Resource Allocation Main Issue in Roll Out of South African Antiretroviral Drug Program, Opinion Piece Says

The "burning issue" in the roll out of an antiretroviral drug program in South Africa is not the "complexity" of the program but the amount of money that the government allocates for it, Nicoli Nattrass, director of the AIDS and society research unit and professor in the School of Economics at the University of Cape Town, writes in a Business Day opinion piece (Nattrass, Business Day, 8/13). The South African government on Friday announced it is creating a national program to provide antiretroviral medications to residents with HIV/AIDS and called for the Health Ministry to develop such a program by Oct. 1 (Kaiser Daily HIV/AIDS Report, 8/11). The government's "discourse of 'unaffordability'" has previously stalled public debate over the amount of resources needed for a roll out of the program, and now it appears to be using a "different silencing discourse" by claiming that a "detailed operational plan is necessary" before it can start providing treatment, Nattrass says. However, successful antiretroviral drug programs in Brazil and Botswana show that "there is only one way of rolling out a treatment plan: start where capacity exists and expand outwards from there," he writes. Because South Africa already has the doctors, infrastructure and monitoring systems established in the Western Cape, Gauteng, KwaZulu-Natal and other locations, "why do we need a detailed operational plan to start providing treatment?" Nattrass asks, adding that delays in the roll out of the program have denied "many people life-prolonging (and life-saving) benefits." The main topic of debate therefore should not be the complexity of the program but the funding allocated to it, he says. "We must not let this new discourse of complexity silence public debate on how South Africans should respond to the AIDS pandemic," Nattrass says, concluding that "far more social deliberation" should be spent on resource allocation (Business Day, 8/13).