Others, who fail to be placed on the ever expanding waiting list, are simply sent home to die.

According to an investigative report compiled by the AIDS Law Project and sent to health minister Barbara Hogan yesterday (SUBS: WEDNESDAY), the treatment of more than 15 000 people has been stopped in the province. The province has also discontinued CD4 monitoring, health workers have ceased referring patients in need of ARVs, there has been a fatal interruption in the treatment of hundreds who have been on ARVs for years and the province is failing to meet the treatment needs of many children.

A provincial moratorium barring new patients from getting antiretroviral (ARV) medicine has been in place since last November, following massive overspending and a failure to apply for emergency funding when alarm bells were ringing.

Many of the 33 000 patients who were on ARV treatment before the moratorium report drug shortages. Some patients have been told to share medication or are simply transferred from three ARVs to a two-drug regimen, increasing the danger of resistance.

 ‘€œAt Pelonomi HospitaI (Bloemfontein) I was told that they have no drugs and that I should come back next week and try again,’€ said a woman last week who has been on triple therapy of AZT, efavirenz and 3TC since 2007.

All but essential health services have also been affected by the financial crisis, and hospital beds have been slashed by more than 50%.

The Free State has blamed the crisis on an over-expenditure on personnel costs, an increase in patient numbers and the increasing cost of goods and services.

Treatment Action Campaign (TAC) supporters picketed outside Parliament’€™s gates yesterday (SUBS: WED) calling for an end to the waiting lists in the Free State.

TAC General Secretary Vuyiseka Dubula claimed that health minister Barbara Hogan ‘€œinformed us that the ban on ARV treatment in Free State has been lifted and that HIV patients are going to be able to access the drugs by Friday and we as TAC are going to monitoring that situation to see that this does happen’€. Hogan said in a statement released on Monday that she was urgently addressing the situation.

Joining the picket COSATU Western Cape organizer Mike Louw slammed the situation in the Free State as criminal calling for those responsible to be held accountable.

Finance Minister Trevor Manuel yesterday announced a sizeable increase in the ARV treatment budget.

His budget papers also revealed that the national health department’€™s oversight capacity over provincial health services would be strengthened.

Reverend Teboho Klaas of the South African Council of Churches (SACC) visited Bloemfontein last week and said it made him ‘€œvery scared that the department is putting people on death row.’€

 ‘€œIf they are aware that they are inadequately funded they should have systems in place to cater for these people rather than say people should go home and die,’€ said Klaas, who is also deputy chairperson of the Treatment Action Campaign (TAC).

Earlier this week Hogan stated her commitment to urgently address the crisis in the Free State.

She said that additional funding was being sought through donors, and that she was also in discussion with National Treasury in this regard.

Meanwhile, desperate Free State patients are being turned away from donor funded treatment sites who have also reached their capacity.

Some patients have turned to private doctors but are unable to consistently afford the R350 per month needed to buy their drugs privately.

Many government doctors spoke to Health-e last week, detailing the collapse of the province’€™s primary and secondary health care system, especially the treatment of people living with HIV, but asked to remain anonymous for fear of losing their jobs.

‘€œAt one Bloemfontein clinic alone, they had to turn away more than 100 patients who had been referred for treatment,’€ said a frustrated doctor said, adding that he knew of a number of patients who had died.

‘€œAt National Hospital (Bloemfontein) there is a three-page list of drugs that are currently out of stock.   At Universitas Hospital they are admitting no new patients for any treatment. There is no elective surgery, so this means anaethetists and surgeons are sitting around doing nothing,’€ he added

He claimed that the manager of a regional hospital had also suggested they stop treating tuberculosis as part of a cost cutting measure.

The doctor confirmed that many clinics were struggling to continue treating those currently on ARVs. ‘€œAt one clinic today they had three boxes of 3TC and 50 patients waiting. The problem is that many of the patients who qualify for treatment now may be relatively healthy, but by the time province get their act together these patients will be fatally ill. We have gone back to that nightmare of not being able to give people ARVs,’€ he said.

 ‘€œWe have around 130 patients who test positive every month and we now have nowhere to refer them anymore,’€ said Trudie Harrison who runs the Anglican Church’€™s Mosamaria AIDS Ministry in Bloemfontein.

A doctor working at a northern Free State hospital which used to start around 200 patients a week on ARVs said he had been told earlier last year already to ‘€œslow down and take it easy’€.

‘€œThe clinics have stopped referring patients to us, they are going elsewhere to die,’€ he said

Another doctor said that although the moratorium excluded children and pregnant women, the supply of paediatric ARVs in the province was sporadic and unreliable.

‘€œThe pharmacies often run out of medication and it’€™s really impossible to try and put a small baby on adult medication.   Today for example we have no ARV stock whatsoever for children,’€ the doctor said.

Dr Petro Basson who runs the United States-funded Bana-Pele project in Bloemfontein said they were increasingly seeing children being put on treatment, but their desperately ill mothers were denied ARVs in accordance with the moratorium.

