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Treat HIV/AIDS as an emergency
By Peter Barron
2002-10-31
Over the next 10 to 15 years, without treatment, 5 million South Africans in the 15 - 50 year old age group will die, leaving behind over a million orphans. South Africa will be devastated socially, economically, culturally and environmentally. Virtually every human developmental indicator in South Africa will deteriorate and by 2010 life expectancy will have plummeted from 65 to 40 years. The number of deaths and the resultant negative consequences for the country are unprecedented in modern history and represent a crisis of the most massive proportions.
With current knowledge the only way of lessening the impact on those infected with HIV/AIDS is to treat them with anti-retroviral drugs (ARVs). ARVs can turn a fatal disease into a chronic one, resulting in an extra 20 years of good quality life and could avert a catastrophe of 5 million deaths (nearly equivalent to the entire holocaust of the second world war).
The case for ARV is clear but providing them is easier said than done. To provide ARVs successfully requires at least:
· A trained medical practitioner (doctor) to make an accurate assessment regarding the optimum time to commence ARV treatment
· A sophisticated laboratory that can carry out the tests required to monitor the health status of the patient
· An adequate drug supply of the appropriate ARV
· A doctor to change the mixture of drugs when side effects occur
· Adequately trained nurses and other health workers to support the patients with issues such as counselling and advice on nutrition
· Adequate financial resources to ensure that these are provided
As business leaders recognise that the costs of treating HIV are less than the cost of not providing treatment, they are at long last starting to come out of their collective stupor, and in increasing numbers are beginning to provide ARV programmes to their infected employees. As this ground swell in business grows, hopefully the majority of those formally employed who need ARV treatment will have access to it.
But what then of the 80% of the population reliant on the public health system, including those in informal and small business employment, the unemployed and disadvantaged rural and urban poor?
The public health system is already creaking under its current load and existing provision of primary care is sub-optimal. In its current form and with its current level of staffing and funding there is no way that the public health system can even contemplate introducing the provision of ARV to those infected with HIV/AIDS.
Introducing a massive curative care programme for ARV will require resources that are in short supply. There are simply not enough doctors and nurses and not enough hours in the day. Even if the money to purchase the ARV drugs was available, the existing infrastructure of the public health system could not cope with the extra burden. As it is other chronic diseases such as tuberculosis and hypertension are often inadequately treated. The introduction of ARVs would result in priority health programmes being further undermined, including programmes such as immunisation, mental health, and maternity care that are already not reaching their targets.
So what then can be done? Clearly the public health system is caught between a rock and a hard place. The first choice is to do nothing and not provide ARV. This will see 5 million people go to an early grave and society increasingly polarised around the demand for ARVs.
The second choice is to go ahead provide ARVs in the public system. However in practice ARVs can and will only be adequately provided in very selected urban sites. The effects of this will see 4,9 million people going to an early grave and the fragile primary care provision system will be further undermined by the pressure to provide a largely ineffective programme of ARVs.
The fundamental and long-term solution requires that the government declare HIV/AIDS a national disaster and provide a comprehensive plan from the highest level of decision-making to radically restructure primary care services through the provision of much more human and financial resources. However, this will take a minimum of 3 - 5 years to implement even if the strategic decisions to do this were taken today.
In the short term a solution is the brokering of a partnership between the public and private sectors. One such partnership could see patients with HIV diverted out of the public system of primary care to accredited general practitioners who could treat these patients on a per capita basis. Suggestions of a partnership between the private and public sectors currently being mooted could be much more seriously and thoroughly explored.
The wave of impassioned calls led by the Treatment Action Campaign and fellow travelers for the provision of ARV in the public sector will come to naught unless the public health system is placed on an emergency footing, and strategic decisions to make both short term and long term plans for the treatment of people with HIV/AIDS taken now. Do we have a choice? (Source: P. Barron*, The Star, 22 October 2002)
*Peter Barron has written this article in his personal capacity.
