November 8, 2002
"The ultimate goal of most advocates -- a coherent plan that would safely supply antiretroviral medications to the millions who need them -- has not been reached. But the South African government seems to have recognized that this must happen, and is exploring ways of making it a reality," said IAPAC President/CEO José M. Zuniga, who served on South African President Thabo Mbeki's 2001 HIV/AIDS advisory panel.
"In less than a year, President Mbeki and his cabinet have gone from overstating the danger of antiretroviral therapy to recognizing that such treatment is necessary to prevent the untimely death and improve the quality of life of one in four South African adults," said Zuniga.
An early and clear indication that President Mbeki's cabinet was shifting its HIV policy came in an October 9, 2002, memorandum that stated the government was working "to create the conditions that would make it feasible and effective to use antiretrovirals in the public health sector." On October 29, 2002, the government announced plans to spend an additional US$329 million on HIV/AIDS over the next three years, up from US$487 million, and stated that a large portion of that money would be spent on efforts to increase access to antiretroviral therapy.
There are other positive developments. The government cites two primary difficulties to providing antiretroviral therapy: the cost of the drugs themselves, and the improvements that must be made to the medical infrastructure so that those drugs can be properly administered. It seems now that progress is being made on both fronts.
A generic drug manufacturer from South Africa, Aspen Pharmacare, has recently concluded a deal with three multinational pharmaceutical corporations allowing it to produce less expensive versions of their antiretroviral drugs. The KwaZulu-Natal Enhancing Care Initiative launched a program this month, with funding from the Global Fund to Fight AIDS, Tuberculosis, and Malaria, meant to provide antiretroviral treatment in one of South Africa's hardest hit provinces. And, as President Mbeki's cabinet stated in its October 9, 2002, memorandum, the government is working on HIV treatment education programs in collaboration with "academic institutions and other role players such as: the Southern Africa HIV/AIDS Clinicians Society, the International Association of Physicians in AIDS Care, the Foundation for Professional Development, and the South African Medical Association."
"Drug cost and treatment capacity are legitimate concerns. But they are not insurmountable obstacles," said Mulamba Diese, Executive Director of IAPAC's Southern Africa Regional Office (SARO), who applauded the South African government for having the courage to shift its policy stance and committed IAPAC SARO to working with the government wherever possible to overcome the difficulties associated with antiretroviral therapy.
"We encourage the entire world community to lend assistance as they are able so that these promising first steps can be turned into a clear and thorough HIV/AIDS treatment plan whereby appropriate care is provided to all," added Diese.
As an educational partner in Pfizer's Diflucan Partnership Program, IAPAC has worked in South Africa and other sub-Saharan countries to train thousands of physicians in the use of Diflucan, an important antifungal medication, and in prophylaxis and management of opportunistic infections. Beginning in November 2002, IAPAC is training in South Africa (as well as Ethiopia) using the antiretroviral therapy curriculum from its Global AIDS Learning & Evaluation Network (GALEN).