 ‘€œThe mothers are too ill to work and therefore unable to afford the transport money to get the children to hospital which means the children default,’€ said Basson.

‘€œIt’€™s a grim picture from my side. You lose the mother and it creates so much trouble. Everywhere the posters and TV tell them to get tested and then what?’€

An internal one-page memorandum faxed to health facilities on Monday from the province’€™s head of health Professor Pax Ramela states that ‘€œorders for ARVs have been placed and are expected to be received in 2 to 3 weeks from today’€.

Activists have questioned the continuous delay stating that drug companies have stated their ability to distribute the required drugs within days.

At the time of going to press the Free State Health Department had failed to respond to a list of questions.

For more details on the crisis in the Free State go to www.health-e.org.za

ARV CRISIS TIMELINE

3 November 2008

Head of the province’€™s HIV programme Dr Mvula Tshabalala sends an email via the province’€™s Chief ARV Pharmacist Palesa Santho to a group of health care workers, mainly facility managers, informing them that the province was experience an acute shortage of ARVs. She states that ‘€œthe remaining ARVs are for the exclusive use of those on treatment already with the exception of clients on the PMTCT program (pregnant women).’€

4 November 2008

Tshabalala replies to questions from staff saying she is unable to say when the ARVs will again become available. She recommends the suspension of drug readiness training as it will ‘€œraise false hopes’€. She also recommends the suspension of baseline blood tests.

10 November 2008

The Treatment Action Campaign releases the e-mail correspondence and says it has been inundated with calls from concerned healthcare workers. The TAC demanded an immediate end to the stoppages and requests a detailed investigation into the shortages and stoppages which it said ‘€œallegedly stem from gross financial mismanagement within the Free State Health Department’€.

12         November 2008

Health minister Barbara Hogan acts swiftly and orders the immediate transfer of R9.5 million for purposes of procuring essential drugs for patients on the programme. She approaches the donor community to assist in ensuring the continuity of the programme in the province. The US Centres for Disease Control grants permission for PEPFAR funds to be used by two NGOs that work in the province to purchase drugs that are in short supply.

A team of senior officials from the Department of Health is immediately dispatched to the Free State to work with their counterparts in the provincial health and Treasury departments to find ways of resolving their financial/budgetary problems.

14 November 2008

Head of the Free State Health Department Professor Pax Ramela releases a statement blaming the stoppages on underfunding from National Treasury, the addition of AZT to the Prevention of Mother to Child HIV transmission (PMTCT) programme regimen and an increase in patients needing treatment.

He confirmed that the ‘€œentry of new patients’€ had been ‘€œdelayed’€ since the beginning of November.

25 November 2008

The Free State Health Department Communications directorate releases a statement conceding that the financial situation in the department is ‘€œreaching dire proportions’€. It announces radical cost containment measures including the cancellation of all routine non-emergency surgical cases until the end of January 2009, the discharge of all patients other than those needing ‘€œhigh acuity care’€, directing all private patients to private hospitals, accepting only emergency referrals, placing staff on mandatory leave, redeploying personnel and stopping all non-critical appointments.

27 November 2008

The TAC warns that there will be huge increases in mortality and morbidity if ARV treatment is delayed for even a few weeks.

19 December 2008

The TAC writes a letter to the Free State Health MEC Sakhiwo Belot asking for clarity on a range of issues.

21 January 2009

The TAC sends another letter after Belot fails to respond.

27 January 2009

The TAC releases a statement revealing Belot’€™s failure to respond.

28 January 2009

Belot and Free State Premier Beatrice Marshoff send replies to the TAC and Aids Law Project head Mark Heywood. Belot states that a donation of drugs to the value of R17,8-million would hopefully be enough to only sustain patients currently on treatment until the end of January 2009. He said funds had been shifted from the other programs in the conditional grant to the ARV programme in the hope of initiating new patients, but that the delivery of drugs to the province was a challenge. He also confirmed that ‘€œalmost all services’€ had been scaled down because of budgetary constraints.

3 February 2009

The Free State Health Department says in the statement that due to financial constraints it was not in a position of admit new patients on the ARV program and ‘€œthe status quo thus remains’€.

4 February 2009

The South African Council of Churches sends a letter on behalf of civil society organizations to Belot and Marshoff warning that the poor and vulnerable were being most severely affected. It calls on the Free State Aids Council to give a written explanation at its meeting on 11 February as to why it had failed to take strong leadership in preventing the moratorium.

5 February 2009

The Programme Implementation Committee of the SA National AIDS Council proposes that the moratorium be lifted by February 9. The Director General for Health undertakes to provide a plan on how the situation can be addressed by Monday, February 9.

6 February 2009

The TAC states that the moratorium has caused avoidable death and illness.

9 February 2009

Health Minister Barbara Hogan releases a statement giving an undertaking to urgently address the situation whereby no new patients are initiated on treatment in the Free State.