SA’s HIV treatment plan in disarray

South Africa’s HIV/Aids treatment programme is in a state of disarray, and could result in the deaths of thousands of people dependent on it for life-prolonging drugs, Aids activists and doctors have charged.

Early last year, a coalition consisting of local and international NGOs, including Doctors Without Borders (MSF), the Treatment Action Campaign (TLC) and SECTION27, raised the alarm over massive antiretroviral (ARV) and TB drug shortages in the Eastern Cape province.

At the time, the coalition stressed that the systemic failings in the drug supply chain at the province’s Mthatha medical depot was affecting more than 100 000 people who depend on 300 facilities served by that depot. But their cries fell on deaf ears.

“This situation is catastrophic. It means many thousands of people living with HIV have risked treatment interruption for months now. The stock-outs consequently undermine clinical benefits of life-saving ARV treatment.

“Over time, more deaths will occur as a result and the likelihood of increased drug resistance is significant,” Dr Amir Shroufi, the Deputy Medical Coordinator for MSF in South Africa, said of the Mthatha crisis.

Research shows that drug resistance occurs when there are prolonged breaks or interruptions in treatments such as HIV and TB medications, and microorganisms such as bacteria, viruses, fungi and parasites get a chance to mutate in ways that render the medications ineffective.

When cracks become chasms

Now, almost a year later, the crisis still remains unresolved. And to add insult to injury, the drug stock-outs (shortages) have spread to neighbouring provinces.

“The Treatment Action Campaign is able to confirm that 54% of clinics in the Free State province are now also experiencing widespread TB and ARV drug stock-outs,” SECTION27 Executive Director Mark Heywood told Health24.

While there is no set figure on how many patients are being sidelined when it comes to accessing their treatment in these provinces, the coalition believes that scores more could now be slipping through the cracks in the government’s treatment plan.

But South Africa is no stranger to dragging its feet on the roll-out of life-prolonging ARV drugs, and was until just 10 years ago the centre of global attention due to its dogged determination to frustrate the implementation of free treatment for HIV-positive citizens.

“The TLC report on the Free State situation has drawn ire from the provincial government – to the point that the local TLC leader has received death threats and has had to be relocated to a safe house,” said Heywood.

Dr Gilles Van Cutsem, MSF Medical Coordinator, says intimidation such as this is totally unacceptable.

“We ask government to express their support of a vibrant civil society that not only speaks about the good of the healthcare system, but can freely criticise its shortcomings,” Dr Van Cutsem said.

Success not what is seems

Meanwhile the government continues to broadcast how well it is doing in curbing the pandemic by placing over 2 million people on ARVs.

The South African government has HIV under control, according to Health Minister Dr Aaron Motsoaledi, who says recent statistics back his claim:
•    2.1 million people are on ARVs (up from 923 000 in 2009)
•    3 540 treatment sites have been created (up from 490 in 2009)
•    23 000 nurses are able to initiate patients on treatment (up from 250 in 2009)

While this is a major step forward in the fight against HIV/Aids, the coalition says it is pointless if patients continue to slip through the cracks.

“South Africa’s national figures reflect the total number of people who have been initiated on ARV treatment but, very importantly, not those who are currently in care,” Professor Francois Venter, the Deputy Director of Wits University’s Reproductive Health and HIV Institute, told Health24.

The coalition is urging the Minister of Health to use his powers in terms of Section 100 of the Constitution to intervene on an emergency basis to provide health services in line with national standards.

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