South Africa’s antiretroviral programme is short of R1-billion this year alone, yet the ANC wants to introduce a “wholly unrealistic” National Health Insurance (NHI) scheme within five years.

So said SA National AIDS Council deputy chairperson Mark Heywood at the 4th South African AIDS conference on Friday.

“It’s not that we don’t want an NHI, but the way in which they envisage setting it up will divert even more money away from critical areas such as HIV and TB at a time when we can least afford it,” said Heywood, who has studied the ANC’s 250-page draft proposal on the NHI.

Heywood was speaking during a protest to draw attention to the fact that South Africa’s antiretroviral treatment programme is short of R1-billion for this year alone if it is to reach an additional 220 000 people.

“The ANC government must promise that the ARV programme will be fully funded,” Heywood told protestors carrying placards saying “HIV is not in recession” and “Fix Free State”, in reference to the cutbacks to the province’s ARV programme last November because of financial problems.

“According to government, the new National Strategic Plan will cost R48-billion over the five year period, but the total HIV/AIDS allocation is only R11.4-billion,” said Treatment Action Campaign chairperson Nonkosi Khumalo

The financial implications of increasing the country’s HIV/AIDS treatment programme increasingly dominated conference discussion.

Earlier in the day, Africa director of the Global Fund Dr Fareed Abdullah warned that “costs are ballooning in terms of ARVs”.

“It is fantastic that we have over 600,000 people on ARV treatment but at least a million people need treatment,” said Abdullah.

One ARV, efavirenz, accounts for half the country’s drug budget. Meanwhile, a newer ARV with fewer side effects called Tenofovir was 10 times more expensive than the drug currently being used.

Abdullah warned that activists who wanted people with HIV to start treatment earlier – when their CD4 count is 350 instead of the current 200 – were “naïve” to “debate in abstraction from the resource envelope”.

However, doctors and activists who want patients to start ARVs earlier argue that their earlier treatment will cut hospital costs and help AIDS prevention.

“Annual HIV testing and starting people on ARVs immediately regardless of CD4 count would eliminate HIV in 10 years and bring the TB rate close to pre-HIV levels,” argued Dr John Hargrove, head of the Centre for Excellence in Epidemiological Modelling and Analysis.

“The cost of doing this would be high but not unaffordable.”

Dr Francois Venter, head of the SA HIV Clinicians’ Society, said it cost R7000 to treat one person with ARVs for a year. However, it cost over R1000 a day for a person to be treated in hospital. So treating people earlier before they got sick was resulting in savings in other parts of the health system.

Conference chairperson Professor Linda-Gail Bekker said she had asked Treasury officials to address the conference but they had said they were “not ready” to do so.

Meanwhile, Abdullah was scathing of the fact that 60 000 babies a year were still being born with HIV saying that there would be far more action if “any other problems was killing so many babies”.

“With prevention of mother-to-child infection, finances are not an obstacle as it is a low cost intervention,” said Abdullah.

“We have a sub-optimal drug regimen that is not getting us out of the starting blocks when what we need is a safe triple therapy regimen that also covers mothers with they are breastfeeding.”

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