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Unified bid to step up AIDS treatment
Liz Clarke. Republished courtesy of Independent Newspapers (pty) Ltd
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The government faces its biggest challenge yet as South Africa's powerful lobby of health-care providers joins forces with AIDS activists to thrash out a national HIV/AIDS treatment plan for the country, including a roll-out of anti-retroviral drugs.
The move, backed by the Nelson Mandela Foundation, is seen as a direct call to government to speed up its treatment delivery plans in the face of a marked and dramatic increase in AIDS morbidity and mortality figures.
Quarraisha Abdool Karim, of the University of KwaZulu-Natal, said that the conference, held in Durban on 29 November/1 December, was a "defining moment" in the country's commitment to AIDS treatment and the diversity of highly active anti-retroviral therapy (HAART) strategies already in place were a strong basis for synergy.
It is estimated that more than 4,5 million AIDS-related deaths will occur over the next five years if no significant treatment plan is in place. Dr Fareed Abdullah, Deputy Director-General of Special Health Projects in the Western Cape, said that there was no way the country could survive such a calamity. Treatment with ARVs, he said, which brought a measure of hope, was "the only effective way" to reduce stigma and discrimination, two of the major stumbling blocks in mounting a meaningful response.
He said that among lessons learned from ARV regimens in the Western Cape co-ordinated by Medecins Sans Frontieres were that treatment should be started as late as possible, good adherence to AIDS drugs is possible in resource-poor settings, and counselling would be an essential element.
The biggest challenge to the roll-out of ARVs would be the selection of those who would qualify for therapy. It would require the costs of drugs to be reduced by 30 to 40 % before universal access to ARVs could be considered.
Another problem is the poor quality of public health care infrastructure in South afr8ica, which on a world scale is rated 173rd out of 191 countries, below Zimbabwe and Rwanda. What is urgently needed is to have guidelines on the numbers of people who would need treatment in the next few years, an assessment of costs involved, and the power to cut through red tape.
The government should also be urged to create a separate ministry for HIV/AIDS. At present R4 billion to R5 billion is included in the health budget of R33 billion. This should be placed in a separate fund for more streamlined access. An estimate by the Treatment Action Campaign (TAC) is that by 2015, R18 billion will be needed to treat approximately 2,7 million infected people. There is optimism that soon ARVs will be produced locally, which will reduce prices.
Zackie Achmat, chairman of the Treatment Action Campaign, said that if Zimbabwe and Namibia, as well as 14 countries in West Africa, could mount a national treatment plan for their infected people, then so could South Africa.
The aims identified at the two-day meeting included:
- setting of minimum standards for ARV treatment regimes, ensuring that the dignity and welfare of patients were paramount;
- creating a comprehensive framework for joint training programmes to accelerate access to treatment and promote ethical standards and quality of care;
- to investigate ways of procuring drugs on a joint basis to get the most cost-effective benefits;
- to look at joint applications for funding - for example, to the Global Fund to Fight AIDS, TB and Malaria - to network the delivery of treatment and services.
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