs to 2700 patients. At the time of this study, the Uganda Government, under the National Strategic Framework for Expansion of HIV/AIDS Care and Support - 2001/2-2006/7, was providing ARVs through 140 accredited sites. Most of these are district hospitals and health centre IVs (rural health units offering primary health care, usually staffed by one doctor, one clinical officer, three nurses and three midwives). By September 2005, 14 300 patients were accessing ARVs through these Government facilities (National Strategic Framework for Expansion of HIV/AIDS Care and Support - 2001/2-2006/7).
In addition to the Government facilities, some nongovernmental (private not-for-profit) organizations also provide ART. The foremost of these are: The AIDS Support Organisation (TASO) with 6600 patients; JCRC which provides ARVs to 18 000 people through its various sites across the country; and Mildmay International Centre with 2500 clients on ART. Others include Uganda Cares, Medical Access and the Uganda Business Coalition for HIV/AIDS.