Lack of staff threatens ARV plan
The biggest obstacle to getting more HIV positive people on antiretroviral treatment is the lack of health staff.
Over the next five years, government’s HIV/AIDS care, support and treatment plan will need about 13 800 more staff if it is to be implemented properly.
Approximately 3 200 doctors, 2 400 nurses, 765 social workers, 765 dieticians, 112 pharmacists and 2000 data capturers will be needed by 2009 to implement the full roll out of the antiretroviral component of the plan.
By April, over 1000 health professionals had been recruited and more than 7 600 trained.
But, say researchers Rob Stewart and Marian Loveday, ‘concerns have been raised that recruited staff have been reallocated from existing services to the ARV programme’.
Thus there is a real danger that, given the overall health staff shortages, the ARV programme may ‘undermine the provision of existing services’.
By March, every one of the 53 health districts in the country had at least one site providing ARVs and some122 sites had been accredited.
An estimated 100 000 people are now getting ARV treatment at government sites, although accurate figures are hard to come by as the national monitoring system is not yet operating.
Both the Western Cape and Gauteng have exceeded their patient enrolment targets, while KwaZulu-Natal has the most ARV sites.
The money is also in place. Government has allocated R6,6-billion to addressing HIV/AIDS in this year’s Budget.
The Global Fund has committed $65-million (about R409.5-million) and the US President’s Emergency Plan for AIDS Relief (Pepfar) has allocated $89-million (R560.7-million) for 2004/5 to South African HIV/AIDS programmes.
The Belgian government has provided funds to ensure that every TB patient is also tested for HIV and that people with HIV get TB tests.
Cheap generic drugs should start to bring down costs after government awarded a three-year, R3.4-billion ARV drug supply tender earlier this year. The bulk of the tender went to local generic manufacturer Aspen.
R7-million has been set aside to provide nutrition for TB and HIV patients who need it, but ‘the absolute shortage of social workers and nutritionists’ makes it hard to ensure that needy patients are being reached.
Despite the money, ‘there is insufficient capacity to treat everyone in need’.
‘A number of sites have reached saturation level with their present human resource capacity and are struggling to expand their services to include all patients on their waiting lists,’ say Stewart and Loveday.
They propose an urgent move to nurse-based ARV services that are integrated into primary health clinics, instead of the current doctor-driven plan.
They also urge long-term planning, including a detailed time frame, to ensure that the programme is sustainable.
Meanwhile, millions of taxpayers’ rands have been poured into three HIV/AIDS prevention campaigns, but there hasn’t been a reduction in infections, reports researcher Jo-Anne Collinge.
However, she notes that getting people to change their sexual behaviour is a slow, complicated matter that doesn’t simply involve serving up the facts about HIV infection.
The campaigns ‘ Soul City, loveLife and Khomanani ‘ have had a positive impact on reducing the stigma associated with HIV and more people have started to develop more healthy sexual habits.
But, notes Collinge, there is no formal co-ordination between the campaigns. However, there are both overlaps and gaps that could be addressed even through occasional meetings to exchange information.
The oldest campaign is Soul City, launched as a television and radio series for adults in 1994. It takes the form of dramas with key messages delivered by strong positive role models. Soul Buddyz is aimed at children.
The richest campaign is loveLife, which has an annual budget of R200-million, R76-million of which comes from government.
Lauched in 1999, it aims at 12 to 17 year-olds and uses mass media campaigns, direct communication and youth-friendly sexual health clinics.
Khomanani, launched in 2002, is the only campaign to fall directly under the health department, although it is implemented by a private sector consortium.
It is aimed at changing social norms and behaviour by changes people’s attitudes.
Over the first 30 months, Khomanani used R121-million, mainly on radio and television advertisements, pamphlets, face-to-face campaigns and an AIDS hotline.
Soul City commissions independent evaluations after each series, while Khomanani commissioned ‘before and after’ research to evaluate its impact. loveLife has evaluated some of its services but has not researched its overall impact.
But, notes Collinge, of the three campaigns loveLife has generated ‘considerable debate’.
‘The criticism that loveLife has drawn may be due to its unorthodox approach, its prominence or the fact that it absorbs a huge amount of public funding against light accountability,’ she says.
She adds that ‘there is a clear need for some mechanism to facilitate broader accountability in the field of HIV and AIDS communication,’ and suggests that role players look into setting up a health promotion foundation
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