Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
Mail & Guardian (Johannesburg) - July 21, 2003
The Department of Health is not disputing the report's finding that 1,7-million fewer people will die between now and 2010 if 100% of people with HIV/Aids are treated with anti-retroviral drugs.
Ayanda Ntsaluba, Director General of health, admitted to John Perlman, presenter of SAfm's AM Live, that the reason for delaying the health and Treasury costing report was "contextual issues" and had nothing to do with affordability.
The Treatment Action Campaign (TAC) leaked the costing report, which calculates whether South Africa can afford anti-retroviral treatment, earlier last week.
The report says the benefit of anti-retroviral treatment is that it reduces Aids mortality significantly. The government lambasted the TAC for releasing the document, saying work on it was continuing. The version presented to all provincial health ministers at a meeting in May was the same as that leaked last week.
Ntsaluba said this version had subsequently been reworked, though the core figures had not changed.
Perlman asked whether the costing report was delayed by "quibbling" over the core figures. Ntsaluba replied: "I don't think it is fair to present it as misgivings that delay action on [the report]. But I think it is far more an issue of clarification." The report is still under review but is expected to be presented to a Cabinet meeting on July 23, according to sources.
Legal experts slammed the government this week for creating the impression that the costing report was a secret and had to be "leaked".
"We have a Constitution that promotes transparency and openness. There is nothing top secret about the document. The mere fact that the government commissioned this study makes it a public document," said a senior attorney. He says the costing report can be used in a legal case against the government to compel it to implement a national anti-retroviral programme. Such a case can be argued on the constitutional right to life and the right of access to public health care.
Nathan Geffen, TAC spokesperson, said the government could stop all civil disobedience and legal action by announcing a treatment plan.
The secrecy around the costing report also defies the constitutional judgement of July 5 2002 on the universal provision of nevirapine, which calls for transparency when dealing with the HIV/Aids challenge.
The judgement reads: "The magnitude of the HIV/Aids challenge facing the country calls for a concerted, co-ordinated and co-operative national effort ... This can be achieved only if there is proper communication, especially by government."
The report has a section that looks at the constitutional and legal aspects of a treatment plan. It says: "Phased implementation of the plan is acceptable. The state must have a clear, transparent and reasonable plan, which has the flexibility to address the changing circumstances."
Its rationale, says a government official, is that "South Africa is close to its epidemiological peak of the disease. Curative policy needs to form the bulk of government work."
The report acknowledges that sites need to have doctors familiar with HIV medicine. In terms of infrastructure there is a proposal that there will be one site per district or region and 156 sites within the first two years.
The report says not everyone who is HIV-positive needs anti-retroviral treatment. It also emphasises that adherence to the drugs is critical to avoid treatment failure.
The cost of a year's supply is calculated at the current South African price of R12 232, which includes laboratory and service delivery costs, and government officials expect this to fall.
While the initial costing is based on patented drugs, Treasury officials anticipate the use of cheaper generics.This treatment plan would make South Africa the largest purchaser of anti-retroviral drugs in the world. "Fifty percent is not a constraint, if there's an acceptance, we will increase the take-up. Once it's up and running, it will be the largest ARV programme on the planet. Most [of] the drugs should be manufactured locally," says a government official.
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