Khadija Magardie
The debate over the affordability of providing anti-retrovirals free in public hospitals has taken on a new controversial dimension, after President Thabo Mbeki quoted an International Monetary Fund (IMF) study out of context on national television.
The study on the economic impact of HIV/Aids in Southern Africa was cited by Mbeki on last Sunday’s SABC Newshour programme in defence of the government’s stance on the provision of nevirapine to HIV-positive pregnant women.
Mbeki said the IMF discussion paper concluded that even if anti-retroviral drugs were made available in all public health facilities, the government of a developing country like South Africa could only afford to cover 10% of the people infected.
It has been established, however, that the study assessed the impact of providing anti-retrovirals to all people infected by HIV/Aids in their respective countries, and not just people in certain categories, like pregnant women and rape victims.
Mbeki’s mention of the study has been criticised as confusing issues because he used its projections to back up what was a discussion specifically around the provision of the drugs, like nevirapine, to HIV-positive pregnant women.
During the programme, host John Perlman quoted a study by the University of Cape Town’s Jolene Skordis and Professor Nicoli Nattrass on mother-to-child transmission of HIV. The study concluded that in terms of long-term financial viability, the costs of providing anti-retroviral drugs to HIV-positive pregnant women would be far less than those for the treatment and eventual hospitalisation of a sick child.
In rebuff, Mbeki cited what he called “an IMF study, on the same question”.
According to Mbeki, the study said that: “As far as South Africa is concerned, if South Africa were to make all these drugs available, it could at best, without a very serious impact on the rest of the budget, only afford to treat, at best, 10% of the people infected.”
“I can produce all sorts of studies on the subject,” Mbeki said.
The actual study concludes that owing to price, anti-retrovirals will remain accessible to a minority of the population only. But it is based on the total figures of people infected; the conclusion is in no way specifically related to mother-to-child transmission. The figures in the study, which include estimates of the costs of drug treatment, cover all people diagnosed with HIV/Aids in the respective countries.
According to the researcher, “significant proportions of the population in the countries covered would not have easy access to the most basic medications for Aids-related diseases”. Quoting recent World Bank figures, the study highlights the finding that, based on total numbers of HIV-positive people, the costs of the drugs, and the gross domestic product per capita in the respective countries, the amount involved would be out of the reach of at least seven out of 11 sub-Saharan countries. South Africa does not fall into this latter category.
These drugs, the study concludes, would “not be affordable for a major proportion of the population”. It includes a table that assumes, on the basis of projections, “a coverage rate of 10%”. This appears to be the figure used by Mbeki.
Reacting to Mbeki’s “cost-factor logic”, Aids activists have described the comments as unfortunate. “Even if we can only save 10%, why not go ahead and save that 10%?” one asked.