20 NOVEMBER 2003

Dear TAC Volunteers, Members, Supporters, Allies and Friends


Decision Gives Hope to Poor Communities Across South Africa

The South African Cabinet has approved the Operational Plan for Comprehensive Treatment and Care for HIV and AIDS. The plan envisages that "within a year, there will be at least one [antiretroviral] service point in every health district across the country, and within five years, one service point in every local municipality." [Cabinet Statement, 19 November 2003]. The plan also commits government to investing substantial finance into "upgrading our national healthcare system" via "recruitment of thouands of professionals and a very large training programme to ensure nurses, doctors, laboratory technicians, counsellors and other health workers have the knowledge and the skills to ensure safe, ethical and effective use of medicines." Government has also committed to a massive public education campaign, improved prevention efforts and improved treatment of opportunistic infections.

The Treatment Action Campaign (TAC) welcomes the Cabinet decision. This is a wonderful day for all in South Africa. There is now real hope for millions of people with HIV and their families. It is tragic that for many people this decision has come much too late, such as a founding member of TAC's Samora branch in Cape Town who died of AIDS today.

The challenges ahead for all of us are to ensure that the plan is implemented as speedily as possible and to mobilise our communities around counselling, testing and understanding how treatment works. Critically, we need to develop and implement more sophisticated prevention messages.

We urge government to release the full treatment plan so that civil society can study its details and assist with its implementation.

The Cabinet Statement and a Question and Answer document on the Operational Plan handed out by government are copied at the end of this letter.


Nearly five years after the launch of the TAC, we have reached a crucial turning point in our struggle. We stand on the brink of the implementation of a treatment plan that has the potential to save millions of lives. This is what we have worked for since the TAC began. It is therefore a good opportunity to examine what the TAC has achieved and what the way forward is.

Together with our allies in South Africa and internationally we have successfully changed our government's policy, challenged the power of the pharmaceutical industry and made many important international organisations and governments realise that people with HIV/AIDS in poor countries have a right to have access to medicines and must be treated with dignity.

On behalf of the TAC National Executive, we wish to thank the thousands of individuals and organisations, including TAC members, MSF, the South African trade union movement, the churches, NGOs, our funders and activists around the world, too numerous to name, who have made these achievements possible.

We also pay tribute to our many comrades who died because of HIV before we reached this turning point.

You can all feel justly proud that your immense efforts, to build a more equitable and just world, have been worthwhile.

The combination of the Constitutional Court decision on mother-to-child transmission prevention, the Stand Up for Our Lives march in February, the civil disobedience campaign and the international protests around the world have convinced Cabinet to develop and implement an antiretroviral rollout plan.

But government must do much more including implementing better prevention programmes, better opportunistic infection treatment and greatly improved work-conditions for health-care workers. We also need clear messages of support for prevention and treatment from President Mbeki and all Cabinet ministers. We have come a long way but we must be ready to put more pressure on government if it does not implement the treatment plan properly.

Hundreds of our members across the country live openly with HIV. They tell their friends, family and work colleagues they have HIV. They even say it in newspapers, on radio and on television. Our HIV-positive t-shirt, a sign of openness and solidarity, is worn by thousands of people.

Nevertheless, many people with HIV still experience discrimination and cannot be open. We still have much to do to create openness.

Before we began our campaign, antiretrovirals cost over R4,000 per month. Patented antiretrovirals now cost about R1,000 per month. TAC, MSF and GARPP also purchase generic antiretrovirals, in breach of patent, at R300 or less per month. The deal announced by the Clinton Foundation will bring the prices of generic antiretrovirals down to less than R90 per month for government.

We still cannot get these generic medicines, but our pressure on the drug companies through the Competition Commission will surely succeed in the near future.

A few years ago, the dominant view was that prevention of HIV was all that was necessary for the developing world. This has changed. UNAIDS, the European Union and the United States now say that treatment is critical. The Global Fund has been established to help poor countries improve their health care systems so that AIDS, TB and malaria can be treated. Furthermore, HIV/AIDS activism is taking route in many African countries strengthened by the Pan-African Treatment Access Movement.

The global political will to treat people in poor countries is unprecedented.


The TAC's struggle is seen as a model by many organisations and people in South Africa and across the world because of the commitment we demonstrate and our ability to mobilise poor people across the country. Although we can be proud of this, we should also be careful because the expectations upon us are enormous. We must not become complacent because this can easily lead to errors which will destroy the good reputation and work of the TAC. We must live up to the expectations upon us that are realistic. After five years of struggle and the loss of many comrades to AIDS, most of us are tired. We must rest but there is hard work ahead.

