The theme of the 4th South African AIDS Conference taking place in Durban this week is 'Scaling up for success', but activists have drawn noisy attention to the fact that expanding South Africa's antiretroviral (ARV) treatment programme will be impossible unless the government addressed a significant funding shortfall.
They warned that current funding levels were not keeping pace with the targets set out in South Africa's National Strategic Plan for HIV/AIDS which aims to have 80 percent of those in need of treatment on ARVs by 2011. Treatment lobby group, the Treatment Action Campaign (TAC), estimates that in 2009 alone the government needs to allocate an additional R1 billion (US$100 million) to meet current treatment needs and to have a chance of meeting the 2011 deadline.
"The cabinet, and not just the health department, needs to face up to this funding shortfall," said Mark Heywood, director of the AIDS Law Project.
Heywood noted that an impressive 200,000 people were initiated on ARV treatment in 2008, but that the scale up had been under-budgeted and mismanaged.
The most notable consequence was the decision by local health authorities in Free State Province to stop putting patients on treatment for three months, beginning in November 2008, because of massive overspending. The Southern African HIV Clinicians Society has estimated that 30 lives a day were lost during that period as a direct consequence of patients not being able to access ARVs.
A press statement released jointly at the conference by the AIDS Law Project, the TAC, Medecins Sans Frontieres and the HIV Clinicians Society, also alleged that new ARV guidelines that would have raised the threshold for the start of ARV treatment from a CD4 count of 200 to 350, were rejected by the National Health Council on grounds of affordability.
The CD4 count measures the strength of a persons immune system, and a number of studies in the past year have confirmed that starting patients on treatment before their CD4 count drops below 350 improves their health outcomes both in the short- and long-term.
Dr Francois Venter of the HIV Clinicians Society questioned the rational of the National Health Council's decision. "It doesn't take into account the cost savings of raising the ART threshold that would prevent people from getting sick."
South Africa is not alone in facing a treatment funding crunch. According to Dr Fareed Abdulah, Africa director for the Global Fund to Fight AIDS, Tuberculosis and Malaria, a number of other countries with large treatment programmes are facing a similar cash flow crisis.
"Countries need to dig deeper into their pockets, they also need to make health care management decisions that use money more efficiently," he told IRIN/PlusNews.
Perhaps, the most significant factor affecting governments in countries hard-hit by the AIDS epidemic and international donors was the global financial crisis. Abdulah noted that the Global Fund was "extremely concerned" about its ability to continue raising sufficient funds to meet the constantly growing demand for its grants.
While no countries had so far reversed their commitments to the Fund, said Abdulah, "the inflows we were expecting just aren't materializing."
"I think it's important for recipients to raise their voices when governments are bailing out banks on the scale we've seen," he added. "The amount we're asking for AIDS in Africa pales in comparison."
See also: BOTSWANA: Bleak outlook for future AIDS funding
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