Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.
South African Press Association - February 24, 2004
The plan -- approved by the Cabinet last August -- aims to provide at least one anti-retroviral service point in every health district within a year.
The longer-term aim is to give all South Africans requiring treatment access to the programme in their local municipal area within five years.
The Department of Health's acting Director General, Kamy Chetty, told the committee that one of the most important aspects of the plan is to ensure that the uninfected remain HIV-negative.
"That is why the issue of prevention is stressed time and time again. We will continue to stress that prevention remains the cornerstone of fighting HIV and Aids. Individuals sometimes have the perception that the [anti-retroviral] treatment is a cure or that their behaviour does not have to change ... prevention is very important."
There are currently 5,3-million HIV-positive people in South Africa and it is vital that their progression to full-blown Aids is as slow as possible, Chetty said.
The plan will see patients receive comprehensive care -- including nutritional supplements -- and not just anti-retrovirals.
Dr Nono Simelela, chief director of the Aids directorate, said the department will buy supplement meals for patients who are "food insecure".
"We will provide micro-nutrients for all patients who are HIV-infected ... we will [also] acknowledge the role of traditional medicines."
She said the department is working with the Medical Research Council to evaluate the safety and efficacy of traditional medicines.
"We will not discourage it, but we will try to follow up patients to see if there are any interactions between traditional medicines and anti-retrovirals."
"So, what we have said and re-emphasised is that patients have a choice. People will not be forced to take anything that they are not willing to take. But, at least, we're providing the full comprehensive package."
The actual distribution of the anti-retrovirals is a challenge, said Dr Humphrey Zokifa, the Health Department's cluster manager of pharmaceutical policy and planning.
"You bring in this drug into the public health system, it's like bringing gold. It can leave the public sector and find its way into the private sector or even leave the country and go into neighbouring countries. This is going to be a well-sought-after item."
He said the anti-retrovirals -- including d4T, 3TC, nevirapine, AZT and Ritonavir -- will be treated like schedule-five drugs and will also be monitored using a tracker system.
"The tracker system is electronically based, so it allows you to track the drug from the time it gets to the facilities to the time it left. You can account for the stock."
The department is drawing up specifications for a tracker system and will soon be advertising the tender.
The drugs will be housed in a government depot in each of the nine provinces. The Eastern Cape alone will have two depots.
He warned that manufacturers of anti-retrovirals will have to ascertain how they will keep producing the drugs as the key ingredient is imported from India and China.
"The disease in India and China is growing so the companies that make the ingredient will have first loyalty to their local market before supplying to us. We can get into a situation where we can run out."
He said that advertisements have been placed in a Sunday newspaper for manufacturers interested in eventually tendering for the right to produce the drugs to approach the department with proposals on how this problem can be solved.
"We have to look to a medium- to long-term strategy," he said.
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