The success of the treatment plan rollout depends on our ability to mobilise our communities. Because of this fact, we are going to focus much of our energy at the level of the District Health Service. We are going to assist with service delivery but keep up our pressure through mobilisation and demonstrations when needed.

Branches must work with clinics and campaign for their problems to be rectified. For this to succeed, TAC structures have to function better than ever and our understanding of treatment literacy must improve.

Finally, we will keep up our capacity to mobilise at a national and international level. There are still people high in our government who oppose a treatment plan and will try to delay the rollout of antiretroviral therapy. Pharmaceutical companies will continue to try to profiteer from medicine. Laboratory costs have not yet come down sufficiently. We will have to monitor all of these things closely and be able to apply pressure when needed. The TAC is not going away.


Each structure has a clear mandate of what is expected from it.

Our provincial offices must ensure that each district has the resources they need to perform their duties. We must ensure that people of all races participate in our provincial activities. NGOs, religious organisations and unions must continue to be involved in our work.

Our district committees are responsible for the functioning of TAC branches within their jurisdiction. Every TAC district should have at least 30 activists who are trained on treatment literacy to be able to educate their own communities.

Each branch should have an outdoor and indoor programme. The indoor one should include workshops on improving clinics in the branch area, antiretrovirals, opportunistic infections, social grants and prevention. The outdoor one should involve pamphleteering, public speaking and door-to-door campaigns. Critically, we need to learn to use the clinic checklist and to work with our clinics so that we can improve them.

Comrades from different areas must understand their responsibilities and be visible in their communities. We must understand our provincial government's rollout plans so we can intensify our treatment literacy and openness campaigns in clinics where antiretroviral therapy is implemented.

Many clinics will not implement antiretroviral therapy immediately. We need to get those clinics ready so that they can begin treatment. This means we must make sure that they have enough nurses and doctors who are properly trained on HIV/AIDS. HIV and CD4 tests must be available. Appropriate medicines must be given to patients with opportunistic infections. There must be high-quality counselling, including information on safer sex. Condoms must be distributed at all clinics.

Here are some things to be done:

1. TAC meetings must be held in every district to brief activists about our role in the rollout.

2. Every provincial office must assess the role TAC is playing in the existing pilot programmes and what lessons could be learnt in order to prepare us for the rollout.

3. District general meetings should be held every month to brief organisations of the progress made and how they can help.

4. HIV support groups groups must be challenged to work with the TAC to address stigma and improve clinic services.

5. We need to work closely with government institutions distributing food parcels and help speed up delivery of this programme.

6. Social Grant education should be done at branch level and in support groups and form part of our door-to-door campaigns.

7. We must organise events at district level to keep people mobilised and ensure that we deal with stigma and discrimination.

8. The TAC Treatment Project must be integrated into the activities of the TAC, especially the wellness programme, so that our activists with HIV can stay healthy. By integrating the TAC and the Treatment Project we will also assist the treatment plan rollout.

9. TAC people should speak at public forums and create more awareness about the challenges lying ahead and the solutions.

10. Volunteer exchange programmes between branches, districts and provinces will help activists to exchange knowledge and skills to better equip us for the challenges ahead.

We have come a long way and achieved magnificent successes, but the hardest work is ahead of us. Let us mobilise for the treatment plan rollout. Aluta Continua!

Yours in the struggle for health and human rights

Mandla Majola, Sipho Mthathi, Mark Heywood and Zackie Achmat
20 November 2003


Cabinet statement on treatment plan for HIV and AIDS

19 November 2003

[Presented by Minister of Health, Dr Manto Tshabalala-Msimang]

(Relevant link: Questions and answers [outside link])

Cabinet today in principle approved the Operational Plan for Comprehensive Treatment and Care for HIV and AIDS, which it had, on 8 August this year, requested the Department of Health to prepare. Amongst other things, the Plan provides for Anti-retroviral Treatment in the public health sector, as part of the government's comprehensive strategy to combat HIV and AIDS.

The meeting instructed the Department of Health to proceed with implementation of the Plan.

It is envisaged in the Plan that, within a year, there will be at least one service point in every health district across the country and, within five years, one service point in every local municipality. Some areas will be able to start sooner than others, and the Department of Health will keep the public informed of the progress of the rollout.

