AIDS policy shifts

A rebellion against government policy on the treatment of HIV/AIDS is taking place in South Africa, with four provinical governments openly defying national policy and announcing the provision of nevirapine to all pregnant women in the public sector. Prominent leaders have also called for a rethink of the government's current AIDS policy. So far, South Africa's focus has been on four priorities - prevention, treatment care and support, research and surveillance, and human rights. According to Joanne Collinge, chief communication director in the department of health, the prevention of mother-to-child transmission (PMTCT) programme is only one part of the strategy. "Our focus remains a massive prevention campaign directed at ensuring that the high rates of awareness translate into a change in lifestyles; care for the affected and infected; treatment of all diseases, including those associated with AIDS; and research into a vaccine," President Thabo Mbeki said in his state of the nation address earlier this year. Presidential spokesperson Bheki Khumalo has been quoted as saying that the country "spends more on tackling AIDS than any other in the continent". And in his budget speech last week, Finance Minister Trevor Manuel said that in addition to an estimated R4 billion (US $348 million) spent by provincial health departments on AIDS-related illnesses, funding for "prevention programmes in schools and communities, hospital treatment and community-care programmes will amount to R1 billion (US $87 million) next year, rising to R1.8 billion (US $156 million) in 2004/5". However, while information, education and communication campaigns targeting young people have made an impact among the youth, there has been no decrease in the prevalence levels among the different age groups. "We saw that we're not getting something right there, but over the next two years we will be launching several campaigns to address this," Collinge said. She said voluntary counselling and testing sites had been expanded to between 300 and 400 around the country and about 250 million condoms had been distributed by the national government. "This is one of the biggest distribution programmes in the world," she said, adding that care and support services were being improved at primary health level to ensure that everyone could be treated for opportunistic infections. Yet the government has been widely criticised for doing too little to fight the disease and for failing to provide adequate treatment for the prevention of mother-to-child transmission. Its policy has been viewed as confusing and lacking direction. "The reason for all this confusion is because the government, under the leadership of the president, has taken a position which is increasingly becoming untenable," Stephen Friedman, an analyst from the Centre for Policy Studies, told PlusNews. Criticism from prominent leaders such as Nelson Mandela and ArchBishop Desmond Tutu had forced the government to acknowledge this and slowly start to shift their policy, he added. This, however, was not being done fast enough, as the longer they waited, the more people died, Friedman said. According to a research report commissioned by the health department and released on Friday, there are no good reasons for delaying the gradual and phased expansion of PMTCT services in all provinces. But the report also highlights that given the difference in capacity and infrastructure, it is reasonable for provinces to expand the provision of PMTCT services at different speeds. At a recent meeting held by the health minister and her provincial counterparts, each province was meant to consider the experiences of the current pilot MTCT sites "and make recommendations about the way forward," Collinge said. In instances where there was sufficient capacity and resources to expand the programme, then this would happen. "We just have to watch and listen over the next few months to see if there will be a confirmation of the status quo or some change," Collinge told PlusNews.