The demand for people living with HIV and AIDS in Africa to access treatment cannot be ignored. At the same time the challenges to meeting this demand are many. They include the shortfalls in health services and lack of knowledge about treatment, making decisions about newer regimens, and the risk of resistance to antiretrovirals. The challenges also include ensuring uninterrupted drug supplies, laboratory capacities for CD4 monitoring, accessible voluntary counselling and testing, trained healthcare workers, and effective monitoring of resistance to antiretroviral drugs. A series of papers produced in 2003 through the southern African regional network on equity in health raised further concerns about measures to ensure fairness in the rationing of scarce treatment resources and the diversion of scarce resources from strained public health services into vertical treatment programmes.
Equity and HIV/AIDS
In Malawi, HIV/AIDS has created an increasing demand for healthcare, exacerbated by population pressure, chronic poverty and food insecurity. This demand is set against a reduced capacity to supply healthcare. With funding from the Global Fund for HIV/AIDS, Tuberculosis and Malaria (GFATM), Malawi is now in a position to commence a programme of provision of anti-retroviral therapy (ART) using a public health approach, within an integrated programme of prevention, care and support. This technical paper, produced by Equinet in cooperation with Oxfam GB, analyses the equity issues in HIV/AIDS health sector responses in Malawi, including access to ART.
AIDS activists from the advocacy group, AIDS Therapeutic Treatment Now, South Africa (ATTN SA) expressed outrage and frustration over the move by the South African government to cut by two-thirds its AIDS budget. According to the Financial Times (UK) newspaper (2/2/04), "The initial budget of R296m (pounds Sterling 22m, $42m, euro 34m) for the first phase of the roll-out of treatment, up to the end of next month, has been cut to R90m by the Treasury, without explanation."
Problems with drug supply of antiretrovirals have come to the surface in both Nigeria and South Africa in the past few weeks as the realities of implementing large-scale treatment access begin to hit home. In South Africa the Treatment Action Campaign (TAC) has issued a warning that supplies of the paediatric formulation of efavirenz (Stocrin) are running out, with no stock guaranteed to be brought into the country by the drug’s manufacturer, Merck Sharp and Dohme (MSD), before January 28. TAC claims that one patient has already had to interrupt treatment as a result of the drug `stock out`, and highlights the risk of resistance that may arise if efavirenz treatment is interrupted without planning.
A paper developed by the Health Systems Resource Centre on behalf of the Department for International Development (DFID) and in collaboration with the World Health Organisation (WHO) aims to increase understanding of the requirements for introducing and scaling up provision of antiretroviral therapy (ART) as part of comprehensive HIV/AIDS programmes in resource-poor countries. The paper provides an overview of experience and lessons learned with regard to: The feasibility of ART in resource-poor settings; The different approaches being taken to delivery of ART; and The issues to be considered in scaling up ART provision. The review is based on published and unpublished literature, interviews with key informants, web searches and country information.