These service points will give citizens access to a continuum of care and treatment, integrated with the prevention and awareness campaign which remains the cornerstone of the strategy to defeat HIV and AIDS.

Concretely this far-reaching decision of government will mean:

* Stepping up the prevention campaign so that the 40 million South Africans not infected stay that way
* A sustained education and community mobilisation programme to strengthen partnership in the fight against the epidemic
* Expanding programmes aimed at boosting the immune system and slowing down the effects of HIV infection, including the option of traditional health treatments for those who use these services
* Improved efforts in treating opportunistic infections for those who are infected but have not reached the stage at which they require antiretrovirals
* Intensified support for families affected by HIV and AIDS
* Introduction of antiretroviral treatment for those who need it, as certified by doctors


To deliver this kind of care across the country, with equitable access to all, will require a major effort to upgrade our national healthcare system. This includes the recruitment of thousands of health professionals and a very large training programme to ensure that nurses, doctors, laboratory technicians, counsellors and other health workers have the knowledge and the skills to ensure safe, ethical and effective use of medicines.

Built into the implementation of this programme will be a massive public education campaign so that patients will know what is expected of them. This will include the provision of all the necessary information about benefits as well as dangers of usage of ARVs, to allow patients to make an informed choice.

Over half of the total budget that will be spent over the next five years in implementing this programme will go to upgrading health infrastructure, emphasising prevention and promoting healthy lifestyles. As such, the implementation of this plan will benefit the health system as a whole.

Cabinet agreed that the funds allocated for this programme should be "new money". The programme will and must therefore not detract from other programmes of health care and provision of social services.


South Africa has reached this point at which qualitative enhancement of our response to HIV and AIDS, within the framework of our five-year strategic plan, is possible due to a number of factors. These include

* A fall in the prices of drugs over the past two years without which this programme would have been impossible, including new opportunities to manufacture some of these drugs in South Africa, as well as successful negotiations with pharmaceutical companies
* New medicines and international and local experience in managing the utilisation of ARV's and other interventions
* Growing appreciation of the role of nutrition in enhancing people's health and efficacy of medicines
* The building of a critical mass in our country of health workers and scientists with skills and understanding of the management of HIV and AIDS
* The availability of fiscal resources to expand social expenditure in general, as a consequence of the prudent macro-economic policies pursued by government.


Government wishes to reiterate that there is no known cure for AIDS. We cannot therefore afford, as a nation, to lower our guard. Prevention therefore remains the cornerstone of our campaign.

The eradication from the body of the HIVirus remains beyond reach. The mechanisms of HIV infections remain difficult to fathom, and the downhill plunge of the infected, to severe immune deficiency over the next 2-14 years is ill-understood. The co-factors that are thought to mitigate immune destruction of healthy CD4+ cells by the minority of infected CD4+ are still uncharacterised. In the South African context the immune systems is assaulted by a host of factors related to poverty and deprivation.

The Operational Plan places a high premium on strengthening prevention efforts and it underlines the critically important messages of prevention and of changing lifestyles and behaviour. These elements of our Comprehensive Strategy remain the starting point in managing the epidemic.

At the same time, it should be noted that not everyone who is HIV positive requires Anti-retroviral Treatment. As such, the plan also provides for enhanced care for those who are infected but have not as yet progressed to an advanced stage of AIDS.

At the same time, the challenges of home-based care, the campaign to combat discrimination against those who are infected and affected remain critical. So is the task of intensifying efforts to deal broadly with poverty and poor nutrition.


Progress in implementing the Plan adopted by government today will depend, to a significant degree, on intensified mobilisation across society. Besides the legion of non-governmental and community-based organisations who are involved in constructive work in this regard, the media is an important partner, as it has the potential to communicate messages of awareness and hope, and to keep the nation accurately informed about the campaign against HIV and AIDS.

A cooperative relationship among all sectors of society, particularly in the implementation of this element of the comprehensive strategy, the spirit of letsema and vuk'uzenzele, a message of hope and responsibility as well as constructive engagement in the realm of practical work will ensure that South Africa advances even more decisively in this endeavour.

The Comprehensive Plan for Treatment and Care carves out a future for those infected with HIV, and for those suffering from immune deficiency; whilst assisting the vast majority of South Africans who are HIV negative to remain that way. The peculiarly South African nature of the problem demands South African solutions; solutions contained within this complex and detailed Comprehensive Plan for Treatment and Care.

