Tamar Kahn
1 December 2008
opinion
Johannesburg — JUST two months after assuming office, Health Minister Barbara Hogan is already making her mark in the fight against AIDS, inspiring fresh hope after years of government obfuscation on one of SA's most pressing problems.
In word and deed, she has made a complete break with the past. She has spoken out frankly about the ravages wrought by HIV/AIDS, describing the deaths among young adults attributable to the disease as akin to those seen during a war. She has moved swiftly to try to address crises such as the critical shortage of antiretroviral medicines in Free State, and she has employed the prominent AIDS activist, advocate Fatima Hassan, as an adviser, an appointment that would previously have been unthinkable.
Yet it will take more than the brave political leadership of one woman to turn the disastrous public health system around and reverse the AIDS crisis. The status quo can in no small way be attributed to Hogan's predecessor Manto Tshabalala-Msimang, who was shunted into a relatively harmless post in the Presidency in the cabinet reshuffle that followed the African National Congress's (ANC's) recall of her master and protector, former President Thabo Mbeki, in September.
A recent study by the Harvard School of Public Health starkly illustrates the terrible toll their resistance to proven AIDS medication exacted upon SA: 330000 lives could have been saved and 35000 HIV-positive babies could have been protected from the HI-virus between 2000 and 2005 if the government had not stalled on providing the drugs.
While experts agree the rate of new infections has slowed since the 1990s, the situation remains grim: 5,7-million people are now infected with HIV, more than any other country, according to the United Nations (UN). Tuberculosis (TB) rates have surged, as HIV weakens the immune system and increases vulnerability to TB. In 2005, the most recent year for which national figures are available, almost 340000 new cases of TB were detected: six out of 10 of these patients were also infected with HIV, the UN says.
The extent of HIV and TB places an almost impossible load on the public health system, casting into sharp relief the problems caused by years of mismanagement and underfunding in critical areas. Financing for public hospitals, for example, has remained largely unchanged over the past 10 years, resulting in a real decline in budgets, according to the Development Bank of Southern Africa's (DBSA's) recent health roadmap report.
The refreshingly frank assessment of the state of SA's health is intended to guide future government policy, and makes the point that both the national and provincial health departments are hobbled by hopelessly inadequate systems for monitoring information and tracking spending. Thus, four and a half years after the government finally began providing treatment to people with HIV, it can provide figures only for the total number of patients who have been enrolled on the programme.
There is no coherent data on how many patients have since died, been forced to switch drugs because of serious side-effects, or stopped treatment altogether.
Such information is vital for future planning.
Over time, the cumulative total of people started on treatment becomes a less and less useful number: the point was illustrated earlier this year by SA's biggest generic drug maker, Aspen Pharmacare, which estimated in February that no more than 350000 patients were on treatment, a figure markedly lower than figures published by the treasury that month showing 418000 people had started treatment in the first four years of the programme.
The Treatment Action Campaign estimates that another 100000 people are on treatment in the private sector.
Although the moribund South African National AIDS Council (Sanac) was supposedly revived after the cabinet approved the National Strategic AIDS Plan to great fanfare 18 months ago, in reality it has struggled to get much done since then.
Without political backing from then health minister, Tshabalala-Msimang, its secretariat languished in the health department without a CEO, and few personnel were appointed: more than two dozen Sanac posts are still empty. That may be changing, as the Sanac secretariat is now moving into the DBSA's offices, and a search is under way for a CEO.
The health department, with support from Sanac, was expected to lead the development of new policies on the role that male circumcision can play in preventing HIV, revise adult and child treatment guidelines, update guidelines for preventing mother-to-child transmission of HIV, and devise a new AIDS drug tender.
But the lack of capacity in Sanac, combined with a dearth of energetic, skilled staff in the health department, has proved an immense source of frustration to the medical fraternity over the past year.
Last July, for example, local researchers released interim findings of a study showing that the death rate among HIV-positive babies fell dramatically if they were treated with antiretrovirals as soon as possible, rather than waiting until they fell sick. The scientists briefed health department officials last November, and their research was published last month in the prestigious New England Journal of Medicine.
The World Health Organisation and agencies in the US and Europe revised their guidelines for treating babies in the light of the research earlier this year, but health officials here at home were still debating the issue last week.
While new, improved protocols for preventing mother-to-child transmission of HIV have been implemented, the delay in approving new treatment guidelines for adults has led to a bizarre situation where the government has put aside money to buy the drug tenofovir (which has fewer side-effects than the widely prescribed stavudine), awarded the supply contract to Aspen Pharmacare, and yet patients still cannot get the drug because doctors have not been told how to use it.
Hogan's uncertain future -- no one knows whether she will be reappointed health minister after next year's general election -- makes tackling one of the most insidious legacies of Mbeki and Tshabalala-Msimang immensely difficult. Under their leadership, denial of the benefits of antiretroviral medicines was encouraged, and purveyors of dubious alternative remedies were given free rein. The confidence they instilled in their acolytes was made apparent last week, when Health-e news service reported that KwaZulu- Natal's health MEC, Peggy Nkonyeni, was pressing an AIDS hospice to introduce unproven traditional remedies, with the assistance of traditional healers who spurn antiretrovirals. Hogan's hands may be tied on this issue: just as she cannot purge her department of civil servants who subscribed to Tshabalala-Msimang's quixotic views, she does not have the power to discipline an MEC apparently intent on undermining government policy.
World AIDS Day is traditionally a time to take stock and reflect on how the country is faring in its efforts to deal with the disease. There is no doubt great political strides have been made to tackle AIDS since Jacob Zuma was elected president of the ANC last year. But translating that into better care for the millions of South Africans affected by HIV/AIDS remains a daunting task.
Kahn is science and health editor.
Be the first to Write a Comment!
Copyright © 2008 Business Day. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of this material, click here.
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
