Last week, on April 15, South Africa launched the largest HIV testing campaign in the world, aiming to have 15 million South Africans tested by June 2011. This initiative is evidence that the recent budgetary increase of over $1 billion in funds available for HIV prevention and treatment are having an impact on the ground, and it is a welcome and optimistic sign for a country that has had its head in the sand for far too long.
South Africa currently has the world’s highest number of people living with HIV, estimated at more than 5 million. The country also has one of the most controversial histories of HIV, rivalling the legendary struggle for treatment in the United States in the 80s and 90s. Lack of political action in the early years post-apartheid, then outright denialism during the Thabo Mbeki administration, have taken their toll. A recent Harvard study has claimed that South African policies caused as many as 365,000 premature deaths.
Despite significant progress since treatment was introduced in 2003, South Africa continues to struggle with its legacy of inaction. Of the nearly 900,000 people needing treatment in South Africa in 2007, only 42% were receiving it – and these officially-reported numbers continue to be disputed.
To put the budget numbers in perspective, then, we must ask: what would it take? Is an increase of R8.4 billion ($1.1 billion) over three years significant, and if so, will it make a difference?
To do the math simply (recognizing that this will invite dispute): Let’s use an estimated annual cost of antiretroviral treatment at $1500 per patient, of which half is used to buy drugs and the other half is for the system to support delivery. Recent forecasts project that there will be 2.1 million South Africans requiring ARVs by 2012. Assuming costs remain constant, treating all eligible South Africans will cost roughly $3.2 billion annually by 2012.
To go from 380,000 people on treatment in 2007 to 2.1 million in 2012 constitutes a whopping 462% growth in treatment numbers, yet a $1.1 billion increase over three years represents only a 60% increase in annual spending (over public spending of $600 million annually in 2007) — and that’s HIV spending in total. There is a strong case that spending for prevention should grow by at least as much, which means the pot of funding for ARVs is even smaller.
At the same time, the 2010 budget only forecasts a 17% increase in overall health spending, which means that much of this treatment is going to be delivered in a system that is already riddled with severe resource constraints. Coupled with a 6% forecasted inflation rate…well you see where I’m going.
The increase in awareness and public spending for HIV/AIDS treatment is a welcome shift in South Africa, and for this, there should be loud applause. But there is serious disconnect between the stated goals and the reality of the numbers. Digging South Africa out of the consequences of its past policies is going to be a long and difficult journey – but, encouragingly, these first steps have been decisive strides.