Such an ambitious goal - targeting the immense complexity of the human immune system operating within the environmental milieu of Africa - predicates a multifaceted, integrated and intersectoral response in prevention, treatment and care. The Plan is the final piece completing the jigsaw puzzle of the National Strategic Plan for HIV and AIDS 2000 - 2005 whose four key areas of intervention were: prevention, treatment, care and support; research, monitoring and surveillance; as well as legal and human rights.


Cabinet wishes to express its appreciation of the work done by members of the Task Team - including in particular experts and specialists from inside and outside the country - whose contribution has helped shape this Plan. We are confident that, as with our national prevention efforts, this Plan will rank among the most comprehensive in the world.

Government is once more strengthening the hand of the nation in the fight against HIV and AIDS, in keeping with its mandate to build a better life for all. If correctly implemented this Operation Plan provides an excellent opportunity to complete the treatment sector of the National Strategic Plan for HIV and AIDS whilst also strengthening prevention. The challenge is immense but not impossible.

We are confident that, together, bound by a people's contract for a better life, we shall all continue to make progress in building South Africa into a land our dreams.

There is hope!

19 November 2003

Issued by: Government Communication and Information System (GCIS)
For further enquiries contact:
Joel Netshitenzhe
082 900 0083


A better formatted version of this document is available from:

Cabinet's decision on the Operational Plan for Comprehensive Care and Treatment of people living with HIV and AIDS

Question & Answers

19 November 2003

Government is taking advantage of new developments to enhance our country's comprehensive response to HIV and AIDS. It will, as matter of urgency, start implementing a programme to provide anti-retroviral treatment (ART) in the public health sector. Let us build on the foundations laid in the past three years through implementation of the five-year strategic plan.

What is government's approach to HIV and AIDS? [top]

Ours is a comprehensive strategy based on a partnership of all sectors of society, because HIV and AIDS represent a challenge to all of us. Success depends on close collaboration and continuing strengthening of partnership. The Partnership was formalised in October 1998 in a national launch by then Deputy President Thabo Mbeki, and is now represented by the South African National Aids Council (SANAC).

What are the elements of the comprehensive approach? [top]

The comprehensive programme includes prevention, treatment and care, research and human rights:

* Prevention of HIV infection is the bedrock of Government's approach to halt the spread of HIV and the impact of AIDS, since there is no cure for AIDS. We must ensure as a nation that the 40 million South Africans who are not infected stay that way.

* Ensuring that those who are currently infected with HIV but have not developed AIDS progress as slowly as possible to this stage, through enhanced efforts in dealing with opportunistic infections, prophylaxis, improved nutrition and lifestyle choices.

* Effective management of those HIV-infected individuals, currently estimated at 400,000 to 500,000, who have moved on to develop AIDS, through appropriate treatment of AIDS-related conditions (including using antiretroviral therapy in patients presenting with low CD4 counts, and suitable care where treatment has run its course.

* Important in supporting these efforts are:
o Social programmes that aim to reduce poverty, improve education and bring about moral renewal.
o Strengthening the immune system, of critical importance for the health of those infected by HIV.
o Promoting a climate of acceptance of all people infected and affected by HIV and AIDS; intensifying implementation of a policy and legislative framework and community awareness to promote the rights of all.

What are the main elements of the treatment plan? [top]

The treatment plan has two goals - to provide comprehensive care and treatment for people living with HIV and AIDS, and to help strengthen the country's national health system.

The programme responds to the holistic needs of people at all stages of HIV infection and attempts to slow progression and maintain the person at the highest functional level.

Voluntary counselling and testing (VCT) is a crucial entry point. Once identified as HIV-positive, patients will be assessed for the stage of their illness and referred into appropriate medical care. The assessment will involve a CD4 count test and the patient's medical history and status.

HIV-positive patients will enter into a system of care that monitors progress of infection. Care will focus on slowing progression to full-blown AIDS and maximising health through prompt diagnosis and treatment of opportunistic infections, periodic medical examinations and CD4 and viral load tests. They will be closely monitored for TB, a common opportunistic infection associated with HIV.

At what stage, for patients, will ART be considered? [top]

Patients who are symptomatic and/or with a CD4 count less than 200 will be counselled and offered the option of antiretroviral therapy. They will be fully informed about the benefits of restoring immune function and improving the quality of life and about serious side effects that may result from treatment with these drugs. For those choosing antiretroviral therapy, CD4 and viral load tests will be done as treatment begins.

