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HEALTH: S. Africa Becomes a Victim of its ARV Treatment Success

Kerry Cullinan

DURBAN, South Africa, Aug 23 2010 (IPS) - Almost a million South Africans are already on lifelong antiretroviral (ARV) treatment and this number is supposed to triple in the next decade if the South African government keeps to its implementation plan.

But the prospect of the government being able to meet its target of treating 80 percent of those who need it by 2011 is being threatened by a lack of funds. A number of organisations and prominent officials in the AIDS field condemned the “flat-lining” of donor funds at the recent international AIDS conference in Vienna.

In 2009, donors contributed 7.6 billion dollars to the international fight against HIV and AIDS, slightly down from 7.7 billion dollars in 2008, according to the Kaiser Family Foundation.

Yet in order for more people to be put on life-saving medication, more money needs to be spent. South Africa alone needs an extra 272 million dollars a year to reach all those who need antiretroviral treatment.

Scenario planning by the South African treasury department indicates that the demand for treatment and care will peak in 2021, when the country will need some four billion dollars to provide these services.

“We are facing a double whammy of having to rapidly scale-up spending on HIV and AIDS at the same time that we have to replace donor funds,” said Dr Keith Cloete of the treasury department of the Western Cape, a province in the south of the country.

“For the next five to 10 years, we need additional funds. This is not the time to pull out funds as programmes are going to collapse,” said Cloete, addressing a meeting of South African projects funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) earlier in 2010.

For the current budget year (2010), PEPFAR contributed 585 million dollars to the country’s ARV treatment programme – almost matching the government’s total contribution of 680 million dollars, according to the treasury.

The U.S. government announced in Dec 2009 that it would be giving South Africa an extra 120 million dollars “in direct response to a request from President Jacob Zuma” to “procure ARVs will help ensure that there are adequate stocks on hand to meet the growing demand for ARVs in South Africa”.

This followed ARV shortages in most notably the Free State, a province in the centre of the country that suspended its HIV treatment programme as it had overspent its budget.

However, the extra PEPFAR contribution is regarded as being exceptional and not likely to be repeated, according to Dr Roxana Rogers, South Africa health team leader of the U.S. Agency for International Development (USAID).

While PEPFAR officials speak of making a transition from an “emergency plan” to a “sustainable programme”, the prospect of additional U.S. funding for the ARV treatment programme is remote.

Instead, donors and government alike are trying to find ways to cut costs. The first target is the actual cost of ARVs, with South Africa paying around 20 percent more for ARVs than the cheapest drugs on the market.

This is partly due to PEPFAR’s insistence on brand name ARVs being used in the programmes it supports and partly due to costs charged by Aspen, the generic pharmaceutical company that won the tender to supply ARVs to government.

The tender ran out in May 2010 and a new one has not yet been issued, but health minister Aaron Motsoaledi has made it clear that the government is looking for the cheapest options.

Another problem, according to U.S. health analyst and author Laurie Garrett, is the shortage of “good news” about progress sub-Saharan African countries are making to prevent new HIV infections.

HIV prevention has been painfully slow, yet as health economist Professor Alan Whiteside says: “HIV treatment without prevention is like mopping the floor while the tap is running.”

In South Africa the antenatal HIV infection rate (measuring HIV among pregnant women) has declined slightly over the past four years but not nearly enough to turn the tide against HIV.

Bill Gates, the world’s biggest single donor to HIV and AIDS, told the Vienna AIDS conference in July 2010 that, “we have to be honest with ourselves: We don’t have the money to treat our way out of this epidemic.

“Even as we continue to advocate for more funding, we need to make sure we’re getting the most benefit from each dollar of funding and every ounce of effort,” he added.

Gates advocates “a new focus on efficiency, especially in prevention” that focuses on, firstly, scaling up existing prevention tools such as male circumcision and preventing mother-to-child transmission; and secondly, focusing prevention efforts on high-risk communities such as men who have sex with men, injecting drug users and sex workers.

The third focus should be on innovations in basic science, including vaccines, new diagnostics and ARV-based prevention (pills, injections and gels).

However, until these efforts start to make a significant impact, money to treat all those who need ARVs is going to be in short supply and rationing is likely to occur in which the poor, rural and most marginalised groups will once again suffer the most. – Health-e News Service