SAHR 2007 - Health Systems Trust

The proportion of children in need accessing ART has
commonly lagged behind the adult figure. The UNAIDS/
UNICEF/WHO publication assessing “Actions and progress
during the first year of Unite for Children, Unite against AIDS”,
showed that only 18% of children under 15 who needed
treatment were accessing it in South Africa in 2005 [Children
and AIDS]. At the South African AIDS Conference in 2007, it
was claimed that “only 21 000 children were getting ARVs
out of an estimated 123 000 children who needed the
medicine”.
The financial implications of the NSP have been projected,
and will demand a number of new approaches. The line
item “Maintain health of HIV-infected adults” is expected to
consume 57% of the total expenditure over 5 years, with 40%
being for antiretroviral treatment for adults only. A further
6% is expected to be spent on ART for children. The NSP
document notes that the full costs may, under some options,
exceed “20% of the health budget without considering the
costs arising from the effect of the epidemic on hospital and
primary care services”. Meeting this demand will not only
require “increasing the affordability of medicines”, but also
a shift in the Department of Health’s approach to the use
of donor funding. The NSP calls for “ [i]nnovative financing
arrangements such as partnerships with the key donors
(Global Fund to Fight AIDS, TB and Malaria and PEPFAR) as
well as partnerships with the private health sector, business
and a range of other stakeholders”.
The number of complementary sources of HIV-related data
continues to grow. For example, a cross-sectional, voluntary,
anonymous unlinked survey among 2 032 public sector
health workers showed an overall HIV prevalence of 11.5%,
with 19% of these having a CD4 count below 200 cells/µl
[SAMJ 97(115-20)].
As noted before, the StatsSA Adult Mortality report devoted
much of its effort to demonstrating the extent to which
increasing mortality in both males and females could be
related to HIV. It noted that peak HIV-related death rates
had a distinctive pattern, peaking at 30-34 for females and
at 35-39 for males. As HIV is not a notifiable disease in South
Africa, many HIV-related deaths were attributed to other
conditions. The potential link with TB has been described
above. The StatsSA report concluded that “[b]ased on the
age pattern of death rates by sex, it is likely that a high
proportion of deaths registered as due to parasitic diseases,
parasitic opportunistic infections, certain disorders of the
immune mechanism and maternal conditions (females only)
are actually caused by HIV”. In other cases, where age
patterns indicate otherwise, “some of the deaths are likely
actually due to HIV, but some of the deaths are likely due
to something other than HIV”. This was thought to apply to
“all infectious diseases, tuberculosis, malaria and nutritional
deficiencies”.
An increasing number of deaths are reported as HIV-related
(ICD-10 codes B20-B24), and the temporal trends are
Farai Dube, Enhancing Children’s HIV Outcomes. Quoted by Health-E
News, 7 June 2007.
http://www.health-e.org.za/news/article.php?uid=20031682
Figure 7: Death rates by age and sex per 100 000 from deaths registered as due to HIV, 1997 and 2004
140
120
Deaths per 100 000
100
80
60
40
20
0
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Male 1997 Male 2004 Female 1997
Female 2004
Source:
StatsSA Adult mortality.
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