Sunday Times (Johannesburg) - July 20, 2003
Claire Keeton

"Very poor countries have shown they are capable of doing effective treatment in the public sector and that they would be ready to scale up rapidly," said the UN special envoy for HIV/Aids in Africa, Stephen Lewis.

Speaking after this week's international Aids research conference in Paris, the executive director of the UN Global Fund for the Treatment of Aids, Malaria and Tuberculosis, Richard Feachem, said that Africa was on the threshold of an explosion in treatment.

Botswana, with the highest HIV infection rate in the world, at about 38.5%, is leading the way by promising free antiretroviral treatment to all of its 1.5 million citizens.

The national programme has opened six treatment centres since January last year and is treating more than 6 000 people - of an estimated 330 000 with HIV/Aids - using drugs donated by pharmaceutical giant Merck as well as millions of dollars from the Melinda and Bill Gates Foundation.

Now Malawi, Mozambique, Namibia, Angola, Zambia and Zimbabwe are preparing to follow this life-saving initiative by launching or expanding treatment programmes in the public sector as swiftly as possible.

They reported on their progress towards rolling out treatment at a World Health Organisation (WHO) Africa region conference in Zimbabwe last week and at a Southern African Development Community meeting in Lesotho earlier this month.

The UNAIDS programme adviser for Southern and Eastern Africa, Dr Catherine Sozi, said that partnerships between governments, non-government organisations and donors, including pharmaceutical companies, are managing and funding these programmes.

The WHO has set a target of three million Africans on treatment by 2005.

Only South Africa, which has yet to approve a roll-out of antiretroviral drugs in the public sector, is seen as lagging behind. South African Health Minister Manto Tshabalala-Msimang has raised problems around the government's capacity to provide sustainable treatment.

But Dr Kgosi Letlape, the chairman of the Medical Association of South Africa, said enough capacity existed in the public sector to provide treatment to 100 000 people tomorrow, if the government gave the go-ahead.

An estimated 600 South Africans die every day from Aids-related illnesses.

Health Ministry spokesman Jo-Anne Collinge said this week that the Cabinet would deal soon with a joint Treasury and Health Department report on treatment - which found it was affordable and could save up to 1.7 million lives by 2010.

But the signing of a national treatment and prevention plan, which was high on the agenda of a National Economic Development and Labour Council meeting this week between the government, labour, business and community organisations, has stalled again.

In South Africa, about half a million people need antiretrovirals now - but only about 21 000 people are on treatment, 20 000 of whom get access through medical aids.

Outside the private sector, there are about 18 projects run by non-government organisations or universities, which offer sponsored treatment to roughly 1 000 people. Ten of the projects are in urban or peri-urban areas in the Western Cape, five in KwaZulu-Natal and three in Gauteng, and rural projects are to be launched later this year.

Other African countries that have made strides in treating Aids are:

Nigeria has about 15 000 people on treatment and is planning to expand its programme;

Uganda has 10 000 on treatment and its antenatal HIV rates have dropped from double digits to 6%;

Cameroon has about 6 000 on treatment; and

Senegal has about 1 500 people on treatment, and is planning to increase this to 7 000 by 2005.

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