Sunday Times, South Africa - June 20, 1999
Laurice Taitz
Their study, published in the prestigious British Medical Journal this week, shows it is more expensive to deal with children infected with the virus than it is to try to prevent infection.
Dr Glenda Gray, director of the perinatal HIV research unit at Chris Hani Baragwanath Hospital, Dr Karen Zwi from the paediatrics department and health economists Neil Sderlund and Anthony Kinghorn, estimated that setting up and running a national programme to provide the drug AZT to pregnant women would cost less than 0,5 percent of the total health budget of R26-billion.
This figure included the costs of training healthcare workers about HIV infection, infant feeding practices and equipping them with counselling skills.
The authors argue that while HIV infection in children is being eliminated in the US, in subSaharan Africa it has become a common reason for hospital admissions and is responsible for a large number of deaths among children.
The most recent figures released by the Department of Health for 1998 show that one in five women attending ante-natal clinics nationally are HIV positive.
The figures are based on voluntary anonymous testing. There is no policy to encourage women to be tested.
The Department of Health has said this would be pointless as there are not enough counsellors available and there is no treatment to offer those who test positive.
Critics have raised the problem of the costs of looking after an increased number of orphans if children are protected from HIV infections. But the authors say that infected children, whether orphaned or not, incur substantial cost to the health system because of being repeatedly admitted to hospital, staying in hospital longer and dying before the age of five in many cases.
"Even if children are orphaned, they will incur less cost to the state and their relatives if they are not infected."
The authors concluded: "Combined with our assessment that the intervention is likely to be cost saving, and the enormous social, economic and health system burden imposed by having to care for sick children infected with HIV, such absolute cost levels tend to refute the claim that strategies to prevent transmission of HIV are unaffordable."
The authors said primary healthcare clinics and hospitals in urban and much of rural South Africa probably already had the capacity to test for and treat HIV.
The former Minister of Health, Dr Nkosazana Zuma, was to announce the price at which AZT would be affordable to the government. The task now falls to the new minister, Dr Manto Tshabalala-Msimang.
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