Approximately 30 deaths a day as Free State ART shortages continue

The ART moratorium in the Free State was enacted almost four months ago. Since then, the HIV Clinicians Society conservatively estimates that about 30 people have died every day due to their inability to access ART in the province. Approximately 15,000 people in need of treatment are on a waiting list. However, many were turned away during the moratorium without being added to the waiting list. Others have had their regimens interrupted due to the drug stock-outs.

Despite promises by the provincial Department of Health in the Free State that the antiretroviral treatment (ART) moratorium would be lifted last week, TAC continues to receive complaints from doctors and activists in the provinces that they still do not have access to drugs. 

The ART moratorium in the Free State was enacted almost four months ago. Since then, the HIV Clinicians Society conservatively estimates that about 30 people have died every day due to their inability to access ART in the province. Approximately 15,000 people in need of treatment are on a waiting list. However, many were turned away during the moratorium without being added to the waiting list. Others have had their regimens interrupted due to the drug stock-outs.

Despite promises by the provincial Department of Health in the Free State that the antiretroviral treatment (ART) moratorium would be lifted last week, TAC continues to receive complaints from doctors and activists in the provinces that they still do not have access to drugs.

No new patients have been given access to ART at Pelonomi, and ongoing shortages of the antiretroviral 3TC have forced patients to default on their regimens, reported on Friday 20 February by Sello Mokhalipi, a TAC activist in the Free State. In addition, 3TC has not been available for three consecutive days according to Makhalipi, who conducts drug readiness programmes for pregnant women at Pelonomi Hospital, and was one of the organisers of the TAC protest march there on Tuesday 10 February.

A doctor from the provincial Department of Health recounted how two women had presented at Pelonomi on Monday 16 February to access ART for their babies. The women were told that no drugs were available, but that they should wait until 2 pm that afternoon at which time they would arrive. At 2 pm, they were told to come back the following Friday (27 February). The women were afraid to talk to journalists as they feared that this would derail their chances of accessing ART for their babies. This fear of punishment by the Health Department for speaking out about ongoing ART shortages is dogging healthcare workers and patients, and Mokhalipi has been warned by healthcare officials that he is under surveillance at Pelonomi because he is a member of TAC.

During the time in which the ART moratorium was in place, a glossy internal newsletter of the Free State Department of Health (distributed in healthcare facilities across the province) included a section on ‘Alternative Remedies’, which highlighted the healing capacity of beetroot, garlic, olive oil and lemon. This section glowingly documented an ‘experimental project’ run by Tine van der Maas at the National Hospital in Bloemfontein. [Click here to see a scanned copy of the pamphlet.] Van der Maas is the force behind the quack remedy ‘Africa’s Solution’, which is promoted as a cure for HIV. It is a damning indictment of the Free State Department of Health that this information was being disseminated at clinics across the province while patients desperately in need of ART were being denied access.

On Wednesday 11 February a circular was sent to staff at ARV sites advising them to follow a set of guidelines in the initiation of new patients. These guidelines were vague and unrealistic, with the recommendation that ‘prescribers are to consider the staggering of initiation of new patients from the existing waiting list over one to two months’. One doctor explained that it would be at least six months before provincial healthcare sites are able to catch-up with the ART waiting list, and that patients will continue to die in the interim because of a lack of treatment.

On 18 February, the Premier of the Free State, F. B. Marshoff, gave her ‘State of the Province’ Address. The speech was 6, 757 words long, and devoted a mere 143 words to HIV/AIDS in the province. The Premier made no mention of the ART moratorium and other severe cutbacks in healthcare services which have caused death and suffering in the province she leads. Instead, the Premier spoke of structural changes within the Provincial AIDS Council and of increased co-operation with other stakeholders, and gave no concrete information regarding the ART roll-out, TB treatment or PMTCT in the province.

Actions to ensure ART is made available in the Free State

The Programme Implementation Committee (PIC) of the South African National AIDS Council (SANAC) has established a committee to monitor developments in the Free State, and to ensure that ART is made progressively available to all who need it. This committee is comprised of the Director General of Health, Thami Mseleku, Yogan Pillay, Helen Rees, Ashraf Coovadia and Mark Heywood.

• Dr. Pillay visited Bloemfontein on Monday 16 February in response to continued complaints from patients regarding their failure to access ART at local healthcare sites.
• The committee held a teleconference on Wednesday 18 February to discuss the continued treatment shortages in the Free State despite promises by the provincial Department of Health that drugs should have been available in all Bloemfontein clinics by 18 February and throughout the province by 19 February.
• David Kalombo, an ARV site accreditation officer from the National Department of Health, has committed to daily checks to establish whether clinics have received drugs, and the National Department of Health has promised to support a communication campaign via radio and newspaper which will encourage people to go to healthcare sites to seek ART.
• The SANAC Treatment Task Team has drawn up guidelines on treatment for people who are very sick with AIDS and therefore in need of rapid access to treatment. These will be distributed in the Free State shortly.

TAC/ALP Action

On Thursday 26 February, a meeting of civil society is taking place at Pelonomi Hospital. TAC, ALP and others will discuss the establishment of an Interim Committee to visit clinics across the Free State to establish whether ART is being progressively made available to all those in need.

TAC and ALP continue to monitor ART access in the Free State very closely, and to demand that the Department of Health mount a transparent investigation into the ART moratorium in the Free State. The figures responsible will be held to account for enacting a series of measures which violated the rights of patients there.

Director General Mseleku has admitted that the financial crisis in Health Departments affects every province. Provincial and district TAC members must report any information about ART stock-outs or cutbacks in healthservices so that the Free State ART moratorium, and the needless suffering and death is has caused, will not be repeated.