About 5,000 protestors marched on the South African Parliament Building in Cape Town on Wednesday, February 16th, demanding that the government speed up the rollout of antiretroviral treatment (ART) to its citizens with HIV. The marchers, rallied by the Treatment Action Campaign (TAC), demanded that the government put 200,000 patients (at least ten percent of which should be children) on ART by February next year.
Activists are also calling for the government to address growing inequities in the delivery of healthcare that exist between the public and private sectors and between urban and rural areas.
A belated and sluggish rollout
In November 2003, the government in South Africa committed to a comprehensive plan to provide care and treatment to South African’s infected with and affected by HIV. This included a promise to treat every patient with HIV and less than 200 CD4 cells with ART within five years.
Treatment was expected to begin almost immediately, according to comments by Ira Magaziner of the Clinton Foundation’s AIDS Initiative, which authored much of the operational plan for the programme. In September 2003. Magaziner was quoted in the South African press as saying that as soon as the plan was approved, "the programme could begin almost immediately after that. We are taking [health] centres identified by the provinces and getting them ready."
But it wasn’t until half a year had passed, that South Africa’s public health system finally began providing ART to a handful of patients (with the exception of the programme in the Western Cape). Today, approximately 30,000 are receiving ART in public hospitals in South Africa (see table at the end of the article), while 45,000 are receiving care through the private sector.
But the need is much much greater. For example, last year, 300,000 South Africans are estimated to have died from AIDS. At least as many need ART today.
Obstacles to treatment
But most South Africans with HIV remain unaware of their HIV status. And in order to reach patients, not only do testing and counselling services have to be rapidly expanded, but the infrastructure (clinics, laboratories, etc) to delivery treatment must be upgraded.
South Africa has some of the finest medical facilities in the world. But the standard of care delivered varies dramatically depending upon where healthcare facilities are located — and whom they treat. There is a shortage of qualified health care professionals to provide treatment, especially in remote, rural areas. Often a facility will have the doctors and nurses to treat patients, but be short a pharmacist qualified to dispense the medications.
Ensuring a steady supply of affordable medicines has also been a challenge for the South African programme. According to a TAC memorandum to the President, presented at the end of the march on Parliament: “The drug supply is irregular and uncertain, largely because the procurement process has not been finalised, despite a commitment from the Department of Health to have done this by June 2004.” Affordable generics, in particular, are in short supply.
(See companion piece on South Africa Completes Negotiations for ART Procurement).
Reaching goal will require co-operation
TAC called on President Mbeki and health minister Manto Tshabalala-Msimang to lead the campaign for HIV prevention and treatment “by making regular calls on television and radio for people to access testing and, where necessary, to get treated.” TAC believes testing must be offered on a routine basis “to patients presenting at public hospitals and clinics, regardless of their state of health.”
But TAC noted that it was not solely the government’s responsibility to remove the obstacles to treatment. At the end of the march, TAC spokesperson Vuyiseka Dubula said that it was “the responsibility of every person to get tested, to seek and demand appropriate treatment and to use condoms.”
For its part, TAC promised to “assist government with meeting its targets by continuing to increase the scale of our treatment-literacy programme, providing treatment to our volunteers and community members through our treatment project and promoting prevention of HIV transmission.”
For more on the march, and TAC’s demands see: the TAC website
Cumulative number of patients on ART in South Africa
Province Number of Patients on ART Jul Aug Sept Oct Nov Dec Jan Eastern Cape 618 986 1780 2147 2749 — — Free State 114 139 372 599 677 945 — Gauteng — 3594 4832 6143 7450 8684 9691 KwaZulu Natal 527 1556 2034 3414 4263 4964 — Limpopo 9 63 112 305 497 729 — Mpumalanga — 136 333 378 516 754 — Northern Cape 95 108 81 253 289 386 515 Northwest 294 631 796 1121 1574 2083 2797 Western Cape 3843 4356 4895 5337 5965 6188 — Total 5500 10583 15235 19697 23980 27482 29332*
The grand total of 29,332 is based upon the most recent figures TAC could obtain.