The decision, announced in the first week of August, comes after intense and increasing pressure from HIV-positive South Africans and dire warnings of the threat the epidemic poses to the country’s economy.
The South African PLWHA advocacy organisation, Treatment Action Campaign (TAC), welcomed the decision, but organisers said they would wait to see the details of the plan before celebrating. “For all of us living with HIV in South Africa, and our families, this is the first sign of hope,” TAC chair Zackie Achmat told the BBC.
There are questions, however, about the ability of the government to pay for its promise. With more than five million of its population of 44 million infected with HIV — the highest incidence of any country — South Africa will need billions of dollars to pay for the drugs. A government feasibility report released last month said that providing treatment and care for just 120,000 of the most severely ill patients would cost US$1.8 billion a year.
Health minister Manto Tshabalala-Msimang, a central target of anger at the government’s intransigence who has previously described antiretrovirals as “poison,” warned that the AIDS treatment plan may be some time coming yet.
“I can’t say we have a rollout, because the plan has not been adequately costed,” she said.
The policy about-face came just days after Tshabalala- Msimang told the country’s first national AIDS conference that a program for provision of antiretroviral treatment could not be commenced “without adequate preparation.”
The government came under sustained criticism at the four-day conference, held in Durban, as activists from the Treatment Action Coalition (TAC), church leaders, media commentators and high-profile judge Edwin Cameron spoke out against the government’s persistent inaction on HIV treatment.
Justice Cameron, who is HIV-positive, led a protest against the decision by organisers to exclude PLWHAs from the conference. “This must be the first AIDS conference I’ve attended in ten years where there has been this omission,” he said.
Inside the conference, speakers warned that South Africa is entering the “death” phase of the epidemic, with the number of deaths — more than 600 a day — now exceeding the number of new infections.
“South Africa is experiencing a devastating epidemic — the world’s worst — and this is just the beginning,” University of Natal researcher Quarraisha Abdool Karim told the conference. The statistics paint a grim picture of the effect the epidemic is having on Africa’s most successful economy, with the disease taking its greatest toll on young people and children. The mortality rate for men between the ages of 20 and 40 has risen by more than 150% since 1998, while the mortality rate for women between 20 and 35 is even greater. More than half the children seen in Johannesburg hospitals are infected.
In a chilling prediction, US researcher Rod Hoff said that HIV/AIDS mortality was “really just staring and won’t peak for another three to four years.”
The details of the new treatment plan are due to be released by the end of September. While the announcement said the government “shares the impatience of many” over treatment access, many activists doubt the program will be rolled out quickly enough.
Aid group Médecins Sans Fronti?res is concerned that the government might run the treatment program in limited pilot sites as it did before introducing nevirapine to prevent mother-to-child transmission of HIV. Such a pilot program could delay universal treatment access for years.
That would be “an absolute catastrophe,” MSF’s South African head Eric Goemare said.
—AFP, Reuters, Kaiser Health Network, The Globe and Mail
