South Africa: Nation Becomes a Victim of Its ARV Treatment Success

The prospect of South Africa meeting its target of providing antiretroviral treatment to 80 percent of those who need it by 2011 is being threatened by a lack of funds. Nearly 1 million South Africans are receiving ARVs through the government, and that number is supposed to triple in the next decade.

This year, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is providing South Africa with $585 million for its ARV program, nearly matching the government's total contribution of $680 million, according to the South African treasury.

In December 2009, the U.S. government said it would provide South Africa with an extra $120 million "in direct response to a request from President Jacob Zuma" to "procure ARVs that will help ensure that there are adequate stocks on hand to meet the growing demand for ARVs in South Africa." At the time, South Africa had been experiencing ARV shortages, most notably in the Free State.

However, the extra PEPFAR money is regarded as being exceptional and not a recurring resource, said Dr. Roxana Rogers, South Africa health team leader for the U.S. Agency for International Development.

Scenario planning by the treasury indicates that demand for ARV care and services will peak in 2021, when South Africa will need some $4 billion. "We are facing a double-whammy of having to rapidly scale-up spending on HIV and AIDS at the same time that we have to replace donor funds," said Dr. Keith Cloete of the Western Cape's treasury.

South African health officials are looking at ways to cut program costs. They also must redouble efforts to prevent infections, say experts. "HIV treatment without prevention is like mopping the floor while the tap is running," said professor Alan Whiteside, a health economist.

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