While the Treasury and Department of Health(DoH)number-crunch to determine whether government can afford anti-retroviral (ARV) treatment in public health, a number of small ARV programmes are already up and running.
At present, about 700 South Africans who cannot afford medical aid are receiving ARV treatment through a number of research projects, according to a recent ARV conference organised by the Treatment Action Campaign (TAC).
Although modest, the projects - all located either in the Western Cape, KwaZulu-Natal and Gauteng - have already learnt some important lessons. The Western Cape is the most advanced, with seven ARV projects treating over 500 people.
The Khayelitsha programme, started in May 2001 by Medicins sans Frontieres (MSF) and supported by the provincial administration, is the biggest and oldest public health ARV programme in the country.
One of the most striking things about the Khayelitsha project is that it is utilising very cheap generic ARV drugs imported from Brazil which cost R10 per patient per day. It has been given permission to do so - in terms of what is called a Section 21 exemption - by the Medicines Control Council.
We have over 300 patients on anti-retrovirals, and this has completely changed the attitude of health workers. They now see they can do something for people with AIDS, says Dr Fareed Abdullah, Deputy Director General of special health projects in the provincial administration.
We have found that counselling is an essential part of treatment if we are to ensure that people adhere to their treatment, Abdullah told the TAC conference.
Dr Lorna Jenkins from an ARV research project run at Chris Hani-Baragwanath Hospital in Gauteng, says her best advice is don't rush to start.
It is better to wait until your patients are well educated about the programme and you have thorough medical information about them, said Jenkins.
Identifying those in need of ARV treatment is not always easy, given that people often deny that they have HIV. In South Africa, tuberculosis and HIV often go hand in hand.
For example, in 2001 in KwaZulu-Natal 64.6% of the province's 65 654 TB patients were also HIV positive, according to the University of Natal's Professor Slim Abdool Karim. Nationally, 47.6% of TB patients were HIV positive.
There are about 4.7 million people living with HIV in the country, said Karim. How do we find those in need of treatment? One efficient way to people through existing TB treatment programmes. The care infrastructure for TB already exists and there is a high co-infection rate of TB and HIV. In addition, experience from other countries shows us that co-infected patients have a high mortality rate, he said.
But while TB programmes might be a good way to find the people who need AIDS treatment, Karim warns that running TB and ARV treatment concurrently will not be easy.
While these small projects have uncovered a number of important issues, as Karim says, there is a policy vacuum and a leadership vacuum.
Government needs to step in and guide the process if there is to be equal access to anti-retroviral treatment countrywide, rather than small research-driven projects set up here and there.(Source: Kerry Cullinan, Health-e, 28-01-2003)