South Africa has the most extensive antiretroviral treatment programme in the world — but experts in the field are warning that it is failing and could soon collapse.
Aids activist and deputy chairperson of the South African National Aids Council Mark Heywood said the 2009-10 budget for ARV provision will fall short by R1-billion if the numbers of infected people continue to grow at their current pace.
The Free State health department ran out of money for ARV delivery towards the end of the 2008-09 budget cycle.
Two weeks ago the Health Department met researchers, senior officials and organisations dealing with HIV and HIV treatment in Pretoria to examine the cost of providing treatment, based on the numbers of people already receiving medication, the cost of medication and the number of people with HIV/Aids who will need to move on to treatment during the year.
“Based on those numbers the current budget falls short by about R1-billion,” said Heywood.
Roll-out was failing because the government had waited too long to put a programme in place. It now had to cope with extremely large numbers of sick people, in a context of inadequate resources and poor management, he said.
“As more people get on to the programme it is important to have commitment from government and its Cabinet to have proper funding for the programme and avoid the possibility of people falling off the programme and stock-outs in the future,” Heywood said.
The head of policy, communication and research for the Treatment Action Campaign, Rebecca Hodes, said that elements of the state programme were working, while others were not.
The government had to use its finances in a smarter way, Hodes said. “We need to spend on what works and we need to use research to give guidance on where we use the funds.”
She said research across the world showed that calls for abstinence did not work. Despite this, and the growing number of new infections, the government continued to spend large sums on teaching abstinence in schools.
“We should be spending money teaching positive prevention, ensuring better treatment of sexually transmitted diseases and on circumcision,” said Hodes.
The government should also consider starting people on medication earlier to reduce the high levels of co-infection with tuberculosis. “We can’t just pay lip service to HIV only — 85% of HIV positive people are co-infected with TB.”
Hodes said HIV/Aids activists had been “terrified” that last year’s Free State stock-out, which left thousands of people without medication and resulted in many deaths, might be repeated.
“We’re worried that the current global crisis will lead to even tighter finances. We need better management of finances and resources, especially in provinces. Provinces that do not manage their budgets correctly must be held accountable.”
National Health Department health spokesperson Fidel Radebe insisted that the programme is working well, despite the meltdown in the Free State.
“We’re managing the progamme,” Radebe said. “When you have a problem such as the one in the Free State, you start putting measures in place.”