sahr2001 - Health Systems Trust

9 • Mainstreaming HIV/AIDS
Another recent survey in hospitals found that nearly all physicians interviewed
were unhappy about the lack of clinical protocols to deal with both the clinical
and ethical aspects of care. 41 It is thus not surprising to hear of incidents of
discrimination that HIV/AIDS patients have experienced at the hands of health
workers. 42
The current absence of guidelines leads to HIV care being rationed in
‘inconsistent and often unfair ways’, and places tremendous stress on frontline
health workers. 43 The responsibility for this behaviour lies not with the
individual health workers, but with a system that has not yet adequately
provided its workers with the guidelines and skills to provide effective care.
A key focus of the national HIV strategy should therefore be the
implementation of a clearly defined package of treatment and care. The Pro
TEST TB/HIV pilot districts have demonstrated the feasibility and effectiveness
of doing this. In these sites, for example, evaluations of the impact of training
have noted remarkable improvements in the care provided to HIV infected
persons, and also in the attitude of persons living with HIV and their openness
about HIV.
It is against this backdrop, that the decision by the national and some
provincial DoH’s to enter into a partnership with various non-governmental
organisations to dramatically expand the training of PHC and hospital based
staff in the package of care should be applauded. k
Both health workers and the public need assistance in distinguishing between
persons with AIDS near death and HIV positive persons for whom simple
and cost effective treatment and care can be provided to restore health and
improve the quality of life. As one doctor put it, “our whole system is shoving
persons into HBC.” 44
The question of antiretrovirals
Although an expensive treatment programme, combination antiretroviral
(ARV) drug therapy represents one of the greatest pharmaceutical
developments in the history of medicine. 45 Hopefully it will be possible to
determine the compromise point between what is affordable and the cost of
an adequate package of care. The Abuja Declaration and Framework of
African Countries for Action for HIV/AIDS, of which South Africa was a
key author and signatory, recommends that Health Sector expenditure be
increased to 15% of total expenditure. 46 In South Africa, this would amount
to an extra R2-R5 billion for the health budget, in addition to the potential
to tap into the Global HIV/AIDS Fund and the private sector.
k One of the major bodies responsible for this training will be IAPAC (International
Association of Physicians for AIDS Care). IAPAC has been responsible for the highly
successful training of health workers in the Diflucan Partnership Programme (where
health workers were trained in the use of fluconazole for the management of
opportunistic infections).
173