Over the next 10 to 15 years, without treatment, 5 million South Africans in the 15 - 50 year old age group will die, leaving behind over a million orphans. South Africa will be devastated socially, economically, culturally and environmentally. Virtually every human developmental indicator in South Africa will deteriorate and by 2010 life expectancy will have plummeted from 65 to 40 years. The number of deaths and the resultant negative consequences for the country are unprecedented in modern history and represent a crisis of the most massive proportions.
With current knowledge the only way of lessening the impact on those infected with HIV/AIDS is to treat them with anti-retroviral drugs (ARVs). ARVs can turn a fatal disease into a chronic one, resulting in an extra 20 years of good quality life and could avert a catastrophe of 5 million deaths (nearly equivalent to the entire holocaust of the second world war).
The case for ARV is clear but providing them is easier said than done. To provide ARVs successfully requires at least:
· A trained medical practitioner (doctor) to make an accurate assessment regarding the optimum time to commence ARV treatment
· A sophisticated laboratory that can carry out the tests required to monitor the health status of the patient
· An adequate drug supply of the appropriate ARV
· A doctor to change the mixture of drugs when side effects occur
· Adequately trained nurses and other health workers to support the patients with issues such as counselling and advice on nutrition
· Adequate financial resources to ensure that these are provided
As business leaders recognise that the costs of treating HIV are less than the cost of not providing treatment, they are at long last starting to come out of their collective stupor, and in increasing numbers are beginning to provide ARV programmes to their infected employees. As this ground swell in business grows, hopefully the majority of those formally employed who need ARV treatment will have access to it.
But what then of the 80% of the population reliant on the public health system, including those in informal and small business employment, the unemployed and disadvantaged rural and urban poor?
The public health system is already creaking under its current load and existing provision of primary care is sub-optimal. In its current form and with its current level of staffing and funding there is no way that the public health system can even contemplate introducing the provision of ARV to those infected with HIV/AIDS.
Introducing a massive curative care programme for ARV will require resources that are in short supply. There are simply not enough doctors and nurses and not enough hours in the day. Even if the money to purchase the ARV drugs was available, the existing infrastructure of the public health system could not cope with the extra burden. As it is other chronic diseases such as tuberculosis and hypertension are often inadequately treated. The introduction of ARVs would result in priority health programmes being further undermined, including programmes such as immunisation, mental health, and maternity care that are already not reaching their targets.
So what then can be done? Clearly the public health system is caught between a rock and a hard place. The first choice is to do nothing and not provide ARV. This will see 5 million people go to an early grave and society increasingly polarised around the demand for ARVs.
The second choice is to go ahead provide ARVs in the public system. However in practice ARVs can and will only be adequately provided in very selected urban sites. The effects of this will see 4,9 million people going to an early grave and the fragile primary care provision system will be further undermined by the pressure to provide a largely ineffective programme of ARVs.
The fundamental and long-term solution requires that the government declare HIV/AIDS a national disaster and provide a comprehensive plan from the highest level of decision-making to radically restructure primary care services through the provision of much more human and financial resources. However, this will take a minimum of 3 - 5 years to implement even if the strategic decisions to do this were taken today.
In the short term a solution is the brokering of a partnership between the public and private sectors. One such partnership could see patients with HIV diverted out of the public system of primary care to accredited general practitioners who could treat these patients on a per capita basis. Suggestions of a partnership between the private and public sectors currently being mooted could be much more seriously and thoroughly explored.
The wave of impassioned calls led by the Treatment Action Campaign and fellow travelers for the provision of ARV in the public sector will come to naught unless the public health system is placed on an emergency footing, and strategic decisions to make both short term and long term plans for the treatment of people with HIV/AIDS taken now. Do we have a choice?
(Source: P. Barron*, The Star, 22 October 2002)
*Peter barron has written this article in his personal capacity.
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