Although South Africa covers most of the costs of HIV/AIDS services, it does rely on donors to help with the shortfall. In the last application for funding from the Global Fund to fight AIDS, TB and Malaria, South Africa applied for R3 billion. It’€™s not certain if the total sum will be paid out as the Global Fund is facing a deficit due to waning donor support. For this round of applications, the Global Fund was only able to raise just under $12 billion, whereas it needed $13 billion. As this support base is shrinking, South Africa’€™s responsibility to fund the AIDS programme becomes more glaring. Invoking the Constitution, Adila Hassim, head of Legal and Litigation services at Section 27, says this is an ‘€œobligation that government has to fulfill’€.  

‘€œThe first place we need to look for more money is our government. Secondly, we need to make sure the money that does go is properly spent, budgeted for, the Constitutional standards are upheld. The South African Constitution has a right that is meant to protect the right to health. It’€™s in Section 27 of the Constitution. The Constitution goes right to the heart of the matter and it talks about available resources and progressive realisation – that the government has an obligation to progressively realise this right; and the government has to work under financial constraints. But the one thing that the Constitution recognises and that the Constitutional Court has made clear is that merely saying ‘€˜there isn’€™t enough money’€™ won’€™t do; merely saying that ‘€˜that’€™s the budget, this is how we’€™ve carved it up’€™ won’€™t do. They’€™ve actually got to go much further, and, usually, it’€™s national Treasury in this case. They have to go much further to show why it is there aren’€™t enough resources’€, Hassim explains.

She also warns of a looming challenge for government brought about by the waning donor support and the rise of the number of people needing AIDS treatment.    

‘€œWe’€™re going to run into problems. We have more than a million people on treatment at this point in time. The Health Counseling and Testing campaign’€¦ the target is to test one million people per month. Between April to September 2010 more than two-and-a-half million people were tested and as a result of that during the same period of time ‘€“ April to September 2010 ‘€“ there have been about 500 000 newly-diagnosed infections. In the same period of time about 73 000 more people were put on to treatment. Now, the greater the testing campaign, the more the demand, the more the need for treatment is going to grow, the more there is a need for treatment the more we’€™re going to need money’€, she says.

Responding to the concern, Health Minister Dr Aaron Motsoaledi said the government is committed to providing sufficient care and support for people living with AIDS.

‘€œThis question, I don’€™t want it to trouble South Africans anymore. The answer has been provided, and it’€™s clear. In August last year, the prestigious British Medical Journal released a report of a thorough study about the South African society and they simply say we are going through four clear pandemics that are taking place all at the same time. The first one is HIV/AIDS and TB pandemic. It’€™s the biggest by far because we only form 0.7% of the world population, but we are carrying 17% of the HIV-positive people in South Africa. It is 23 times the global average. We are also carrying 5% of TB sufferers in the world. In fact, of the 22 high-burden countries which are carrying 80% of the TB of the world, South Africa is number one. That’€™s by far the biggest pandemic. We’€™re not challenging it’€, said the Health Minister.

However, he said the country is not self-sufficient. South Africa will still need help from foreign donors to achieve its targets for AIDS treatment.

‘€œWe have applied for R3 billion from the Global Fund. But 80% of our funding comes from ourselves. And Treasury, here ‘€¦ I need to praise them. Last year before World AIDS Day, the budget for the next three years for ARVs was only R5 billion. After the President’€™s announcement on World AIDS Day it was increased to R8 billion. All we are saying is the Global Fund and others must help. But we’€™re trying our best on our own’€, he said.

Sections 27’€™s Adila Hassim said it’€™s important for South Africa to continue spending on HIV and AIDS for a number of reasons.

‘€œIf we had not tackled HIV in this country in a focused way that we have tackled it, then our health system would be even further under pressure now than it already is. And so, the fact that we’€™ve put money into HIV has actually, firstly, strengthened the health system because there are more health care workers, there are counselors, there is additional infrastructure. But, also, there are fewer people who are showing signs of morbidity and of opportunistic infections and placing a burden on the health system. So, it’€™s a very false argument’€¦ It’€™s a very, very narrow argument which says ‘€˜if you’€™re only giving money to HIV you’€™re not actually strengthening the system at all’€™, Hassim said.