South Africa Study Says AIDS Program Is Affordable

A long-awaited cost study conducted by South Africa's health and finance ministries has concluded that AIDS drugs are affordable and that a nationwide rollout is feasible, according to people with detailed knowledge of the report's contents.

The government has often argued that AIDS drugs are too toxic and expensive for use in public hospitals and clinics. But the report is likely to push the ruling African National Congress into a corner -- especially since more and more prominent people, most notably former President Nelson Mandela, argue that the government's policy of not broadly providing AIDS drugs costs lives and makes it look callous.

The cost report could actually give South African President Thabo Mbeki a face-saving way to roll out the drugs -- and there are signs Pretoria is positioning the report that way. Essop Pahad, a longtime friend of the president and one of his closest ministers, said in a recent interview, "It's we who took the initiative to do the costing exercise, not anybody else." But he declined to speculate on how the cabinet might act and added, "I'm not sure the [toxicity] debate is closed."

The report estimates that the per-person cost for each year of life saved would initially run about 8,000 rand (roughly US$1,100 at today's exchange rate) according to people familiar with the study. But that cost would drop sharply in a few years, the study estimates, and it outlines options to help bring down prices, including the introduction of generic drugs and a budget to accelerate regulatory approval. The study envisions that the government could provide the drugs to as many as half a million South Africans within five years. That could help negotiate volume discounts.

South African government officials, stressing poverty reduction and nutrition, have said the focus on antiretroviral drugs is too narrow. Pahad notes that South Africa still has problems getting TB patients to adhere to a six-month regimen of antibiotics. Such concerns are shared by many AIDS scientists and policy makers. South Africa -- in contrast to some other nations hard-hit by AIDS -- has not run any adult-treatment pilot projects to work out such problems.

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