Large numbers of HIV-positive South Africans are expected to develop
AIDS-related diseases, as the country's high prevalence rates start manifesting
themselves in illness and death, predicts the Health Economics & HIV/AIDS
Research Division (HEARD) of the University of KwaZulu-Natal, in the coastal
city of Durban.
HIV patients might soon account for 60 percent to 70 percent of hospital
expenditure in medical wards, says HEARD researcher Nina Veenstra.
Already, about half of all patients admitted to hospitals in South Africa seek
care for HIV-related illnesses, while the numbers of HIV-positive patients in
paediatric wards are even higher, she added. According to figures posted on the
website of the Joint United Nations Programme on HIV/AIDS, adult HIV prevalence
in South Africa is 21.5 percent.
As the numbers of AIDS patients grow, there will be a greater demand for skilled
health workers, medication and hospital facilities.
According to researchers at the Cape Town-based Human Sciences Research Council
(HSRC), a non-profit organisation partly funded by government, AIDS patients
generally stay in hospital for a greater length of time than other patients
because it takes them longer to recover from opportunistic diseases.
HIV-positive patients stay on average four times longer in hospital than
non-HIV patients, explains HSRC President Olive Shisana.
Greater pressure on health facilities will impose a heavier financial burden on
the country's public health care sector -- even as health workers suffer more
stress from an increased workload. This is likely to prompt higher levels of
absenteeism, low staff morale, and large numbers of health care workers quitting
South Africa already suffers a shortage of health workers, due in large part to
unattractive working conditions. Many posts for health workers remain vacant,
notes a study by a national research organisation, the Durban-based Health
Systems Trust (HST). (This organisation is funded by a range of national and
According to the HSRC, these pressures will compromise the quality of HIV/AIDS
care on offer.
The HST has already found that a number of sites where anti-retroviral drugs (ARVs)
are dispensed have reached saturation level due to staff shortages.
HST researchers estimate that only 12 to 13 percent of all patients in need of
ARV therapy are receiving it at present. Limited human resources capacity
is the biggest constraining factor on further rollout of the ARV programme and
must be addressed as soon as possible, state researchers Rob Stewart and
Marian Loveday in the organisation's annual health review for 2005.
In addition, the already-limited number of health care workers will be further
reduced through HIV-infection. According to an HSRC study, 13 percent of health
workers who passed away between 1997 and 2001 died of AIDS-related diseases.
These findings are likely to receive attention this coming week, during the
latest of the United Nations General Assembly Special Sessions (UNGASS) on
In 2001, the assembly held its first special session on HIV/AIDS, in
acknowledgement of the fact that while some progress in increasing access to
HIV-prevention and treatment initiatives had been made, the programmes were
still failing to reach those most vulnerable to HIV.
During the first UNGASS meeting, participants agreed on goals set out in a
'Declaration of Commitment on HIV/AIDS' which was adopted by leaders from 189
countries. The declaration sets targets to halt and reverse the spread of the
pandemic by 2010 through action by government and civil society.
Together with other countries, South Africa vowed to improve conditions for
health care workers, and upgrade supply systems and financing plans concerning
access to ARVs, testing facilities and care by 2005.
Delegations from South Africa will have to report back on progress in achieving
these goals at the UNGASS+5 meeting, which will take place from May 31 to Jun. 2
in New York, five years after the General Assembly held its first special
session on HIV/AIDS.
Taking action to improve South Africa's response to the pandemic will, in part,
require hospitals to give health workers greater job satisfaction through better
salaries and working conditions, says Elsje Hall, a researcher at the
Pretoria-based Independent Research Services.
HST figures show that by 2009, an additional 3,200 doctors, 2,400 nurses and 765
social workers will be required to run the country's ARV programmes. This will
translate into a substantial increase in personnel costs.
The supply of ARVs and drugs to treat opportunistic infections will also need to
be increased, Hall adds.
The cost of full-scale ARV treatment is expected to come with a price tag of
about 996 million dollars by 2008/2009, up from 179 million dollars in
2005/2006, according to the HST.
* Kristin Palitza is the editor of Agenda: a women's rights and gender media
project based in Durban, South Africa (FIN/2006)