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The Treatment Era: ART in Africa
Plusnews
2005-01-14

As a result of falling antiretroviral (ARV) prices, new sources of international funding and growing political commitment, providing treatment for Africa's HIV-positive citizens is, for the first time, an achievable goal.

The enormity of the challenge is daunting for a continent that, over the past two decades, has witnessed the attrition of public services and the deepening of poverty. Even Africa's targets under the World Health Organisation's '3 by 5' initiative - three million people in the developing world on antiretroviral therapy (ART) by the end of 2005 - seem incredibly ambitious.

But, although little more than pilot programmes in many countries, the rollout of ART is underway, and lessons are being learnt on the job.

The delivery platform for national programmes is the overburdened and under-resourced public health system, whose decline has been accelerated by the toll of HIV/AIDS. In Malawi, more than half of all government health posts are vacant and, according to a report by the Regional Network for Equity Health in Southern Africa (EQUINET), 90 percent of public health facilities do not have the capacity to deliver even a minimum healthcare package.

Given Prime Minister Tony Blair's commitment to driving the AIDS agenda forward, both Lewis and South African treatment campaigner Zackie Achmat highlighted in interviews with PlusNews the significance of Britain's chairmanship of the G8 and European Union in 2005.

ART should be part of a continuum of care: a comprehensive approach that includes voluntary counselling and testing, prevention of mother-to-child transmission, and other prevention and social support services. A regular supply of drugs, treatment preparedness and literacy are important factors in achieving high and sustained adherence rates.

A mix of payment systems - free, subsidised or self-paying - are employed by governments, and criteria for access to ART differ widely. What is increasingly clear, however, is the inequity in access, even when the drugs are free.

Because of the additional cost of paediatric ARVs, and the difficulty of calculating the correct dose when using adult ARVs, HIV-positive children are another group that are often sidelined by existing ART.

A study in Senegal found that when the cost of drugs for opportunistic infections, laboratory exams, consultations and hospitalisation fees are calculated, patients on ART pay an additional US 130 a year - a significant amount for the majority of people who live on less than a dollar a day, and a reason cited for treatment interruptions.

Read further in the full article on IRIN PlusNews Website: http://www.plusnews.org/webspecials/ARV/default.asp

Resources:

• ART Treatment access and effective responses to HIV and AIDS - Providing new momentum for accessible, effective and sustainable health systems - Equinet:
• The Network on Equity in Health in Southern Africa. To visit this website on-line click on the following link: http://www.equinetafrica.org/
• Treating 3 million by 2005 - World Health Organization. To visit this website on-line click on the following link: http://www.who.int/en/
• How the Fight against HIV/AIDS is Being Undermined by the World Bank and International Monetary Fund - Action Aid USA. To visit this website on-line click on the following link: Barriers to better care for people with AIDS in developing countries - electronic BMJ British Medical Journal. To visit this website on-line click on the following link:http://bmj.bmjjournals.com/
• Gender, AIDS, and ARV Therapies: Ensuring that Women Gain Equitable Access to Drugs within U.S. Funded Treatment Initiatives - Center for Health and Gender Equity. To visit this website on-line click on the following link: http://www.genderhealth.org/ and Free by 5 - University of KwaZulu-Natal. To visit this website on-line click on the following link: http://www.ukzn.ac.za/

(Source: Plusnews, December, 2004)

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