This is the finding of a monitoring report compiled by the Treatment Action Campaign (TAC) and Aids Law Project, 18 months after the government approved the national HIV and
AIDS treatment plan. But not all the news about the roll-out is bad. Several studies have confirmed good outcomes in the use of ARVs in the public health sector, said the report, saving the lives of thousands of people living with HIV and AIDS. About 42 000 patients are receiving ARV treatment in the public health sector. 'The unexplained and unjustified delay in formal accreditation is one of the main reasons' North West province has in the past few months increased its ARV patient numbers dramatically, a development the report attributes to exemplary leadership and commitment shown by healthcare workers.
Limpopo, on the other hand, has still not accredited essential treatment sites, and refuses to release information about its roll-out programme. And the Eastern Cape is still underspending on its health budget. A combination of a shortage of medical staff and inefficient systems has resulted in waiting lists of up to six months in some areas. The problem is compounded by the fact that several sites ready to start treatment are still awaiting formal accreditation. The unexplained and unjustified delay in formal accreditation is one of the main reasons why several sites across the country cannot commence ARV treatment and help share the burden, the report said. In some areas waiting lists for treatment go back four months. Given the need, patient numbers in the public sector are significantly lower than what the demand actually requires, the report said. In comparison, the number of patients on ARV treatment in the private sector is between 50 000 and 60 000. This figure includes medical scheme beneficiaries, patients on employer-funded workplace treatment programmes, out-of-pocket payments, and patients receiving treatment through the support of non-profit programmes, run mainly by faith-based and community organizations. According to the government's operational plan, the department of health's
nutrition strategy must dispense a meal and micronutrient supplements to selected groups of people living with HIV/AIDS and tuberculosis.
Good nutrition is medically necessary for people with HIV and AIDS before they can start ARV treatment - yet there are serious gaps in the government's nutrition programme, the report found. About 14 million South Africans do not have a secure food supply, and 1,5 million children suffer from malnutrition. Manto Tshabalala-Msimang, the health minister, angered AIDS activists at the South African AIDS Conference in Durban last month when she claimed that 90 percent of people who access ARV treatment through the public service are given food supplements. Strong anecdotal evidence points to the fact that few patients receive nutritional support, the report said. At the Harriet Shezi clinic at Chris Hani Baragwanath hospital in Soweto - the largest paediatric treatment site in the country - only 6 percent of children on ARV treatment have access to nutritional support through the resident dietician. Often there are not enough social workers available to advise patients on where and how to access food parcels and supplements, the report said, and the administrative burden of processing hundreds of applications for food parcels also results in limited access. As of April, no patient at the clinic had received food parcels.
Francois Venter, the head of the Wits AIDS Research Unit, said it was noteworthy that in areas with proper leadership, results had been excellent, as in the case of North West where people on ARVs had risen from zero to 1 000. In Mpumalanga and Limpopo, however, the situation did not look good, Venter said.
(Source: IOL, July 3, 2005)