A SECOND LOOK
Belinda Beresford
Poor South Africans can take anti-retroviral drugs to combat HIV as effectively and safely as patients elsewhere in the world, local researchers have proved.
A study released this week flies in the face of local and international justifications for withholding antiretroviral drugs from South Africans. Such arguments have included cost now rapidly falling; the lack of infrastructure being addressed by the private sector; and bizarre suggestions that Africans can’t tell the time well enough to follow complicated drug regimes.
Ian Sanne, of the Clinical HIV Research Unit at Wits University, with doctors at Baragwanath and the University of Cape Town, has analysed more than 750, often indigent, patients in 16 clinical trials. The researchers found that compliance rates among the patients were comparable to those in studies elsewhere in the world, as were the decreasing levels of HIV in the patients’ blood.
In part these results are the outcome of evolving technology. A good triple-therapy regime can consist of two pills, taken twice daily. The days of taking handfuls of pills at strange hours are over for many.
The new research highlighted the need for faith in local solutions. There are differences between treatment in developed and underdeveloped countries. For example, the South African study found that women were as faithful in taking the drugs as men, contrary to evidence in the developed world. In the West HIV-positive women are more likely to be drug users and less likely to be compliant. Similarly, the trials found that younger patients tend to be less compliant and need more intensive education and monitoring.
There are loud arguments that providing anti-retroviral drugs to the public is, if not impossible, inequitable or even dangerous. Lack of compliance in taking the drugs will see a surge of drug-resistant virus, removing weapons from the arsenal against HIV. Such problems are being encountered in the United States and the United Kingdom.
The real lack of equity is, however, going to be emphasised as the private sector discovers the cost benefit in providing anti-retroviral drugs to workers, giving the employed hope denied to the unemployed. Anglo American is planning to start eight pilot sites in September. The studies will look at using an Internet-based system to advise health care workers and monitor treatment. The system, run by a section 21 South African company, Right to Care, will allow experienced HIV doctors to provide advice on a secure Internet system.
Anti-retroviral drugs not only prolong but also save lives by reducing the infectiousness of patients and so potentially save others from the disease. The study shows that South Africans can set out on a journey that will provide some equity between people with HIV in the developed and underdeveloped worlds.