Publications
HST provides free electronic access to over 500 health systems research related reports, publications and papers. Close to 300 of these are publications that have been commissioned and funded by the Trust. Topics include among others district systems development, drug supply management, human resource development, informatics, legislation, finance, environmental health, mental health, lessons learnt, nutrition and sexually transmitted diseases / HIV/AIDS. The main publication of the HST is the annual South African Health Review. From 2005 all HST publications will be available in low resolution only. To explore the range of publications HST offers use the Advanced search to search using a variety of criteria.

Introduction

The HIV/AIDS pandemic is a human catastrophe with far reaching implications for individuals, households, communities and countries. No other disease has so radically accentuated the present inequalities in healthcare access, basic human rights and economic disparities.1. The epidemic is depriving nations of their young and most productive people. Africa will have 71 million fewer people by 2010 because of AIDS and populations may start contracting by 2003 in South Africa, Botswana and Zimbabwe. The epidemic is deepening poverty, reversing human development achievements, worsening gender inequities, eroding the ability of governments to maintain essential services, reducing labour productivity and supply and putting a brake on economic growth.2

For a number of years now there has been growing awareness on the part of the international community that the inequality between rich and poor nations in the care and treatment of people living with HIV/AIDS represents not only a 'moral scandal'3 but also a major economic, political and social challenge that threatens world stability. The distribution of highly active antiretroviral therapies (HAART) in high-income countries has proven to be effective in drastically reducing morbidity and mortality associated with HIV infection4. However, those in low and middle income countries, where 95% of the estimated 42 million infected people live,5 have mostly not had access to HAART and the world is now confronted with the necessity of accelerating access to care and treatment in developing nations.

Economic globalisation, the apartheid legacy, and a failure to implement government policies designed to redress past disadvantage, all contribute to inequity1 in access to healthcare, including access to HIV/AIDS services and interventions. South Africa is a highly symbolic case study in that the in-country inequities mirror global inequities, and lessons gleaned from within the country may be of value more widely.

This paper is one of a series of papers commissioned by the Regional Network for Equity in Health in Southern Africa (EQUINET) for a programme of work with Oxfam GB on Equity issues in HIV/AIDS, Health Sector Responses and Treatment Access in Southern Africa. This programme of work seeks to inform the policy debates and advocacy that have grown around health sector responses to HIV/AIDS in the region.

This paper reviews the equity challenges and concerns related to access to HIV/AIDS programmes in South Africa, with a focus on antiretrovirals. Section two describes the HIV/AIDS epidemic and its impact on society and the health system. Section three outlines some of the inequities in the country and their impact on health and healthcare. Section four explores the countrys response to the epidemic, and highlights a range of factors that have affected this response. Section five deals specifically with the provision of antiretrovirals. The concluding section raises some key issues in need of further consideration.