South Africans march to accelerate rollout of antiretroviral treatment

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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."

Glossary

generic

In relation to medicines, a drug manufactured and sold without a brand name, in situations where the original manufacturer’s patent has expired or is not enforced. Generic drugs contain the same active ingredients as branded drugs, and have comparable strength, safety, efficacy and quality.

CD4 cells

The primary white blood cells of the immune system, which signal to other immune system cells how and when to fight infections. HIV preferentially infects and destroys CD4 cells, which are also known as CD4+ T cells or T helper cells.

standard of care

Treatment that experts agree is appropriate, accepted, and widely used for a given disease or condition. In a clinical trial, one group may receive the experimental intervention and another group may receive the standard of care.

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

ProvinceNumber of Patients on ART

 

JulAugSeptOctNovDecJan
Eastern Cape618986178021472749
Free State114139372599677945
Gauteng359448326143745086849691
KwaZulu Natal52715562034341442634964
Limpopo963112305497729
Mpumalanga136333378516754
Northern Cape9510881253289386515
Northwest2946317961121157420832797
Western Cape384343564895533759656188
Total5500105831523519697239802748229332*

The grand total of 29,332 is based upon the most recent figures TAC could obtain.