Two thousand people are now on the waiting list for antiretroviral medication at Edendale Hospital, which stopped giving new patients ARVs nine weeks ago.

Community pressure against the patient freeze is mounting with a vigil planned for Wednesday morning to mourn those who have died while waiting for ARVs and a protest march organised by the Treatment Action Campaign called for the following day.

Doctors and nurses confirm that patients on the waiting list are dying "every week", yet the provincial health department does not seem to be in a hurry to address the critical shortages of staff and space at the hospital causing the programme's suspension.

Thembinkosi Zuma, aged 27, died on 1 June after waiting more than two months for treatment. His CD4 count was a mere 47 when it was measured in March, and at the time of his death he had TB, according to a family member who did not want to be named.

Meanwhile, Sbu Zondi* told Health-e he had been waiting for ARVs since January, when his CD4 count was 67. Thembi Ndlovu's* mother confirmed that her daughter had been on the waiting list since October last year and that her CD4 is a mere 24.

The hospital stopped initiating new patients on ARVs on 6 May as staff said that this would compromise the care of the 11 000 patients already on ARVs - some of whom have been

unable to get their monthly medication because of the shortage of pharmacists.

The entire HIV treatment programme is being run by the equivalent of three fulltime doctors (made up of a few full and part-time doctors), three pharmacists and two pharmacy assistants.

A further two doctors have been appointed since May, but have yet to start work. Attracting and keeping doctors has been a challenge from the start of the ARV rollout, due to the difficult working conditions and high patient burden.

There have been no applicants for two junior pharmacists' posts and locum pharmacists are reluctant to work at the hospital as its hourly sessional rate is R20 less than that at other health facilities.

Mark Heywood, deputy chairperson of the SA National AIDS Council (SANAC), said the province had a legal and moral obligation to urgently address all factors causing the long waiting list.

"The government has decided that people living with HIV have a right to antiretroviral medication, so it has to take all the necessary steps to ensure that people can get this," said Heywood, who has raised the situation at Edendale with the national health department.

The SA HIV Clinicians' Society sent a letter to provincial health MEC Dr Sibongiseni Dhlomo 10 days ago raising its concern that "a crisis of this magnitude was allowed to develop at this crucial facility".

In the letter, SAHCS president Francois Venter points out that many studies have shown that if ARV treatment is delayed for patients with low CD4 counts and opportunistic infections, this causes "unnecessary" sickness and deaths.

"Regardless of the challenges that the health care system faces in terms of infrastructure and staffing constraints, it is never acceptable practice to halt the initiation of new patients onto ARV treatment," writes Venter.

So far, MEC Dhlomo has not responded to the letter and denies that Edendale has suspended its ARV programme, claiming instead that patient initiation has slowed down and that patients are now being given ARVs at clinics. At the time of going to press, his office had not responded to questions about what it was doing to address the waiting list.

However, while decentralising the ARV rollout to clinics is in the pipeline, to do this effectively these clinics need their own pharmacy staff as most rely on the hospital's overburdened pharmacy.

The uMgungundlovu district, where the hospital is situated, has one of the highest rates of HIV in the country, with 40 percent of people tested for the virus being HIV positive in 2007/8, according to the District Health Barometer. It also has the 8th highest TB rate of all 52 districts.

Hospital staff say that around 60 percent of pregnant women coming to Edendale are living with HIV.

At present, Greys' Hospital is starting Edendale's pregnant women with HIV on ARVs, but it cannot afford to maintain their treatment because its facilities are also overloaded.

Pregnant women are thus being sent back to Edendale, which is trying to accommodate five pregnant women per week on its treatment programme. - Health-e News Service.

* names changed at patients' request.