HEALTH-SOUTH AFRICA: Ample Time Needed to Provide Free Anti-retrovirals

By IPS Correspondents Reprint | | Print |

Anthony Stoppard

JOHANNESBURG, May 14 2003 (IPS) - South Africans living with HIV and AIDS will have to carry on waiting, while the government decides if it will make anti-retrovirals, drugs which ease the impact of the disease and reduce its transmission from mother to child, freely available in the public health system.

Last week, a joint task team, comprising officials from the department of health and the national treasury, concluded that the country could afford to provide the anti-AIDS drugs to those who need it, and should do so as soon as possible.

Some of the details of the report were first published in the Johannesburg-based Financial Mail. According to one of the scenarios presented in the report, South Africa could comfortably provide the drugs to half-a-million people with HIV and AIDS, at a cost of R4 billion (around 556 million U.S. dollars) a year.

This would make it the largest and cheapest anti-retroviral treatment programme in the world.

But, in her budget speech in Parliament on May 13, the minister of health, Manto Tshabalala-Msimang, said: "Government appointed a Joint Health and Treasury Task Team to undertake a comprehensive projection of the costs of various treatment options, including the use of anti-retrovirals. The report of this team will be presented to cabinet in the very near future and a decision will be taken on this issue that has come to dominate the public debate on HIV and AIDS."

The announcement leashed another wave of criticism from anti-HIV and AIDS activists that the government is dragging its heels on making the anti-AIDS drugs available, even though around 4.5 million South Africans are living with the disease.

The Treatment Action Campaign (TAC), which is lobbying the government to freely provide the anti-HIV and AIDS drugs, estimates that about 600 South Africans are dying from HIV and AIDS a day.

"The excuse that we cannot afford a national rollout of anti-retrovirals, was always flawed, since the state spends an estimated R4 billion (around 556 million U.S. dollars) on treating patients for opportunistic infections. A mere 10 percent reduction in the number of patients being treated for AIDS symptoms will save hospitals an estimated R400 million (around 56 million U.S. dollars) a year," says Mike Waters, of the official opposition in Parliament, the Democratic Alliance (DA).

The DA has called on the cabinet to deal with the report as "a matter of urgency".

Besides the cost, the government has been reluctant to make anti-retrovirals freely available in the public health system because of concerns that they are toxic and that patients will not take them as prescribed – increasing their danger. It is generally accepted in the international medical community that while anti-retrovirals are dangerous, they are the best available means of reducing the effects of HIV and AIDS and reducing the transmission of the disease.

Government is also frustrated that it has not received enough credit for its heavy investments in education and prevention programmes, and its efforts to combat infectious diseases that take advantage of the way HIV and AIDS weakens the human immune system. Government considers these programmes to be among the best of their kind in the world.

It has also made the anti-retroviral, Nevirapine, available at more than 650 service points as part of a test programme to measure its effectiveness in reducing the transmission of HIV and AIDS from mother-to-child.

Instead, much to government’s irritation, all attention is focussed on its reluctance to implement a comprehensive anti-retroviral treatment programme. So, even though its task group recommended the rollout of a comprehensive anti-retroviral treatment, government still has to manage a careful political climb-down if it is to implement it.

Over the past month, government has been staring down TAC – which has been running a defiance campaign in support of their demands for free anti-retrovirals for those who cannot afford them.

TAC activists – many of them members and supporters of the South Africa’s ruling African National Congress (ANC) – have been disrupting public speeches by Tshabalala-Msimang and invading police stations and government offices.

Some South African political commentators believe the controversial campaign has hardened government’s position, as it does not want to be seen giving in to civil disobedience.

For now, the TAC has suspended its defiance campaign and entered into another round of talks with government over making the anti-AIDS drugs available in the public health system. Some commentators hope the suspension of the TAC defiance campaign will give government room to agree to a rollout of a comprehensive treatment programme, without looking as if it is caving in to the demands of the TAC.