Belinda Beresford There are only a couple of hundred doctors in South Africa fully trained to treat HIV-positive individuals. But thousands of other medical personnel are having to deal with HIV/Aids patients, because the hospitals and clinics can no longer cope. Anti-retroviral treatment regimes are difficult to administer because of the powerful side effects and the complex interactions between the drugs, as well as the risk of drug resistance. This means that whatever routine an HIV- positive person starts on affects what treatments can be used further down the line. The Southern African HIV Clinicians Society was set up about 18 months ago to improve access to antiretroviral treatment, by providing both the drugs and the training doctors need. The organisation’s chair, Dr Des Martin, says it already has more than 1E000 doctors who wish to learn more about this area of medicine, which is now viewed as a speciality in itself. In the US, for example, more than 80% of HIV- infected people are treated by less than 1% of practising doctors.
“Doctors don’t feel confident in dealing with patients, but it’s a fact of life they would need to know this. It is no longer an option to refer on, you have to deal with it yourself.”
Martin says centres of excellence for HIV care are urban based, often attached to big teaching hospitals. But he points out that there are also similar hospitals – such as regional facilities in rural KwaZulu-Natal – that have very good track records. Between 5 000 and 10 000 HIV-positive South Africans are receiving the “gold standard’ of highly active anti- retroviral therapy. About 400E000 others are receiving some form of care such as limited anti- retroviral therapy and treatment for opportunistic infections. This is often part of a managed care programme. Most of the estimated 4,2-million HIV- infected people in South Africa receive what care they can at state facilities. But these facilities are becoming overwhelmed with the huge numbers of patients, and are rarely able to diagnose – let alone treat – some of the illnesses that latch on to immuno- compromised patients. Most Aids patients die from tuberculosis, with which doctors are well acquainted. But anything else poses problems where diagnosis is concerned. As one physician in an urban public hospital says: “God help you if you don’t have just tuberculosis. We don’t have the resources to diagnose anything else.” Not that the physician has many options himself. He is currently treating a man with Aids suffering a rare form of tuberculosis which is very expensive to treat. “I now have to decide whether to give him six months of therapy, which will mean a fight with the state,” he says, “or send him home to die.” For many people the only chance of getting anti-retroviral
drugs is to try and get on to a drugs trial, with the risk of receiving placebo drugs and the treatment stopping when the trial stops. There are waiting lists for many of the trails. Alternatively, some people are illicitly importing their own drugs, either cheaper generics from countries like Thailand and Brazil, or unwanted “recycled” drugs from countries like the United States.