CAPE TOWN – South Africa is not succeeding in stemming the tuberculosis epidemic in spite of the Directly Observed Treatment Short-course Strategy (DOTS) and the patient guarantee of being cured if the medicine is taken correctly.

‘€œIn spite of DOTS we do not seem to be succeeding and my sense is that it is due to a lack of research and development of new drugs as well as the stigma associated with TB,’€ said Health minister Dr Manto Tshabalala-Msimang.

Addressing the media during Parliament’€™s briefing week, she said that while TB is curable it was clear that the  monitoring of patients on the drug regimen remained a challenge.

She said the link between HIV and TB was also hindering patients from coming forward for treatment.

With regard to HIV and AIDS, the minister said Government’€™s comprehensive plan had seen significant achievements in the strengthening of the health system and building capacity to address the epidemic.

Tshabalala-Msimang was not prepared to reveal how many people were receiving anti-retrovirals at Government facilities.

‘€œIt is more important to talk about whether we are able to sustain the use of ARVs, whether we are able to control and manage the side-effects,’€ she said.

‘€œWe cannot have a situation where we expose our citizens to ARVs and there is nothing we can to when they have side-effects and have to stop (using the medication),’€ Tshabalala-Msimang added.

She rejected the concept of ‘€œaccess to all’€.

‘€œThere is nothing like access to all. Not everybody who is HIV positive requires ARVs. Some may require nutrition, others exercise, others traditional medicine. There are a number of things you must do before starting ARVs and health professionals must give patients options so they can make informed decisions.

‘€œWe don’€™t know much about these medicines (ARVs).’€

The minister claimed that South Africa was the only country in the world that had gone the route of accreditation, whereby a site (clinic, hospital) has to meet stringent criteria before being given the go-ahead to dispense ARVs.

‘€œEverywhere I go people tell me that our plan is the most wonderful they have ever seen. They support our decision to not just dish out ARVs in the streets.’€

In a veiled reference to the Treatment Action Campaign and its supporters, Tshabalala-Msimang said that instead of ‘€œtoyi-toying in the streets’€ people should be asking why the World Health Organisation commitment to treat 3-million people by 2005 had not taken off and why Anglo America was having problems with adherence.

‘€œInfrastructure has become paramount. Without a health infrastructure you have got to be careful,’€ she cautioned.

The minister admitted that her department did not have reliable figures as to how many people were being treated on ARVs, how many had dropped out and their reasons.

‘€œWe are working in the dark and you just give the medicine and hope God will be on your side.’€

She said Government’€™s commitment to treat 53 000 people by the end next month, was a projection and not ‘€œcut and dry numbers’€.

Tshabalala-Msimang also emphasized the need to scale up interventions against non-communicable diseases such as cancer, cardio-vascular diseases, diabetes and hypertension.

Interventions would involve health promotion campaigns with a particular focus on promoting healthy lifestyles and the major factors behind the high burden of disease ‘€“ lack of exercise, poor diets, smoking and alcohol abuse.

South Africa would be ratifying the Framework Convention on Tobacco Control within the next two weeks and Government was in the process of closing any loopholes as well as increasing fines to discourage infringement.

Draft regulations on the labeling of alcoholic beverages have been published for public comment.

Tshabalala-Msimang said the department was addressing the international migration of health workers and was interacting with ‘€œcountries like Britain’€.

About 136 Iranian doctors will also be deployed in Limpopo, North West and Mpumalanga as soon as Government has finalized contracts with the Iranian government.

The minister said her department was working on the development of a ‘€œnew cadre of health worker’€, mid-level workers who could relieve some of the pressure on the medical (nurses and doctors) and pharmacy staff.

In terms of infrastructure, Tshabalala-Msimang said there were currently 30 hospitals in the hospital revitalization programme and that a further 15 would be added by the end of the next financial year. This would bring the total of completed hospital revitalization projects to 41 by the end of 2005/6.

She added that at least 1 500 new clinics had been built since 1994.