Inter Press Service - November 22, 2003
Ferial Haffajee

Over the next five years, the state hopes to extend the programme to over a million people living with AIDS. The price of a year's supply of the life-prolonging drugs, also known as anti-retrovirals (ARV's), is about 100 dollars - fifty times less than it was in November 2002.

The reason the drug prices have tumbled is because of a concerted local and international campaign to reduce the costs of patented medicines on humanitarian grounds.

Pharmaceutical companies have introduced lower prices in countries where the AIDS pandemic has reached an advanced stage. In the later stages of AIDS, an HIV-positive person succumbs to diseases that take advantage of their weakened immune system.

"Two years ago, this programme would have been impossible - among other reasons, due to the cost of the medicines and laboratory tests required. Falling prices internationally and new opportunities to manufacture some drugs in South Africa, as well as successful negotiations with drug companies, made it feasible to consider such a programme," said Health Minister Manto Tshabalala-Msimang.

According to Peter Piot, Executive Director of the United Nations Joint Programme on HIV/AIDS (UNAIDS), "South Africa's bold move to ensure that millions of HIV-positive people have access to treatment should mobilise other African governments to make treatment a reality for those infected."

He added that the cabinet's approval of the programme had allowed South Africa to enter a "critical new phase" in its battle to contain the pandemic.

In the past, civil society and government have been at loggerheads over the provision of ARV's. While non-governmental organisations made a concerted push for the drugs to be widely available, officials professed concern about the safety of the medicines - and whether South Africa could afford to provide them.

Since 1999, President Thabo Mbeki has been associated with the denialist school of AIDS science, which holds that the human immunodeficiency virus (HIV) which causes AIDS does not exist. Researchers in this camp also claim that ARV's are poisonous.

Now, Piot says, there is a change, "one that is characterised by strong political commitment, a dynamic grassroots movement, more funding, and scaling up (of) prevention and treatment programmes".

"We are quite excited. If the plan is implemented, it would save the lives of many," said Nkululeko Nxesi, the National Director of the Association of People living with HIV and AIDS. Similar messages of support came from trade unions, the Treatment Action Campaign (which has led the drive for ARV provision) and opposition parties.

South Africa has the world's highest number of people living with HIV: five million, according to UNAIDS. This is out of a population of 45 million people. The Medical Research Council - which has offices in Pretoria, Cape Town and Durban - estimates that AIDS is now the leading cause of death in the country.

A survey published this week found that among households canvassed, over half had taken in an AIDS orphan. Research by the Washington-based Joint Centre for Political and Economic Studies and other agencies also showed that ARV treatment would have to be complemented by a range of other social measures. The 400 households surveyed spent less than others on food and were more indebted, while children in these homes were unlikely to attend school

While the approval of the ARV plan has been welcomed with great relief in many quarters, there is a sense that the road ahead will be difficult. From the mid-1990's until two years ago, South Africa underwent a structural adjustment programme which placed severe constraints on public spending. The health system buckled.

Moreover, the country has suffered a "brain drain" of both nurses and doctors who have left for greener - and more lucrative - pastures overseas. This has grave implications for the ARV plan, which requires an adequate network of well-trained health practitioners to be in place throughout South Africa.

The drugs can have severe side-effects that need to be managed. A high level of care is also necessary to ensure that patients stay on the drugs, with doctors warning that the efficacy of the medicines can be radically reduced if they are not properly administered.

"To deliver this kind of care across the country, with equitable access to all, will require a major effort to upgrade our national healthcare system," said the government in a statement. The plan is expected cost authorities 45.4 million dollars in its first year of operation. Over the next five years, about 1.5 billion dollars will be spent on the plan. (END/AF/SA/DV/HE/SD/FH/JH/03)

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