Patients will be treated at Service Points that have been accredited to provide antiretroviral treatment and will be treated by health professionals who have been trained and certified. They will receive psychosocial and nutritional support, as needed.

Community care and support services such as transportation, home-based care, hospice services, etc., often provided by NGOs and CBOs, will help keep people in care and encourage their adherence to treatment.

Nutritional support will be provided as part of this comprehensive care and treatment programme.

When is it to be introduced; where; how it will be scaled up? [top]

The goal of the programme is to establish at least one accredited service point in every health district (in each District or Metropolitan Municipality) by the end of the first year of implementation and within a period of five years to provide all South Africans who requires comprehensive care and treatment for HIV and AIDS equitable access to the programme within their local municipal area.

Some areas will be able to start sooner than others.

However we should all be aware that this is a complex programme with many elements requiring cooperation of various role-players, inside and outside government - the actual pace of change will depend on how well we all cooperate in implementing the plan.

Why is it being introduced in stages? [top]

The plan calls for significant additional capacity in the national health system, in particular strengthening human resource capacity and providing incentives to recruit and retain thousands of health professionals in historically under-serviced areas. Over the next four and a half years, over R750 million is proposed for upgrading systems in the healthcare infrastructure in areas such as drug distribution, patient information systems and monitoring of reaction to the drugs.

We must ensure the safe and effective use of antiretrovirals and other medicines; the care we provide must be of the highest quality; and it must be accessible to all South Africans on an equitable basis.

We will need a system for procuring the necessary drugs at the best price.

We will need to establish facilities - Service Points - of a standard that can provide the whole range of required interventions: diagnosis, counselling, treatment of opportunistic infections, other preventive and supportive strategies such as nutrition and nutritional supplements and traditional and complementary medicines with immune-boosting properties as well as antiretroviral drugs for the management of AIDS. A service point will be a group or network of linked health facilities operating through a hospital or clinic in a defined catchment area.

Is there a role for traditional medicine? [top]

Many people including those living with HIV and AIDS consult traditional health practitioners and use traditional medicine to meet some of their health needs. We will work together with these health practitioners to share experiences in the care of people with AIDS and they will also serve as a critical resource in providing support and assisting patients to adhere to treatment regimen.

Government is also committed to upscale research into traditional medicines that may in future render further treatment options.

What is required for a health facility to be accredited? [top]

The plan establishes standards for accreditation of service points. This will ensure that comprehensive HIV and AIDS care and treatment of high quality can be delivered. There will be technical assistance and financial resources to help service points meet the accreditation requirements, with special attention paid to underserved areas of the country to promote equitable implementation

The criteria defining the conditions at a service point for high quality care and treatment include:

* A service point project manager
* A trained care team on site including clinicians, nurses, and counsellors,
* Easy access to trained laboratory, pharmacy and nutritional staff, and links to NGOs and other service providers
* Standards of care according to the National Treatment Policy Guidelines
* 24-hours a day access to care at the service point, or in the vicinity
* A staff recruitment, training and skills development plan for health care workers responsible for HIV and AIDS care and treatment (including volunteers and lay counsellors) based on initial needs and projected long-term patient numbers
* Consultation, treatment and counselling rooms to assure patient confidentiality
* Access to appropriate laboratory services, overseen by the National Health Laboratory Service;
* Adequate specimen preparation protocols
* Secure pharmacy storage
* Adherence to Drug Dispensing Standard Operating Procedures for Opportunistic Infection prophylaxis and treatment, and ARVs
* Access to patient nutritional status assessment and nutritional support
* Links with VCT centres, antenatal clinics, Family Planning clinics, TB clinics, STI clinics, TB/HIV demonstration districts, and any other patient referral facilities, to ensure that HIV-positive patients are formally referred to the accredited service point
* A PMTCT programme for service points providing antenatal care and a referral system for sites without antenatal care facilities
* Linkages with community resources and other support organisations that complete the continuum of medical care and support services,
* A system to track patients/treatments
* A system to maintain medical records and transmit core data to a central data collection point
* 24-hours post-exposure prophylaxis (PEP) access, according to the latest national guidelines
* Links with the provincial HIV and AIDS Unit
* Participation in Information, Education and Communication activities.

