Government under pressure to provide AIDS drugs

Frustrated at the South African government's refusal to provide antiretroviral treatment in state hospitals, international humanitarian organisation, Medecins Sans Frontieres (MSF), and AIDS activist group, the Treatment Action Campaign (TAC), announced this week that they were importing generic drugs from Brazil. This, coupled with the KwaZulu Natal province's recent decision to make nevirapine available in all state hospitals, has put additional pressure on the government to rethink its current policy on AIDS drugs. The government has refused to supply the drugs, saying the country lacked adequate infrastructure to administer their use. Problems with medical infrastructure and capacity were not insurmountable, as existing projects had demonstrated that antiretroviral (ARV) therapy could be successfully introduced in resource-poor settings, AIDS activists told PlusNews. "From what we've seen from the MSF and TAC project in the Western Cape, it does seem that its probably possible to implement ARVs in other parts of the country as well, but it won't be possible to roll-out at the same time, all over the country," Dan Mullins HIV/AIDS coordinator for Oxfam, told PlusNews on Friday. It was important to note that ARVs were only one component of a "bigger strategy" despite a tendency of the media to focus solely on the provision of drugs, he said. In terms of capacity, the government should not restrict this problem to the health sector as there were a number of NGOs, civil organisations, faith based organisations and private companies that could play a role in providing capacity. "The government can provide unifying leadership by bringing in all these players," said Mullins. A perfect example was the collaboration between TAC activists, MSF and the provincial government in the Western Cape, he noted. According to MSF spokesperson Toby Kasper, the innovative ARV clinics run by the group in the Western Cape, could be easily replicated elsewhere in the country. The three clinics - located in Khayelitsha, a sprawling township outside Cape Town - offer a comprehensive package of services to people living with HIV/AIDS within existing government primary health care centres. To date, 85 people have received ARV therapy and 50 of them are receiving Brazilian generic medicines. The clinics use a tripartite system of peer support groups, trained counsellors and treatment assistants and there are no additional staff used. TAC members form part of the support groups and conduct home visits to patients, reducing the need for any government expenditure. Admittance into the ARV programme is limited to HIV positive Khayelitsha residents with a CD4 count of less than 200. The clinical manifestations of HIV infection are mostly dependent on the levels of CD 4 cells in the blood. A CD4 count of 200 is the internationally accepted level for introducing ARV therapy in a HIV infected patient. "We operate on a 'pro-sick', 'pro-poor' bias," said Kasper. "We are trying to create a model for replication, so we're still tinkering with it. Right now, we're trying to make it more nurse based so that it can be widely used." For KwaZulu Natal, "the issue is not about nevirapine or providing the drug", as they had secured nevirapine free for five years from pharmaceutical company Boehringer-Ingelheim, Mandla Mathaba spokesperson for the health department, told PlusNews. The province still had to provide funding for the training of counsellors as well as physical facilities for the counselling of HIV positive mothers. The cost of infant formula feed accounted for about 50 percent of the implementation budget, Dr Zweli Mkhize, provincial health minister, said in a statement this week. "People tend to look at the direct financial cost of ARV programmes within the health budget, but we need to throw in the massive financial and social impact of HIV/AIDS outside the health sector, before balking at costs," said Mullins