South Africa: Obstacles to "Scaling Up" HIV Treatment Remain

At the opening of the Fourth South African AIDS Conference in Durban, health experts, activists, and politicians said implementation of HIV/AIDS treatment programs remains a challenge. Attendees from 52 countries gathered to discuss the latest strategies for fighting the pandemic under the conference theme of "Scale Up for Success."

In addition to male circumcision, Dr. John Hargrove, director of the center for epidemiological modeling and analysis of the South African Department of Science and Technology and the National Research Foundation, recommended using antiretrovirals "as a defensive weapon" against HIV. "If we achieved universal, voluntary HIV testing and would start ARV treatment immediately [if a person tests positive], regardless of CD4 count, we could eliminate HIV and reduce tuberculosis dramatically," he said.

The cost of providing ARVs to all who need them is high, but it would be more expensive not to stop the pandemic, said Hargrove. "The cost [of ARV as prevention] is high but affordable, and saving people's lives is cost-saving too," he said.

Money is not the barrier to scaling up prevention and treatment in South Africa, said Professor Hoosen Coovadia, an HIV/AIDS researcher at the University of KwaZulu-Natal. "As a country, we do have the funds. It's about political will, budget allocation, and proper use of the money," he said. Public health spending at the provincial level is where HIV/AIDS money is not used in an efficient and effective manner, said Coovadia.

Dr. Gustaaf Wolvaardt, executive director of the Foundation for Professional Development, said accountability is essential to the successful scale-up of HIV prevention and treatment. "If you don't measure it, you can't manage it," he said.

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