What will be needed to ensure that all areas are serviced? [top]

* Strengthen human resource capacity by recruiting and retaining thousands of additional health professionals; and implement a training programme for heath professionals, including traditional health practitioners, as part of the accreditation process

* Upgrade our drug distribution system including secure facilities and training of personnel who handle and dispense drugs

* Strengthen the National Health Laboratory Service, including better coverage and expansion in specific capabilities to perform the CD4 and viral load tests essential for high quality HIV and AIDS care and treatment

* Improve patient information systems

* Strengthen the system which monitors the efficacy of drugs being used as well as any adverse reaction to the drugs (pharmacovigilance)

* Establish a research programme that will focus on practical questions and help us better understand and improve the provision of comprehensive care and treatment

The programme will need an integrated national structure to manage and coordinate implementation, incorporated within the existing national health system, and in particular integrated within the prevention and education programmes.

How long will it take before people can access antiretrovirals? [top]

Within a year there will be at least one service point in every health district and within five years access to all who need it in their own municipal area.

Some areas will be able to start sooner than others, and each service point per district may begin to operate as soon as it is accredited, and as soon as the drugs are available..

Has government made a u-turn? [top]

In April 2002 after reviewing its approach to HIV and AIDS, Cabinet reaffirmed its commitment to the Strategic Plan. Noting progress in the implementation of the Strategic Plan, Cabinet decided on a number of measures to strengthen and reinforce these efforts, including:

* Intensifying efforts to remove systemic constraints on access to ARV drugs such as cost and infrastructure

* Strengthening partnerships, especially via strengthening of SANAC

* Continued use of nevirapine in Preventing Mother-To-Child Transmission, and development of a universal roll-out plan

* Providing a protocol for a comprehensive package of care for survivors of sexual assault, including post-exposure prophylaxis with antiretroviral drugs

* Ensuring that no-one is turned away without appropriate treatment and management of any infection or illness, irrespective of HIV status

* Alongside poverty alleviation and nutritional interventions, to encourage investigation into alternative treatments, particularly supplements and medication for boosting the immune system

In July 2002, Government established a joint Health/Treasury task team to investigate issues relating to the financing of an enhanced response to HIV and AIDS, including Anti-retroviral Treatment.

On 8 August 2003 Cabinet received the team's report, which provided options for introducing antiretroviral therapy. The Minister of Health was requested to present a detailed operational plan in this regard.

An Implementation Task Team was set up, made up of South African experts and advisors working with the Clinton AIDS Foundation. A summary of plan is available on SA Government Online (

Why is this step being taken now -in particular why is ART being introduced now into the public sector? [top]

The possibility of considering sustainable and effective antiretroviral therapy in the public sector is a natural progression of the implementation of the comprehensive 5-year strategic plan. A number of positive developments with regard to the constraints on such treatment made this possible:

* Continuing fall in prices because of new opportunities to manufacture some drugs in South Africa; and successful negotiations with drug companies;

* Increased international and local experience in combating HIV and AIDS

* Growing appreciation of the role of nutrition in enhancing health and improving the efficacy of medical treatment, so that people do not rely only on drugs.

* The building of a critical mass in our country of scientists and health workers with skills and understanding of the fight against HIV and AIDS, as a result of the implementation of our comprehensive strategy over the past few years;

* Initial steps towards strengthening our health system in relevant areas, though much remains to be done in this regard;

* More resources in the budget to strengthen the national health system and to pay for the drugs and testing needed and to improve training and health infrastructure.

* A better appreciation of the social dimensions of the pandemic, which allows policies on health care interventions to be located within a broader social and health context

What will it cost to implement the plan? Is it sustainable? [top]

The cost of implementing the plan is R296 million for the rest of fiscal year 2003/4, growing to nearly R4.5 billion in 2007/8.

The budget is based on international tendering as the means of procuring drugs.

Total Programme Budget Estimate (Millions of Rands)
2003/04 2005/06 2004/05 2006/07 2007/08
New Healthcare Staff 21 322 432 662 1027
Laboratory Testing 20* 152 311 520 806
Antiretroviral Drugs 42 369 725 1118 1650
Nutrition 63 343 421 532 656
Other Health System Upgrades 70 171 184 160 160
Programme Management (National & Provincial) 16 103 128 128 128
Capital Investment 30 75 100 100 0
Research 34 55 55 48 48
Total 296 1590 2358 3268 4474

*Note: Includes R20 Million advance payment to NHLS through March '04.

