RFI: Gender, Human Rights, HIV/AIDS Policy and the Law (2)
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Dear Rouzeh,
Although this is an article and not a study, it may be useful.
It's from the Health and Human Rights section of The Lancet
medical journal.
Best regards,
Priya Shetty
SciDev.Net
97-99 Dean Street
London W1D 3TE
Tel: +44-207-292-9917
Fax: +44-207-292-9929
mailto:priya.shetty@scidev.net
http://www.scidev.net
--
HIV treatment in South Africa: overcoming impediments to get
started
Quarraisha Abdool Karim
In South Africa, the euphoria of the peaceful transition from
apartheid to democracy has been dulled by the devastation of
HIV/AIDS. The epidemic has had a disproportionate effect on
poor, previously disenfranchised groups, in which the apartheid
migrant labour system had destroyed family life and created con-
jugal instability. South Africa is now in the midst of a matur-
ing epidemic, and AIDS dominates almost all aspects of medical
care. HIV-1 prevalence reached 24·5% in pregnant women attending
public health services in 2002.1
Highly active antiretroviral therapy (HAART) symbolises hope for
many communities. But access to these life-saving drugs was se-
verely restricted until the 2000 International AIDS Conference
in Durban, South Africa. This defining moment2 in global soli-
darity and advocacy for treatment access changed the discourse
on AIDS treatment in poor countries from "if" to "when". The
change was largely due to rapid price reductions and funding
made available by, among others, the Global Fund to fight AIDS,
Tuberculosis, and Malaria.
Although there have been many events to celebrate in postapart-
heid South Africa, the government's response to the AIDS epi-
demic was, until very recently, not one.
Before 1994, the apartheid government's approach to dealing with
AIDS was insufficient and lacked credibility. The Mandela gov-
ernment set about redressing this in 1994 by establishing AIDS
as one of the 23 presidential lead projects and one of the 12
reconstruction and development programmes. This initial period
of hope was, however, short lived. The biggest setback came when
President Mbeki (who took office in 1999) expressed doubt about
whether HIV causes AIDS. Mbeki also questioned the safety and
efficacy of antiretrovirals. Subsequently, a presidential AIDS
panel was created with equal numbers of AIDS denialists and or-
thodox AIDS scientists, but it is yet to report recommendations.
Milestones in access to treatment for HIV in South Africa
April, 2000: Médecins Sans Frontières and TAC start HAART provi-
sion at three government primary health care clinics in Khaya-
litsha.
July, 2000: 13th International AIDS Conference march for treat-
ment access.
March, 2001: Pharmaceutical industry withdraw court case against
the state on parallel importation and generic drug procurement.
April, 2002: Global Fund donate US$72 million to KwaZulu-Natal.
Constitutional court rejects government appeal of the Pretoria
High Court decision and orders government to provide drugs for
the prevention of mother-to-child transmission of HIV at all
public health-care facilities in South Africa.
November, 2002: Nelson Mandela Foundation sponsors workshop in
Durban on treatment access.
August, 2003: First South African AIDS conference, Durban; gov-
ernment support national treatment plan for AIDS treatment op-
tions in the public sector.
October, 2003: Competition Commission rule that GlaxoSmithKline
and Boehringer Ingelheim abused their dominant positions in an-
tiretrovirals market.
January, 2004: Western Cape government expands HAART roll-out,
and by the end of March, 2004, 2000 patients start treatment
through an emergency drug procurement mechanism.
February, 2004: Government accepts money from Global Fund.
March 2004: Boehringer Ingelheim threatens to disinvest from
South Africa because of dissatisfaction about draft medicine
pricing regulations of the Department of Health. TAC threatens
to legal action against the government if it fails to implement
HAART programme.
April 1, 2004: Announcement of AIDS treatment roll-out in 27 pi-
lot sites in four of nine provinces.
April 15, 2004: African National Congress (ANC) wins third de-
mocratic election in South Africa. Whether enthusiasm for HIV
treatment programmes generated during election campaign will be
sustained remains to be seen.
In 2001, advocacy groups challenged the government's decision
not to provide two-dose nevirapine treatment to reduce the risk
of mother-to-child transmission of HIV-1. The Constitutional
Court's ruling against the government was a landmark, and it
showed that the country's constitution could hold the government
accountable for its actions (or in this case inaction).
Under increasing pressure to address treatment access, the gov-
ernment adopted the national treatment plan, which recognised
that by mid-2003 about half a million South Africans were in
need of anti-retroviral treatment. The plan established a com-
mitment to measure CD4 counts in about 200 000 people with HIV
infection; starting 53 000 on HAART by the end of March, 2004,
and another 180 000 by the end of March, 2005. The Department of
Health aimed for at least one service point in every health dis-
trict within 1 year, and one in every municipality within 5
years.
The Western Cape Province was the first to provide AIDS treat-
ment free of charge in selected government hospitals, building
on experience from the Médecin sans Frontières treatment project
in Khayelitsha.3
Efforts to overcome operational constraints to national coverage
of AIDS treatment include: urgent procurement of medicines;
speedy accreditation of treatment sites; resource allocation to
underdeveloped sites to build capacity for site accreditation
and treatment roll out; clear, accurate, and appropriate advice
on testing, treatment, nutrition, and prevention; and training
and support of health-care personnel.
If the targets set out in the national AIDS treatment plan are
to be met, South Africa will have to create the largest AIDS
treatment programme in the world--a feat that needs the assis-
tance from all sectors of South African society as well as in-
ternational support to achieve success.
--
CAPRISA, University of KwaZulu-Natal, Nelson R Mandela School of
Medicine, University of KwaZulu-Natal, Durban 4013, South Af-
rica; and Mailman School of Public Health, Columbia University,
New York, NY, USA. (e-mail:abdoolq2@nu.ac.za)
[1] Department of Health, RSA. Twelfth national HIV survey of
women attending antenatal clinics of the public health services.
Pretoria, 2002.
[2] Abdool Karim SS, Abdool Karim Q. Breaking the silence, one
year later: reflections on the Durban conference. AIDS Clinical
Care 2001, 70: 63-65.
[3] Kasper T, Coetzee D, Louis F, Boulle A, Hilderbrand K. De-
mystifying antiretroviral therapy in resource-poor settings. Es-
sent Drugs Monit 2003; 32: 20-21. [PubMed]