Authors from the Perinatal HIV Research Unit at Chris Hani Baragwanath Hospital and Johns Hopkins University examined the current status of the provision of anti-retrovirals (ARVs) in South Africa and found that around 20 000 people of the approximately 5 million living with HIV/AIDS are receiving HAART treatment.

Calculations by the Actuarial Society of South Africa estimate that close to 600 000 South Africans currently need ARVs.

The majority of the 20 000 people receive triple combination drugs as part of a medical insurance scheme while an increasing number of people will be treated as part of occupational programmes in the mining sector.

It is important to note that these people will no longer receive these drugs should they leave the workplace and that their families (dependents) are not part of the treatment programme.

There are also several small treatment projects located in townships within major cities, but none of these treat more than 400 people.

“Government’€™s stance on the use of ARVs has changed in 2002, but there has been no sign of urgency in providing the drugs in the public sector,” the authors said.

They hail ARVs as having revolutionised the treatment of HIV/AIDS, converting a uniformly fatal infection to a treatable, chronic disease.

“Specifically three-drug combinations of ARVs ‘€“ known as triple therapy or HAART ‘€“ have had major impacts on HIV-related deaths and illnesses in settings where these drugs are widely available,” said the authors, Neil Martinson, Busi Radebe, Mdu Mntambo and Avy Violari.

They said that where HAART has been available, deaths and new cases of AIDS had fallen and that it had the potential to reduce the increasingly devastating impact of HIV on households, communities, workplaces and the entire society.

“It would allow infected parents to live long enough to care for their children until they reach adulthood, and may diminish stigma associated with HIV/AIDS and allow greater acceptance of prevention efforts.

“In particular it may encourage more people to present for HIV-testing at an earlier stage in their illness. It may have an impact on the infectiousness of individuals thereby reducing transmission and the enormous burden on hospitals.”

In conclusion, the authors caution that the lack of capacity and operational weakness currently undermine the health system’€™s ability to deliver basic care and that efforts must be made to ensure that universal access to HAART does not steal resources from existing health interventions.

“The introduction of HAART must serve as a catalyst to improve all health services, particularly in rural and remote areas and particularly for HIV-infected people.”

It also urges government to implement urgently a large-scale pilot project in South Africa, learning from programmes in Brazil and Botswana. Botswana is currently treating 1 600 people, far less than expected.

Brazil has 115 000 people living with HIV/AIDS receiving anti-retrovirals, 100 percent of those who need it.