If South Africa does not implement a large scale Aids treatment plan soon, five million South Africans will die from Aids in the next eight to 10 years.
This was the message from Western Cape director of health, Dr Fareed Abdullah at the South African Aids Conference in Durban on Tuesday.
He said no Aids programme could be effective without the widespread use of anti-retroviral treatment.
Abdullah, who received a standing ovation from the 4 000 delegates, said, ”no country can survive a calamity of this order. There are two options for South Africa, treatment success or treatment failure. A no treatment option does not exist for South Africa.”
He called on government to scrap its focus on primary health care, ”this is not the time to make cutbacks on component parts of the health service to fund primary care. A case must be made for a new financing framework that will allow health managers to postpone old reform imperatives to reduce spending on secondary and tertiary hospital care in favour of primary health care”.
By 2006, if no anti-retroviral therapy was given to prevent and treat Aids, there would be an average of 1,4-million Aids cases a year in South Africa. From 2004 onward, without interventions to treat and prevent HIV effectively, there would be around 700 000 deaths a year.
Universal antiretroviral treatment would see mortality figures drop to 400 000 a year.
Last year in South Africa 600 000 people died of Aids, according to UNAids.
Abdullah gave a detailed presentation showing that if medication was not provided for the prevention of mother-to-child transmission (PMTCT), as an example, the ”hospital system will collapse with one million additional bed days required. Social security pressures will rise 500% and family household incomes will collapse.
”Spending on Aids is already crowding out general health expenditure and a treatment intervention will focus the country, especially the treasury, on the urgent need to review expenditure levels for health care.”
He warned that a treatment intervention that reaches 20% or 30% of people living with Aids ”will not only be inequitable but will fall short of the desired impact on mortality”.
The Western Cape had five strategic prevention programmes:
A delay in sexual debut through life skills training in schools,
Treatment of sexually transmitted infections,
Voluntary counselling and testing,
Promotion of condom use, and
PTMCT
Abdullah said the roll out of PTMCT in the Western Cape since 1999 had seen 85% of pregnant women volunteer to be tested for HIV. Ten thousand women had been treated with AZT or nevirapine to prevent HIV transmission to their babies, resulting in an overall five percent decrease in HIV infections in babies.
In dramatic graphs, Abdullah showed that HIV infections rose rapidly in babies from 1992 to 1999 to around 2000 babies.
It began plummeting as the PTMCT programme range expanded with virtually no new HIV infections in babies at present.
Turning to nutrition and alternative therapies for Aids, presently being touted by Minister of Health Manto Tshabalala-Msimang, Abdullah emphasised that, ”no amount of micronutrient replacement or alternative therapies will significantly reduce the burden of mortality confronting us as a result of Aids”.
”The mainstay of any effective intervention can only be as a result of anti-microbials, anti-fungals and anti-retroviral therapies.”
The Western Cape is providing triple anti-reroviral therapy to extend the lives of those infected with Aids at five sites, including Khayelitsha, Groote Schuur, Tygerberg, Red Cross Children’s Hospital and Gugulethu, to extend the lives of HIV-infected mothers and children infected with HIV.
Abdullah said counselling and drug adherence support was as important as giving the drugs to HIV infected patients.
”The first six months are highly staff intensive. This is not a simple intervention but its complexity should not be exaggerated.”
He urged, ”We have to get as many people on treatment as soon as possible. We need to build the infrastructure for a scale up and ensure medical staff gets it right first time around through tight selection criteria of those put on drug treatment programmes, treatment preparedness and counselling.”
Challenges government need to overcome, he said, included more efficient drug distribution; the recruitment and retention of medical and nursing staff; sustainable funding in the fiscus and effective counselling and monitoring of those on anti-retroviral therapy. – Sapa