Nicoli Nattrass’s study (‘AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa’, available at http://afraf.oxfordjournals.org/cgi/content/abstract/107/427/157 ) calculates that a staggering 343 000 deaths could have been prevented.
Nattrass proposed that South African AIDS policy in the post-apartheid era has been a product of enduring hostility towards antiretroviral drugs (ARVs).
She said this approach initially stemmed from former President Thabo Mbeki’s questioning of the science of AIDS, which developed into a marked resistance to the implementation of ARV-focussed prevention and treatment programmes. The persistent portrayal of ARVs as ‘poison’ by the then Health Minister, Manto Tshabalala-Msimang, did little to help the cause.
A Director of the AIDS and Society Research Unit (University of Cape Town) and Visiting Scholar with the Health Economics and HIV/AIDS Research Division (University of KwaZulu-Natal), Nattrass used demographic modelling to calculate the number of HIV infections and AIDS deaths that could have been prevented between 1999 and 2007, had the national government taken a more proactive stance.
The study suggests that if, during this period, the government had used ARVs for AIDS prevention and treatment at the same rate as in the Western Cape (from 10% in 2000 to 65% in 2007), which contravened the national ARV policy, then approximately 171 000 HIV infections and 343 000 deaths could have been prevented.
Nattrass also highlights the fact that the Medicines Control Council (MCC) and the Medical Research Council (MRC), two key scientific bodies, fall under the jurisdiction of the national Department of Health. Due to following a scientific approach to AIDS, both bodies, despite their theoretical independence, have suffered from political interference. Although the situation improved after 2006 when the responsibility for AIDS policy coordination was given to the Deputy President, the study underlines the importance of addressing South Africa’s legacy of governmental undermining of the scientific governance of medicine.
Pride Chigwedere and colleagues at Harvard School of Public Health calculated the number of ‘person-years’ that could have been saved, had a feasible ARV programme been implemented in a timely fashion. The study, ‘Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa’, is available at http://www.ncbi.nlm.nih.gov/pubmed/18931626.
By refusing to accept the scientific consensus that HIV causes AIDS, and by declining free donations of nevirapine and other resources from programmes such as the Global Fund and PEPFAR, the study estimates that the government contributed to the loss of 2.2million person-years (around 330 000 lives) between 2000 and 2005. 35 000 babies were born with HIV, because a PMTCT programme was not implemented. In total, the study estimates that approximately 3.8million people-years were lost in total during this period.
Public sector HAART in South Africa only moved beyond the pilot phase in 2004, with WHO estimates showing that HAART was scaled up from less than 3% in 2000 to 23% in 2005. The study suggests that an earlier state-implemented HAART programme of 5% coverage in 2000 could have been scaled-up to 50% in 2005 ‘ a figure that would still be lower than the 85% coverage achieved in Botswana or the 71% in Namibia.
Both studies concur that government policy towards HIV/AIDS has proved a key, destructive factor in limiting the reach of both HAART and PMTCT.
The HIV Treatment Bulletin Report is available at: