Treatment programmes skewed in favour of urban males

The shortfall in extending antiretroviral therapy (ART) to HIV positive people in Southern Africa is "enormous", with mostly educated, urban males benefiting from existing programmes, says a new report. The report was compiled by the Regional Network for Equity in Health in Southern Africa (Equinet) and Oxfam GB, and focuses on equity in health sector responses to HIV/AIDS. The briefing paper, "ART Treatment Access and Effective Responses to HIV/AIDS - Providing New Momentum for Accessible, Effective and Sustainable Health Systems", found that "only one eligible person in 25,000" in the region was currently receiving treatment. "Adult HIV prevalence in Southern Africa is estimated at 13.7 percent, with upper ranges of over 30 percent. This translates into approximately 15 million adults and children currently infected. Of these an estimated 700,000 to 1 million currently have AIDS. Such data indicates the significant burden of the disease in the region, and the scale of the response required," the report said. The study notes that current health sector responses to HIV/AIDS are taking place "in the context of weakened public health infrastructures, with absolute shortfalls in health care funding, health personnel, materials and recurrent financing". This was particularly evident in the public sector "at lower levels of the health system and in services in rural areas". Current ART access was also concentrated in the private sector, was largely urban-based, and centred around big hospitals with the infrastructure to manage the programmes. "Where ART is introduced in large hospitals, immediate beneficiaries are likely to be the urban educated population, and more likely to be men," the report noted. In rural areas the provision of ART was more limited, and often dependent on mission hospitals and NGOs with external donor funding. "There is a moral imperative to treat people with AIDS that must be addressed," the report urged. Lessons could be learned from countries like Brazil, which "indicate that effective responses to AIDS builds synergies with the wider prevention and care continuum; are based on strong public sector health services; draw on civil society and private sector resources and capacities; and reach through district services to primary care levels". However, there were resource implications in extending treatment. "Costing [for] the provision of treatment has been done in South Africa. While the absolute figures are changing as input costs change, estimates from the South African Health and Treasury Departments estimated that covering 500,000 people with a full package of health care and nutrition support, including ART, by 2008 would cost approximately double the same services and care, excluding ARVs," the report stated. "After decades of macroeconomic measures and health reforms weakening health systems, there now needs to be an explicit global and national refinancing of health services, particularly in Africa, even if this does contradict fiscal and medium-term expenditure frameworks," the report concluded. For the full report go to: www.equinetafrica.org