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JOHANNESBURG, 7 July 2011 (PlusNews) - National AIDS programmes are feeling the pinch as the international community and governments rethink their prioritization of AIDS over other infectious diseases. The withdrawal of support for the fight against HIV is gaining momentum and it is time to get angry, according to Francois Venter, head of the Southern Africa HIV Clinicians Society. He spoke to IRIN/PlusNews about debunking the five major claims fuelling the backlash against global HIV expenditure, drawing on work by University of Cape Town professor Nicoli Nattrass and long-time HIV activist Gregg Gonsalves.

Claim 1: AIDS spending is disproportionate to the disease burden

“People say AIDS shouldn’t be the priority. There are a whole lot of disaffected people who feel they lost out, so they might think it should go to… education, arms or whatever priority they feel is more important. We need to be harsh about this [claim] and say that we’re spending what we should be spending.

“We’ve actually spent so long underfunding health as a whole, and particularly HIV and tuberculosis, that we probably could be spending even more money now [on them].” 

Claim 2: The rise in HIV/AIDS spending has been at the cost of health spending elsewhere

Nattrass and Gonsalves have noted that while the proportion of HIV spending in health budgets globally more than doubled between the early 1990s and 2005, health spending increased generally – a gain Venter said was largely due to the advocacy around HIV.

“We have increased the amount of money being spent on health largely due to the advocacy around AIDS by saying, ‘this is the right thing to do’,” he told IRIN/PlusNews at the recent South Africa AIDS conference.

“If you look at the ‘pie’ it’s much, much bigger than it was 10 years ago. It’s still not big enough but we need to acknowledge that [progress on HIV] is not at the expense of a whole range of other things.”

Claim 3: The AIDS response undermined health systems by creating the “biggest vertical programme in history”

“I think we need to honestly acknowledge the fact that other health programmes are not functioning. I acknowledge the fact that the AIDS programme has been vertical and needs to be [integrated]. I think that AIDS programmes have had minimal impact on other programmes. The challenge for us in the HIV world is going to be to repair the rest of the healthcare system; we’ve made some real strides forward in terms of improving it.”

About 70 percent of HIV patients on treatment in the developing world receive drugs funding at least in part by the Global Fund to Fight HIV, TB and Malaria but Nattrass and Gonsalves highlight that more than one-third of the Fund’s money has gone to strengthening health systems.

The authors note that while the AIDS response initially centred around treatment activism focused on antiretrovirals and the prevention of mother-to-child transmission, it increasingly moved to other illnesses including tuberculosis, sexually transmitted infections and cervical cancer. 

Claim 4: The AIDS response has undermined health systems directly by attracting human resources out of the public health sector

While Nattrass and Gonsalves acknowledge this happened in some cases, they cite a review of studies that concludes that in most cases, the HIV response helped build better public health systems.

Claim 5: Prioritize HIV prevention and radically cut back on AIDS treatment

“This is the one that makes me the sickest and I cannot understand that in this day and age people have started arguing that we should take away drugs from sick people and turn them to [HIV] prevention,” Venter said.

“I don’t think anyone... would argue prevention is properly funded, or has enjoyed the support that everything else gets but to try and pretend that [prioritizing prevention over treatment] is something we can do without losing a lot of sleep over? It’s just rotten.”

Venter quoted Gonsalves, who recently wrote the following in response to the backlash against funding HIV: “So when people say, ‘oh we can’t afford to treat people with HIV. It’s becoming an entitlement,’ we need to reflect on this abject terror: ‘we have what it takes to keep you alive, but we won’t pay for it. Your family is going to watch you die.’

“That’s what it was like eight or nine years ago, that’s what it was like in the United States 15 years ago. We need to tell people when they turn around and say, ‘we just need to spend on prevention,’ that this is what they actually mean,” Venter added. “You’re going to take people [with HIV] and send them back to their families to die and that is not acceptable.”

Rarely in South Africa can a minister have come to power carrying such a weight of expectation as Barbara Hogan. Her first major public speech at the Aids Vaccine Conference in Cape Town in October was greeted with enthusiasm, and even international delegates speculated about the bright future that seems to lie ahead at last for South African healthcare. Her speech was reminiscent of one of those games where one has to bash crocodiles on the head as they pop up apparently randomly through holes in the floor. Politely, and without naming names, Hogan took a baseball bat and bashed all the major crocodiles on the head: Matthias Rath and his vitamins, for instance. Most of all she asserted the fact that HIV causes Aids.

Human rights in health care is not just an apartheid-era issue, but one that still challenges health professionals in South Africa today, the director of the Steve Biko Foundation, Nkosinathi Biko, said on Wednesday.

