HEALTH-SOUTH AFRICA: 'Our Lives Are Most Important'

Terna Gyuse

DURBAN, Apr 4 2009 (IPS) – The Fourth South African AIDS conference ended in Durban Friday with optimism over progress in research and policy on AIDS prevention but serious concerns over finding the resources to effectively implement the country s national strategic plan of action.
According to the Treatment Action Campaign (TAC), a leading AIDS activist organisation, there are more than five million South Africans living with HIV. In 2007, only 700,000 people had access to antiretroviral drugs. An additional 1.2 million will need to go on antiretroviral therapy by 2011.

Referring to a rough costing for ARV treatment for 2008-2009, Mark Heywood of the AIDS Law Project said, If we take the existing numbers of patients who are on treatment, which is estimated to be just over 600,000 people, and if you add to that another 200,000 who will require to be initiated onto treatment this year, then the shortfall between what has been budgeted for and what it would actually cost just to meet the treatment needs is over one billion rand [110 million dollars].

A protest staged by TAC at the conference venue Thursday highlighted a painful example of the effects of under-funding: in November 2008, the provincial health department of the Free State imposed a moratorium on initiating new patients onto ARV treatment after exhausting its budget. TAC estimates that this denial of treatment led to 30 additional deaths a day until the programme resumed accepting new patients when the new financial year began on Apr. 1, 2009.

Our lives are important. We cannot be sitting here for a week talking about scaling up for success when scaling up is not going to be funded, said TAC national chairperson Nonkosi Khumalo.

Our governments internationally are letting us down. They are investing trillions of dollars to rescue banks, to rescue the motor industry. They are not investing one cent of that in the provision of healthcare.
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South African health minister Barbara Hogan, whose personal high standing in the AIDS community was clear from the standing ovation that greeted her entry on the conference s final day, acknowledged the challenge to government while commending what she said was a spirit of solidarity amongst activists, clinicians, researchers, and policy-makers.

As a community of health promoters, we must ensure that health services are not cut, but sustained. For every job that is cut, for every sector that buckles, for every health cent cut, there will be consequences for public health, said the minister.

The issue then for all of us is how to spend the resources we do have with efficiency and increase the pot; with maximum public health benefit; and in a manner that scales up not down so that the [national strategic plan on AIDS] and the TB Strategic Plan targets are met.

In the final session, rapporteurs from the six broad themes covered by the conference picked out key presentations and debates.

Among the highlights were new research into understanding elite controllers , a small minority of HIV-positive people whose immune systems successfully suppress the virus; and studies investigating most effective means of predicting disease progression immediately after infection.

The conference also heard reports on success of ART among children where it was encouraging to find effective monitoring and good response to treatment, despite a majority of children in the survey beginning treatment relatively late. Another paper discussed developing techniques such as dried blood spot test to allow quicker, more accurate HIV testing in field locations.

There was continuing debate on how best to monitor and evaluate implementation of the national strategic plan; the most effective tracking of results involves following groups over time, but this is necessarily slow and costly. Suggestions for improving monitoring included moving away from large and unwieldy national data in favour of carefully selected sentinel sites and ensuring that data is passed on to full range of stakeholders.

Professor Catherine Slack, project coordinator for the HIV/AIDS Vaccine Ethics Group (HAVEG), University of KwaZulu-Natal, captured the tone of the conference in her report back on the Social and Economic Sciences, Human Rights and Ethics sessions.

We need to scale up implementation of generally-enabling and legally-enforced arrangements by acknowledging that the main job is not to get the arrangements in place, it s to implement them so that they are lived out in the experiences of citizens. The job now is guidance, strategy, operational detail, capacity, implementation and foresight, Slack told delegates.

We need to scale down the structural conditions that fuel HIV including the norms that punish and blame. These do not prevent HIV, they make it worse. They re not the solution, they re part of the problem.