R1,8bn award could turn tide against AIDS

The multi-billion dollar international Global Fund for AIDS, Tuberculosis and Malaria has given a whopping R1,8-billion to South Africa - the biggest donation to any country.

The donation, coupled with President Thabo Mbeki's new public statements on HIV/ AIDS and the move to give anti-retroviral drugs to pregnant women and rape survivors, could prove to be the turning point in the war against the epidemic.

The award to South Africa comes in two parts.

Just more than $93-million (about R1-billion) goes to the government "to strengthen national capacity for treatment, care and support related to HIV and TB, building on successful behaviour change".

The proposal to the fund was submitted by the government under the auspices of the SA National AIDS Council.

A further $72-million (about R792-million) is to go to a project proposed by the KwaZulu-Natal government, together with the Enhanced Care Initiative at the University of KwaZulu-Natal and other stakeholders, which a Global Fund spokesperson described as "possibly the most unique and exciting proposal we received from around the world".

The Global Fund spokesperson also said the grants showed the levels of concern internationally about HIV being rampant in South Africa.

A government official, speaking ahead of Minister Manto Tshabalala-Msimang's statement, said, "The inter-governmental review showed that last year South Africa lost R6-billion a year to AIDS.
"Last week's bold steps (in extending anti-retrovirals to pregnant women and rape survivors) and this grant, should begin turning the tide against HIV/ AIDS and TB in South Africa."

The success of the scheme in KwaZulu-Natal is important to the rest of the world. At present there are 45 million people in the world infected with HIV, and the figure could rise to 100 million in the next two years.

Most of the sufferers are in developing nations.

There are just more than five million people infected with in South Africa, with 2 000 new infections a day. In 1991 just one percent of pregnant women were infected with HIV: now infection rates of 40 percent to 50 percent are being found in KwaZulu-Natal, according to research.

At Cecilia Makiwane hospital in East London, the rate is hovering at the 60 percent mark.

"If South Africa can succeed in KwaZulu-Natal based on the proposal we awarded money to, then it will present key guidelines for the rest of the world," a Global Fund spokesperson said.

KwaZulu-Natal becomes the largest and most important site in the world to show whether or not a co-ordinated multi-faceted programme of care, prevention and medication can stop HIV's rampage.

The package will see anti-retrovirals go to 400 000 employees of businesses that are members of the Durban Chamber of Commerce and the KwaZulu-Natal Chamber of Commerce.

Anti-retrovirals will go to mothers with HIV whose babies' lives are saved by nevirapine, to ensure mothers live longer and can take care of their babies and stem a rapidly growing number of orphans in the province.

Over time it is hoped that fathers will also be included in this programme. At present there are an estimated 300 000 Aids orphans in South Africa, of which more than half are in KwaZulu-Natal, and the number is accelerating fast.

Massive voluntary counselling and testing programmes will begin with an average of four counsellors across an as-yet undetermined number of sites province-wide, including those in hospitals, schools, and other non-medical sites.

The project will also hopefully transform provincial and national economic projections and indicators.

For the first time, accurate information will be available about not only areas of HIV infection in KwaZulu-Natal but which economic sectors are carrying the highest burden of infection.

Although the initial figures will apply to that province, the data will make projections more accurate for the rest of the country.

One of the ground-breaking facets of the KwaZulu-Natal proposal focuses on home-based care for AIDS patients.

At present it costs government R720 a day, or R262 800 a year, for every AIDS patient in an academic hospital, while home-based care sees costs drop to R600 to R900 a year for each patient.

At private sector costs, a person ill with HIV, according to Netcare, will spend close to R700 000 on health costs in the course of their life.

As hospitals strain under the burden of AIDS patients, home-based care run by community volunteers becomes essential.

Funding direct to government is an attempt to stem a tide of TB linked to HIV.

Without an urgent intervention of the type presented by the Global Fund, South Africa will have more multi-drug resistant TB strains by 2004 than ordinary TB, according to the World Health Organisation.

Multi-drug resistant TB is increasing because most people are too poor to eat when they take the TB medication, as directed.

If taken on an empty stomach, it provokes nausea, so many people stop the treatment.