This enhancement of our response to HIV and AIDS has been designed to be cost-effective and efficient without compromising quality. To ensure sustainability most of the budget will come from government. This has been made possible by the sound economic policies government has pursued, releasing resources for social spending. But where appropriate, financing of the programme may be supplemented using donor sources.

Won't it take resources from other health care and social service? [top]

The decision of Cabinet comes with new resources that have been allocated to fund it. It will not detract from other programmes, whether in the fight against HIV an AIDS or in the reconstruction and development of our society. In fact the strengthening of the health system which is required for sustainable ART will bring benefits to health care more generally.

More than half the proposed total expenditure will go toward: strengthening the national health system; emphasizing prevention; and promoting healthy lifestyles. These funds will not only allow for delivery of comprehensive care and treatment for those infected with HIV - they will improve the overall capabilities of the public health system and benefit all.

Why is the price of drugs important? [top]

Two years ago this programme for comprehensive care and treatment would have been impossible, amongst other things due to the cost of the medicines and laboratory tests required. Falling prices internationally and new opportunities to manufacture some drugs in South Africa; as well as successful negotiations with drug companies made it feasible to consider such a programme.

The plan provides for a system of drug procurement that will secure drugs at prices well below today's best international prices. In time South Africa will have its own production facilities for these drugs.

What can ART do, and what are its limitations? [top]

Many uncertainties remain and our knowledge of HIV and AIDS continues to evolve rapidly. But we are better equipped now to ensure that the benefits of ART outweigh the risks, for patients already in a desperate state of illness that has progressed beyond what can be managed by other means alone.

There are important facts we should be aware of:

* The new elements of the treatment programme will help extend the lives of those who have reached the stage of AIDS - but antiretrovirals are not a cure

* Not everyone who is infected with HIV needs antiretroviral treatment- the majority with HIV can still live a healthy life, with proper nutrition, treatment of any diseases and a responsible lifestyle.

* Both health workers and patients should adhere to the strict guidelines - antiretrovirals can have serious bad side effects and can be dangerous if not properly used, and the treatment involves a life-long daily regimen.

Patients should be able to make an informed choice. Information will be provided to patients, to explain the benefits, limitations and possible negative effects.

ART also brings great responsibility on health practitioners with regard to ethical conduct in line with the requirements of the profession, concerning such matters as the rigour of HIV tests, counselling, management of ARV prescriptions and so on

How will the ART impact on the comprehensive strategy? [top]

We must not relax our prevention efforts, but rather sustain and intensify them so that we reduce the level of new infections. The operational plan emphasises that prevention of HIV infection is the bedrock of Government's comprehensive approach and makes provision for integrating treatment and care with intensified prevention.

Most people infected with HIV have not reached the stage at which they require antiretroviral medicines. But they do need access to treatment for opportunistic infections, so provision for that treatment will be stepped up. No one should be refused treatment simply because of their HIV status.

Since HIV thrives on a weak immune system, and in turn also weakens this defence system of the body, proper nutrition for all South Africans and dealing with poverty remain critical in the fight against HIV and AIDS. These social programmes of government will continue with even greater intensity.

We will continue and intensify support to families and individuals affected by HIV and AIDS. Together we must continue to fight discrimination and stigma.

Does the role of partnership change? [top]

Success in the implementation of ART, as with every other aspect of our comprehensive strategy will rely on partnership across society.

That includes communication of objective facts about the new elements of treatment and about the spread of HIV infection and the impact of AIDS and its management. Creating false expectations or an atmosphere in which society lowers its guard on matters of awareness or change in lifestyle, or engaging in mutually debilitating contestation about what can be achieved by when, could undermine not only the treatment programme but set back the hard-won advances made curbing the spread of HIV and reducing the impact of AIDS.

We must intensify every aspect of our comprehensive national programme. To do so we must strengthen the partnership by joining hands in the war against AIDS

Through this enhanced care and treatment programme, government is adding to the nation's armoury in the fight against AIDS.

A cooperative relationship among all sectors, particularly in the implementation of this element of the comprehensive strategy, the spirit of letsema and vuk'uzenzele, a message of hope and responsibility as well as constructive engagement in the realm of practical work would ensure that South Africa advances even more decisively in this endeavour, which is literally a matter of life and death.

Issued by: Government Communications (GCIS)
19 November 2003