Signs of progress on ARVs

It has become clear to delegates attending South Africa's national AIDS conference that the provision of antiretroviral (ARV) drugs through the public health sector is no longer a distant possibility. According to Department of Health Director-General Dr Ayanda Ntsaluba, the findings of a controversial joint finance and health departments' report – commissioned to investigate the state's provision of ARVs – had signaled a shift from "if, to when and how ... and at what pace." But as Ntsaluba warned during a press conference on Tuesday, this would not be a "PR exercise", and the country had to be in a position to sustain the drug rollout. The details of when the report will be released remain sketchy. "By the time the document is tabled to cabinet, it must be of such quality ... that cabinet is in a position to make a decision." "I would rather have a delay of one week, two weeks, than have the report sent back," he said. Presenting a plenary session at the conference in the port city of Durban on Tuesday, Ntsaluba highlighted the challenges the government had to face. Human resources were a major obstacle. Alarming findings from a national study of health-care workers, conducted by the Human Sciences Research Council (HSRC) and publicly released on Monday, depicted rising HIV-prevalence among young health-care workers, poor clinical practice and inadequate sterilisation facilities. Just over 16 percent of the 2,000 health-care workers surveyed were HIV-positive, with a higher proportion of HIV infection among younger workers. Twenty percent of those aged 18 to 35 were positive, compared with 16.6 percent of those aged 36 to 45. This had crucial implications for the future supply of health-care professionals, Olive Shisana, director of the HSRC’s HIV/AIDS programme, noted. The epidemic was also exacting a heavy psychological toll on health-care workers, with more than half of them saying they were exhausted and 39 percent saying they were suffering from low morale. These challenges were not to be seen as an excuse, but had to be considered before the government scaled up their response, Ntsaluba noted. "South Africa has what it takes to mount an effective response, if we pool our resources together," he said. In July, after months of frustration over government delay, the Treatment Action Campaign lobby group leaked the key findings of the joint report by the departments of health and finance. The report estimated that 1.7 million lives could be saved by 2010 if ARV drugs were given to everyone needing them. Up to 1.8 million more children would be orphaned by 2010 if ARVs were not provided. This number would be reduced by 860,000 if there was 100 percent drug coverage, and by 350,000 if there was 50 percent coverage. The total cost of providing ARVs to everybody needing them would be around US $1 billion by 2005. Meanwhile, there had been signs of progress in the prevention of mother-to-child-transmission of HIV in some provinces which had expanded coverage from the government's original 18 pilot sites. "With regards to the prevention of mother-to-child-transmission of HIV, good progress has been made throughout the country," Dr Fareed Abdullah, head of the Western Cape's HIV/AIDS programme said. The Western Cape was the first province to defy government policy by rolling out a mother-to-child prevention programme and has already achieved universal coverage. KwaZulu-Natal and Gauteng provinces were also close to reaching all HIV-positive pregnant women. "There's a lot we're doing - true, there are many weaknesses at the level of implementation, but these can't be addressed just by pointing fingers at government," Ntsaluba concluded.