Tamar Kahn
29 November 2006
Cape Town — Red tape is hampering provincial efforts to expand HIV treatment programmes and putting lives at risk, an international coalition of AIDS activists has warned.
"Far too few people are getting treatment in SA," said Fatima Hassan, head of the South African research team involved in a report released yesterday by the International Treatment Preparedness Coalition on the state of AIDS treatment in six countries hit hard by the disease, including SA.
The report says the global effort to widen access to treatment is "stagnating". Without new interventions, at least 5-million HIV patients will not be getting the drugs they need by 2010, it says.
More than 5,5-million South Africans, or about 11% of the population, are infected with HIV. By last month about 800000 needed antiretroviral medicines, but only about 330000 were getting them, according to the latest estimates.
About 213000 patients are on public-sector programmes, says the health department, and at least another 100000 get the drugs privately, says the report.
Hassan said the national health department's requirement for provincial treatment facilities to be inspected by national office officials was causing needless delays in accrediting new sites.
With the notable exception of Western Cape, provinces felt unable to develop treatment guidelines independently of outdated national policies, she said. This was particularly problematic for the programmes to prevent mother-to-child transmission of HIV.
Most provinces were still offering mothers and their newborn babies a single dose of nevirapine, although the World Health Organisation now recommended a combination of drugs, except in the most resource-constrained setting, said Hassan.
The activists urged government to speed up the provision of antiretroviral medicines, and called for 500000 people to be on treatment. More people needed to be encouraged to take voluntary HIV tests, and delays in registering drugs with the Medicines Control Council needed to be addressed, they said.
The activists called for more attention to be paid to children affected by HIV, saying some provinces had not yet begun to treat children. Treating children was made more difficult by the lack of appropriate paediatric formulations.
The report highlights challenges facing the Dominican Republic, India, Kenya, Nigeria and Russia, echoing many of the problems facing in SA.
Kenya, for example, is grappling with an acute shortage of health-care workers, limited access for children and a growing need for expensive "second-line" drugs, used when patients develop resistance or suffer severe side effects with "first-line" regimens. Nigeria's care centres are concentrated in urban areas, and stigma is a barrier to access, says the report.
The activists said while tuberculosis (TB) was the leading cause of deaths among people infected with HIV, there was inadequate linkage of HIV and TB programmes in all countries surveyed. Doctors had limited awareness of potentially dangerous interactions between TB and HIV medication.
Not enough attention was paid to the growing numbers of patients with drug-resistant TB.
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