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SOUTH AFRICA: Implementation, Not Money the Obstacle to Scaling Up HIV Treatment

Kristin Palitza

DURBAN, Mar 31 2009 (IPS) - The money to scale up HIV treatment is there, but implementation of programmes to curb the pandemic is a problem, health experts said at the opening of the Fourth South African AIDS Conference in Durban.

Health scientists, activists, health workers and politicians from 52 countries have come together to discuss latest strategies to fight the pandemic under the theme “Scale Up for Success”.

Dr John Hargrove, director of SACEMA, the centre for epidemiological modelling and analysis of the South African Department of Science and Technology and the National Research Foundation, recommended safe medical male circumcision and antiretroviral (ARV) treatment as key strategies to prevent the spread of HIV.

Male circumcision has the potential to “save millions of lives in the next ten years” because it reduces the HIV infection risk by 35 percent, Hargrove said.

He also recommended using ARVs “as a defensive weapon” in addition to using it as treatment. “If we achieved universal, voluntary HIV testing and would start ARV treatment immediately [if a person tests positive], regardless of CD4 count, we could eliminate HIV and reduce tuberculosis dramatically.”

Hargrove was unconcerned about the finances needed to provide ARVs to all persons living with the virus, saying it would ultimately be more expensive not to stop the HIV pandemic. “The cost [of ARV as prevention] is high but affordable, and saving people’s lives is cost-saving, too.”

“We are years away from delivering a particularly effective vaccine or microbicide,” he warned and therefore needed to find other ways to curb the pandemic. South Africa has more than 5.2 million people living with HIV and AIDS, according to national health department statistics. About 250,000 people die every year due to AIDS-related illnesses and almost half a million are newly infected with the virus.

Prof Hoosen Coovadia, the Victor Daitz Professor of HIV/AIDS Research at the University of KwaZulu-Natal (UKZN) in Durban agreed with Hargrove, saying money is no barrier to scaling up prevention and treatment in South Africa. “As a country, we do have the funds. It’s about political will, budget allocation and proper use of the money,” he told IPS.

Coovadia says the South African government has the financial capacity to provide health services to all HIV-positive persons in the country, explaining that “antiretroviral treatment is now cheaper than diabetic drugs and PMTCT [prevention of mother-to-child transmission] is cheaper than managing blood pressure”.

He believes the biggest flaws in public health spending currently appear at provincial level, where budgets are not used in an efficient and effective manner. “The fundamental problem in society is that we talk a lot but are doing little,” Coovadia lamented.

He complained about South Africa’s politicians solely focusing on the upcoming elections on April 22 rather than on living up to their mandate of delivering services to the people: “Here is this country falling apart with 1,000 people dying a day, but everyone is electioneering instead of putting policies into practice.”

South Africa’s deputy president Baleka Mbete admitted during her opening address that “all the plans we have to fight this disease will not succeed without political will and financial commitment from the government.”

The South African government allocated $50.5 million to HIV and AIDS programmes in 2008, up from $71 million in 2000.

However Mbete disagreed with Coovadia about finances being available for treatment scale-up. “Many challenges still remain. These include the reality that at the current medicine price regime and escalating private health costs the provision of antiretroviral therapy will not be affordable,” she said.

Mbete promised government will “exploit various options to make medicine affordable, including the amendment of the Patents Act and regulating the private health sector” so that private health patients wouldn’t be “dumped in public health facilities”.

Coovadia believes that much more money needs to be spent to boost health resources, speed up implementation and improve quality of health services. “The problem we have is to translate what we already know into practice,” he said. “We know how to do PMTCT, for example, but we don’t have the infrastructure to deliver those services,” he explained to illustrate his point.

Dr. Gustaaf Wolvaardt, executive director of the Foundation for Professional Development, also called for increased investment in health resources and particularly in the training of skilled health personnel. “Hundreds of thousands of people are dying unnecessarily due to lack of management capacity in public health services,” said Wolvaardt, demanding that if managers are incompetent “we have to start removing them”.

He said accountability was a key ingredient for the successful scale-up of HIV prevention and treatment. “If you don’t measure it, you can’t manage it,” he explained, agreeing with Coovadia that the national health department’s “strategic plans are great, but the problem is [lack of] implementation.”

Reflecting upon the progress that has been made since the first International AIDS Conference took place in Durban in 2000, conference chair and deputy director of the Desmond Tutu HIV Centre, Professor Linda-Gail Bekker acknowledged that “no overwhelming breakthroughs” have been achieved within the last decade.

She stressed, however, that “significant moves [have been made] in the right directions, and we have to scale those up if we want to increase roll out throughout the region”, describing the task as “daunting”.

Bekker also stressed the fact that lack of skilled health care workers presents “a bottleneck” in service provision, noting that more efforts needed to be invested in nurse-driven and community-managed HIV/AIDS programmes.

Other priorities should be the expansion and improvement of paediatric treatment as well as PMTCT. Bekker emphasised the crucial role of HIV/AIDS research and “very practical steps need to be taken, based on an evidence-based strategy” to further expand the ARV rollout and make it sustainable.