Africa's governments are failing children affected by HIV/AIDS - up to 65 percent of countries in sub-Saharan Africa have no national policy in place to care for orphans and vulnerable children, a new UN Children's Fund (UNICEF) report has found. According to the report Africa's Orphaned Generations, the cultural practice of the extended family caring for orphans has so far relieved the pressure on governments and national institutions, but this was slowly unravelling. Families had become overstressed and overwhelmed, UNICEF Executive Director Carol Bellamy told journalists at the release of the report on Wednesday in Johannesburg. Orphaned children could no longer remain invisible, shielded by their extended families. It has been too easy for government leaders to assume that the extended families will take on this burden, Bellamy said. Child rights activist Graca Machel, who attended the launch of the report, reiterated the need for African governments to play a greater role. In light of the commitments made by African leaders at the 2001 UN General Assembly Special Session on HIV/AIDS to develop national policies by 2003, the failure of countries to respond was even more disappointing, UNAIDS deputy director Kathleen Cravero pointed out. The numbers presented in the UNICEF report sound an urgent alarm for action. More than 11 million African children have been orphaned by HIV/AIDS, and in Botswana, Lesotho, Swaziland and Zimbabwe, more than one in five children will be without their parents by 2010. Although some governments had introduced orphan policies, there were still a lot of barriers to be overcome before they reached those hardest-hit, Machel noted. She called for new thinking on the way people affected by the epidemic - particularly children - were treated. Paying attention to their emotional and psychological needs was one of the most difficult issues we have to deal with. The UNICEF report recommended interventions that would encompass more than the material needs of families caring for orphans. Psychosocial support is an essential, but often overlooked, service ... early intervention is vital. The Regional Psychosocial Support Initiative [http://www.repssi.org/] is a project featured in the report as an example of how to address these needs. This technical resource network brings together over 30 organisations in eastern and southern Africa and aims to offer psychosocial support to over 25,000 children over the next five years. The report concluded with an outline of the responses needed from African governments and the international community to alter the course of the crisis. Nevertheless, it pointed out, the family remained the single most important factor in building a protective environment for children orphaned by HIV/AIDS.(Source: PLUSNEWS 26 November2003). Full report: http://www.unicef.org/media/files/orphans.pdf

Swaziland's health ministry has begun enlisting traditional healers in efforts to contain HIV and assist patients with AIDS-related illnesses. We are a little behind the curve in getting the 'tinyanga' (traditional medicine men and women) on board, but by now the medical establishment agrees that these healers can be enormously helpful because they have such close ties with the community, Dr John Kunene, principal secretary at the Ministry of Health, told PlusNews. A World Health Organisation survey in the 1990s found that a majority of Swazis use traditional healers as their primary source of health care, despite a growing network of health clinics and private physicians. Understaffed and lacking in resources and medicines, health clinics cannot devote the time to individual patients that traditional healers, working from home, can provide. Health ministry field workers search urban townships and rural areas to locate healers, then arrange their transport to ministry seminars. The healers are taught how the HI virus infects and affects the body, and ways to prevent opportunistic infections. Ten years ago, a self-proclaimed head of Swaziland's traditional healers discouraged the use of condoms, which he said were opposed by Swazi custom. The healer was accused in the press of jeopardising lives, and traditional healers were blamed for furthering the spread of HIV. There is no resistance at all now to accepting and distributing condoms, Dlamini said of her trips to traditional healers. They complain that there are not enough condoms. The bonds that are being made between traditional and Western medicine in the response to AIDS are also bringing together two world views on curing, that in the past were separated by prejudice. (Source: PLUSNEWS, Mbabane, 25 February 2003)

The biggest challenge of the Eastern Cape government's newly-launched Nevirapine project was to increase the rate of voluntary testing. HIV/AIDS activist Dr Costa Gazi said this on Monday, following Friday's official launch at Cecilia Makiwane Hospital. The drug - which reduces the risk of a pregnant HIV-positive woman transmitting the virus to her newborn baby - will be available free of charge at two sites in the Eastern Cape, the East London Hospital complex, including CMH and Frere Hospitals, and Rietvlei Hospital in Umzimkulu. Gazi, who serves as director of the Aid Babies Battling AIDS (Abba) Trust, said only a fraction of women attending antenatal clinics in Mdantsane are currently being tested. Despite greater awareness of the disease, women who tested positive were also still stigmatised, and subjected to isolation in their communities. According to statistics for Gauteng's four trial centres - the Natalspruit, JC Dumane, Kalafong and Pretoria West hospitals - only 30 percent of women seen had agreed to be tested. Provincial health spokeswoman Annette Griessel has confirmed the statistics, and said an intensified information campaign was on the cards. Gazi estimates that one in five pregnant women in the Eastern Cape are HIV positive. HIV-positive babies usually die from AIDS-related complications before the age of two. According to the director of the provincial health department's HIV/AIDS programme Ms Nomalanga Makwedini, babies born to HIV-positive mothers can only be accurately tested for the virus at nine months. The most accurate test is one performed at 18 months. She said implementation of the Nevirapine project would be carefully monitored to see which aspects are most successful, with a view to expanding the programme to other provincial centres. Education programmes in particular would be carefully scrutinised, she said. (Source: SAPA, 30 July 2001)