Anso Thom and Kerry Cullinan
Patients in desperate need of antiretroviral drugs face waiting lists in all provinces, but those seeking treatment in Gauteng and the Western Cape will be treated a lot faster than those in Limpopo, Mpumalanga or the Eastern Cape.
In addition, few children who need ARVs are getting them as many facilities are nervous to treat children. Mpumalanga is treating the lowest number of kids, with only 31 getting treatment by April.
Patients at Tshnidzini in Limpopo and Gauteng's Far East Rand Hospital will wait four months, while at Stanger in KwaZulu-Natal there are 500 patients on a waiting list. Many facilities - including Pretoria Academic, RK Khan, King Edward and Mt Frontier hospitals - are limiting the number of patients they will accept each month because they lack the capacity to monitor large numbers of patients.
Women have been most receptive to getting treatment and account for over 60% of ARV patients, according to health department officials.
More patient details will only be available later in the month when the health department presents a report to Parliament.
Dr Haroon Saloojee of Wits University's Community Paediatrics Division says that children are being forgotten. He estimated that, by April, only about 3 000 children on ARVs countrywide, whereas between 30 000 and 45 000 of the country's 230 000 HIV positive children needed the drugs.
Dr Tammy Meyers, a paediatrician at Chris Hani Baragwanath Hospital, adds that comprehensive guidelines for the treatment and management of HIV-infected children are still not available.
One of the biggest failures of the plan is the lack of public information about the ARV programme, with many people still under the impression that they have to pay for the drugs.
There is no public information campaign telling people where or how they can access treatment and no list of sites, laments Fatima Hassan of the
AIDS Law Project.Hassan is part of the Joint Civil Society Monitoring Forum (JCSMF), set up by a range of organizations to support the implementation of the AIDS care and treatment plan. She says that the Western Cape, Gauteng, Free State, Northern Cape and North West have made an effort to implement the plan, but that there are serious problems in Limpopo, Mpumalanga and the Eastern Cape.
I think the main problem is still at national level. One doesn't know whether they appreciate the need and desperation at community level. It is a
centralized approach where national holds all the strings. They are allowing the provinces to be slack. When we ask tough questions of the provinces, they tell us to speak to national, said
Hassan. Other operational weaknesses identified by the JCSMF include problems with site accreditation lack of capacity to expand voluntary counseling and HIV testing and the lack of staff.
Despite being ready to treat patients, Limpopo's Khensani, Botlokwa, Sheshego and Tintswalo Hospitals have not been accredited to do so.
Hewu in the Eastern Cape, Athlone Park Clinic and Richmond in the KwaZulu-Natal, the Life Care and Witbank sites in Gauteng and Standerton in Mpumalanga are in the same boat.
Dr Maylene Shung King, deputy director of the University of Cape Town's Children's Institute, is concerned that although the focus on ARVs is being done to the detriment of children's other critical health needs such as
immunization, malnutrition and chronic disease treatments. Health minister Dr Manto Tshabalala-Msimang told the National Council of Provinces last week that her department was implementing the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS in its entirety with much more vigour and said they were achieving results.
In line with our stated goals, we have been able to establish a minimum of one service point in every district in the country before the end of the last financial year. Our effort in the coming years is to ensure that these services are made available in every local municipality to increase accessibility and uptake, said the minister.
By mid-May, Gauteng had 13 670 adults and 1 822 children on ARV treatment against a target of 10 000 people.
Other provincial figures, compiled by the AIDS Law Project at the end of May, are as follows:
Eastern Cape: 3 739 in January (target of 2 750 in 2004)
Free State: 1 115 by January, (target of 2 127 by 2004)
KwaZulu-Natal: 11 000 by March (target of 24 902)
Limpopo: 935 by January (target of 6 965)
Mpumalanga: 936 by January (target of 1 934)
NorthWest: 2 625 at the end of January, (target of 1 808)
Northern Cape: 700-800 at the end of January, (target of 790)
Western Cape: 8 402 at the end of May, (target of 2 728).
(Source: Health-e, June 06, 2005)