Cape Town — Huge shortfalls in the Treasury's allocations for antiretroviral (ARV) treatment meant that SA was having to ask donors to fund the sharp growth in demand which was putting pressure on provinces, health department director-general Thami Mseleku said yesterday.

"We are anticipating a big problem as the ARV programme is not going to be rolled out as intended," he warned the National Council of Provinces' select finance committee during a hearing on the Division of Revenue Bill.

"The numbers (of new patients) are very huge and are rising very fast. As a country we will get to a stage where we will never be able to afford the figures required for treatment but that is a challenge we are going to have to face."

The number of people enrolled for ARV therapy has soared from 15311 in 2004 to an estimated 700000 now. An estimated 5,7-million are believed to be infected with HIV in SA with 1,8-million expected to need treatment by 2011.

With the 2009-10 fiscal year not yet under way, Mseleku predicted that by September provinces would be reporting an overexpenditure on their ARV treatment programme because the Treasury had not made budgetary adjustments to cater for the higher number of cases.

In November, Free State had to refuse treatment to 15000 new patients because it had run out of funds for drugs. The province was eventually helped with an R11,2m donation from the US President's Emergency Plan for AIDS Relief (Pepfar).

Mseleku said the health department had requested R1,4bn for the 2009-10 roll-out of the comprehensive HIV/ AIDS plan but had only received R200m.

Requests for the two other years of the medium-term expenditure framework totalled R3,8bn whereas only R732m had been assigned. Last year an adjustment estimate of R300m was granted compared to the R938m requested to deal with the greater than projected number of people needing ARV treatment.

This funding shortfall was why some provinces -- not only Free State -- were stopping treatment or reporting overexpenditures, Mseleku said.

"Contact is being made with donor agencies to assist with the funding gaps. We are also looking at redirecting funds from other programmes such as home-based care to antiretroviral treatment."

Pepfar was being asked to shift more of its R590m allocation to SA towards treatment -- only 7% of the total at present -- from support services.

Treasury official Kenneth Brown said that there were competing priorities for government funds.