Cosatu and the Treatment Action Campaign (TAC) are to table a national HIV/AIDS treatment plan in the National Economic, Development and Labour Council (Nedlac) following the first national treatment conference which concluded in Durban yesterday (sat).

This would allow Cosatu to declare a dispute with government and business should no agreement be reached in Nedlac on implementation of the treatment plan.

Chief director of HIV/AIDS in the Department of Health, Dr Nono Simelela, said she welcomed this move as “every organisation and person must be involved in the fight against AIDS”.

A key aspect of Cosatu and TAC’s plan involves making anti-retroviral drugs available in public health for those with HIV.

Preliminary cost estimates by TAC put anti-retroviral treatment at R400-R700 a month for adults, depending on the person’s medical condition, and around R583 for children.

Although the drugs are expensive and TAC’s Mark Heywood admits their introduction “will not be easy” the two organisations believe South Africa cannot afford the social costs of not doing so.

“It is more cost effective to manage HIV properly than to let people get sick and die,” says Heywood.

Cosatu secretary general Zwelinzima Vavi told the 700-strong treatment conference that government could produce generic anti-retroviral drugs for the whole of Africa “then we can start to see a real Nepad”.

According to Cosatu, “increased generic production for sub-Saharan Africa is also likely to result in economies of scale which will reduce costs, insulate anti-retroviral therapy from currency fluctuations, stimulate the local pharmaceutical industry and provide jobs”.

TAC and Cosatu say their plan aims to “keep people alive for as long as possible” while government’s strategy ultimately aims at “shunting people towards home-based care and preparing to live with the social consequences of millions of deaths”.

They say that drug costs can be offset against savings as people on anti-retorviral drugs will be able to remain in productive employment, parents will be able to care for their children rather than the state bearing the burden of AIDS orphans and there will be less need for home-based care.

Medical Research Council president Dr Malegapuru Makgoba told the conference that actuarial projections showed that the introduction of anti-retroviral drugs could halve the number of AIDS orphans in 2014, resulting in a million rather than two million orphans.

TAC chairperson Zackie Achmat also warned that unless the drugs were introduced, the massive demand for care from people with AIDS would “destroy the healthcare system”.

According to the Department of Health, in 2000 some 24% of all hospital admissions were the result of AIDS yet deaths due to the epidemic are only expected to peak in around 2010. By 2004, government expects to spend R7-billion a year on managing AIDS in hospitals.

Dr Des Martin from the HIV Clinician’s Society says international research by Johns Hopkins University shows that patients on anti-retroviral drugs reduced their hospital costs by 46% on average. In Brazil, the introduction of the drugs in public health reduced HIV-related hospital costs by 80%.

Cosatu and TAC’s plan proposes a “triangle” of interventions, with HIV prevention and improved treatment of other sexually transmitted diseases at the base and anti-retroviral drugs and home-based care at the apex.

A beefed up SA National AIDS Council, with a permanent secretariat and proper resources could monitor the implementation of the plan, according to TAC and Cosatu.

“People with asymptomatic HIV don’t need drugs. It is only when there CD4 count (measure of immunity in the blood) is less than 200 copies per mililitre of blood that people need drugs,” stressed Martin at the conference.