Misguided national leadership, particularly President Thabo Mbeki’s questioning of whether HIV causes AIDS, has contributed to South Africa’s HIV/AIDS prevalence rate amongst pregnant women jumping from 7,6% to 24,5% in seven years.

This is the view of researchers writing in the 2001 SA Health Review, due to be released by the Health Systems Trust (HST) in Pretoria today (tues).  

Other examples of poor government leadership in the past year, according to the researchers, were:

• The establishment of the Presidential AIDS Advisory Panel, which was “expensive, time-consuming and dangerous”. (The panel included “dissidents” who dispute whether HIV causes AIDS.)
• The decision of “certain sectors of government” to criticise the methodology of the Medical Research Council’s report on AIDS mortality in South Africa, rather than deal with its “horrific” message that deaths amongst young adults had increased by up to 350% in some age groups.  
• The failure of government departments to build AIDS into their core business.

Leadership was also lacking in other sectors, argue researchers Chris Kenyon, Mark Heywood and Shaun Conway.  

The SA National AIDS Council, set up in 2000 to lead the national, multi-sectoral HIV/AIDS campaign “has proven to be largely invisible and ineffective”, while many of its members were “uninspired choices with little experience in the HIV/AIDS field”.

Lack of formal leadership, however, been offset to a certain extent by the “re-emergence of health activism and social action to combat the epidemic”.  

Other problems undermining government’s “well thought out (HIV/AIDS) plan” include:  

• Unequal gender relations, where 39% of teenage girls report having been forced to have sex,
• The lack of training of healthworkers (less than 10% of the country’s clinics had copies of the national treatment guidelines for opportunistic infections) and the prejudiced attitude of some to people with HIV.  
• Social denial and stigma, where less than 10% of people know they are HIV positive, only 0,5% believe that someone in their family has HIV and up to 92% of people who test positive are unable to tell their partners.

Describing anti-retroviral (ARV) drugs as “one of the greatest pharmaceutical developments in the history of medicine”, the researchers call for a balance to be struck between affordable and adequate treatment.  

 According to the Abuja Declaration, of which South Africa is a signatory, health expenditure should be increased to 15% of total expenditure.

“In South Africa this would amount to an extra R2 to R5billion for the health budget, in addition to the potential tap into the Global HIV/AIDS Fund and the private sector,” the researchers argue.

This extra cash could open the door to a limited ARV treatment programme, as 250 000 people could be treated for about R0.5 billion a year (R2 000 each).  

Meanwhile, researcher Paul Whelan, also writing for the Review, said “the complex financial mechanisms” governing the flow of money from national to provincial governments was making it difficult for provinces to spend their HIV/AIDS allocations.

“Units require considerable budget and business planning abilities to direct all these resources effectively,” argues Whelan. “Given the lack of coherent strategic plans within provincial HIV/AIDS units, these skills seem to be lacking.”

The full text of the SA Health Review can be found at: http://www.hst.org.za/sahr/2001/