As of today (Thursday 5 March), 7 of the 28 ARV sites in the Free State are still not initiating new patients onto treatment.
Critical shortages in essential healthcare services and equipment continue.At Pelonomi Hospital in Bloemfontein, doctors have been using stationary stickers to close drips because they have not had access to vital medical equipment.
On Friday 27 February, TAC activists, led by Sello Mokhalipi, picketed outside the city hall in Bloemfontein. They held placards stating: 'Budget + antiretroviral treatment prolongs HIV-positive people’s lives'; 'Please don’t forget people living with HIV/AIDS', 'We want, we need and we demand treatment', and 'Stop the shortage of ARVs'.
David Bourne died suddenly on 24 February 2009. He was a Chief Research Officer in the University of Cape Town School of Public Health and Family Medicine. Those of us in TAC and the ALP who worked with him enjoyed his vibrant, warm personality and the glee he enthusiastically conveyed whenever he called one of us to announce his, and his researchers', latest finding.
More importantly though, David was an excellent scientist of immense integrity. The School of Public Health has accurately described him as "a leading demographer and statistician in the field of HIV in South Africa." He often assisted TAC with the interpretation of epidemiological data.
There were many scientific studies on TB and HIV at the 16th Conference on Retroviruses and Opportunistic Infections (CROI). While the reports on TB diagnostics were bleak, there have been advances in TB treatment, particularly the use of prednisone in patients with Immune Reconstitution Syndrome related TB. There were also important scientific findings presented on how TB can be managed more effectively using existing technologies. Data on drug-resistant TB continues to be very concerning, with some studies reporting extremely high mortality rates.
The ART moratorium in the Free State was enacted almost four months ago. Since then, the HIV Clinicians Society conservatively estimates that about 30 people have died every day due to their inability to access ART in the province. Approximately 15,000 people in need of treatment are on a waiting list. However, many were turned away during the moratorium without being added to the waiting list. Others have had their regimens interrupted due to the drug stock-outs.
Despite promises by the provincial Department of Health in the Free State that the antiretroviral treatment (ART) moratorium would be lifted last week, TAC continues to receive complaints from doctors and activists in the provinces that they still do not have access to drugs.
TAC has taken to the streets in the past week to demonstrate our frustration with the needless pain and death caused by ART delays, and to show solidarity with patients in the Free State who have been denied access to essential healthcare services.
TAC’s first action was a march which began inside Pelonomi Hospital in the Free State. The march was organised by comrade Sello Mokhalipi and led by TAC Chairperson Nonkosi Khumalo and Deputy Chairperson Tebogo Klaas. Activists marched to the headquarters of the MEC for Health, Sakhiwo Belot, where a memo was presented by Nonkosi to a representative of MEC Belot. The memo condemned the ART moratorium and demanded its immediate abolition. The memo also made demands for more information about the budgeting shortfall, and for far greater accountability in the Free State Department of Health.
TAC’s second action this week was a picket outside parliament in Cape Town, chosen for its proximity to Finance Minister Trevor Manuel as he delivered his annual budget speech which outlined government’s health expenditure plan for the next financial year. The picket was also attended by activists from COSATU, the Social Justice Coalition and other civil society partners.
The Treatment Action Campaign and the AIDS Law Project (ALP) welcome the budget speech of the Minister of Finance. In the days ahead we will study the detail of the health appropriation and provide further comment if necessary. Given that the bulk of health spending comes from resources that are allocated to the provinces, provincial budgets are particularly important to establish whether there is an appropriate growth in the health allocation.
We commend the following aspects of the budget speech:
There are other aspects of the budget speech that we support. We outline these, along with our reservations, below.
Minister of Health Barbara Hogan and incoming UNAIDS Executive Director Michel Sidibé paid a visit this week to TAC and MSF in Khayelitsha. Minister Hogan was highly impressed by her visit and has promised to look into Khayelitsha’s successful health model, used to fight against HIV/AIDS, and see if it can be transplanted into other struggling health districts countrywide.
She said the community had shown the world that proper partnerships, patient adherence and treatment literacy were not rhetoric, but could help the government to improve health delivery systems.
At the 16th Conference on Retroviruses and Opportunistic Infections (CROI) Dr Tammy Meyers presented data from a large cohort of children on highly active antiretroviral therapy (HAART) at Harriet Shezi Children's Clinic in Chris Hani Baragwanath Hospital, Soweto, South Africa.(1) Of 2,102 chidren initiated on HAART over a four year period (April 2004 – March 2008), 1734 (82%) are alive and in the programme. Most of these children started HAART with severely compromised immune systems. Based on studies of untreated children at this stage of HIV disease(2)(3), it is fair to say that nearly all would have been dead had they not been placed on HAART. By the end of the study, half the children had been on HAART for at least 17 months.
Analysis shows that more than 90% of the cohort had less than 400 copies of HIV per millilitre of blood after 18 months on the programme1, indicating that treatment was effective. On average, CD4 percentage rose from 11% to over 25% (in children CD4 percentage, rather than CD4 count is used because it is more stable). HIV-positive children on average weigh less and are shorter than HIV-negative children of the same age. The children in the cohort showed remarkable improvements in both these measures.
*Please note that the young girl pictured in the photos above is not enrolled on Harriet Shezi's treatment programme; she is enrolled on ART through a similar programme at a rural Eastern Cape health facility. The photo on the left was taken shortly before she started ART, the photo on the right is of the same girl six months after having been initiated onto antiretroviral treatment. Hers is one of the thousands of paediatric ART success stories in South Africa.
The decision of the Free State government to scale back essential health care services has resulted in thousands of patients in immediate need of care being turned away from Free State clinics since 1 November 2008. This has caused avoidable deaths and illness.
The TAC and our partner, the AIDS Law Project, welcome the recommendation that was made by the Program Implementation Committee (PIC) of the South African National AIDS Council (SANAC) on 5 February, proposing that the moratorium on access to Antiretroviral Therapy (ART) for new patients in the Free State be lifted by Monday 9 February. In response the Director General of the Department of Health, who co-chairs the SANAC PIC, offered to provide a plan on how this situation could be addressed by Monday, 9th February 2009. This is a positive development.
Today, the Pretoria High Court handed down judgment in the matter of Treatment Action Campaign v Minister of Correctional Services and Another (case no. 18379/2008). The judgment is available online at www.alp.org.za. In short, Justice Southwood's decision provides as follows: