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What made Cabinet change its mind on HIV/AIDS?
Kerry Cullinan. Health-e News Service
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Cabinet's surprise decision to make anti-retroviral drugs available to rape survivors contradicts the ANC's National Executive Committee's position taken in March.
However, it represents a victory for a number of key government officials who have been working for months behind the scenes to improve government's HIV/AIDS stance. These include Health Director General Dr Ayanda Ntsaluba, head of the HIV/AIDS Directorate, Dr Nono Simelela, Joel Netshitenzhe, head of Government Communication and Information System and Inkatha's Dr Ben Ngubane, Minister of Arts, Culture, Science and Technology.
Last month, the ANC NEC announced that anti-retroviral drugs to prevent HIV transmission following sexual assault or needle-stick injury "could not be provided in public health institutions" as their efficacy was "unproven". After the NEC decision, health officials believed their recommendation for drugs for rape survivors would never get past Cabinet and they reported biting their nails in anxiety while waiting for the outcome of the Cabinet meeting.
However, after Cabinet's announcement Dr Simelela said she was "very, very happy" and looked forward to the speedy implementation of the new plans. Government has allocated a massive R1 billion to tackling HIV/AIDS for 2002/03, an increase of over R600-million in one year.
Why the turnabout? Official sources say that government has been trying to make a new start on HIV/AIDS all year.
Dissatisfaction with the government's handling of HIV/AIDS was voiced at January's Cabinet "lekgotla", and Ministers Manto Tshabalala Msimang, Essop Pahad and Dr Ngubane were charged with preparing a document that could improve on this.
President Mbeki indicated in his address to Parliament in February that government was committed to "intensifying its comprehensive programme against AIDS" and had "initiated discussions with some of [the pharmaceutical companies] to examine new ways of making drugs more affordable and to strengthen our health infrastructure".
Meanwhile, Dr Simelela's directorate and Dr Nsaluba were drawn into preparing the new document for the three ministers. This went through a number of Cabinet committees before finally reaching Cabinet on Wednesday.
In the meantime, however, confusion with the Nevirapine roll-out, which was incredibly badly handled by Dr Tshabalala Msimang, and the subsequent court case instituted by the Treatment Action Campaign had made government look even worse. The HIV/AIDS proposals gave Cabinet the golden opportunity to send a message of hope to the nation, particularly on the eve of the Moral Regeneration conference, called in response to baby rapes in the country.
Strangely, some ANC NEC members had access to this document before their meeting last month, yet still resolved that drugs for rape survivors should not be available in public health. Aside from anti-retroviral drugs for rape survivors, other important Cabinet recommendations are: the establishment of a Presidential HIV/AIDS Task Team consisting of Deputy President Jacob Zuma and Ministers Tshabalala-Msimang, Pahad and Ngubane; revamping the SA National AIDS Council (SANAC), the multi-sectoral body that was charged with leading the national HIV/AIDS campaign.
Health spokesperson Jo-Anne Collinge said SANAC was going to be "significantly changed", as at present it was a "voluntary structure with no independent administrative capacity". Dr Simelela said recently she would like SANAC to include all HIV/AIDS stakeholders in the country. It would then be able to set priorities and make applications for money to the Global Fund to Fight HIV/AIDS, TB and Malaria.
The Treatment Action Campaign's Nathan Geffen said his organisation would give "serious consideration" to becoming part of a genuinely representative SANAC. They would call for recognition that anti-retroviral drugs "can make a difference", and commitment to obtaining these drugs more cheaply by engaging manufacturers, investigating generics and applying to the new Global Fund to Fight HIV/AIDS, TB and Malaria for help. They would also issue a call to people living with HIV/AIDS to "partner with government" in monitoring the availability of drugs at health institutions to treat opportunistic infections.
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