ARV shortage poses serious risks

As doctors warn about the dangers of interrupted treatment in the wake of the crisis caused by the ARV shortage, the government claims that stock is almost replenished.

South Africa has turned to another of its Brics partners, India, to stock up on second and third line ARV drugs in a bid to alleviate their serious  shortage.

Health department director-general Dr Anban Pillay assured New Frame that the department is restocking ARVs in state health facilities. “Stocks come in every week. After mid-November, there will be no stock to come because everything would have been delivered,” he said.

Pillay’s statement comes in the wake of growing warnings that the health of patients with HIV is being severely affected by the ARV shortfall, and that there is a danger of the virus mutating. According to Health Minister Aaron Motsoaledi, 4.2 million South Africans are now on ARV treatment. But in recent months the programme, which has kept millions of people alive and in good health for years, has been threatened by a shortage, which has now reached crisis level.

The rollout of HIV treatment in South Africa from 2004 is often regarded as one of the state’s most significant achievements. It came after a long struggle led by the Treatment Action Campaign, with strong support from trade unions and other progressive formations.

Andrew Mosane from Stop Stockouts Projects (SSP), a consortium of organisations formed to deal with the chronic lack of essential medicines and vaccines, says about 160 000 patients on second-line treatment are the most affected. A report by SSP suggests that Mpumalanga is the province worst hit, followed by North West, Gauteng, Limpopo, Eastern Cape, Free State and KwaZulu-Natal.

When ARV treatment is interrupted, people with HIV are at increased risk of opportunistic infections, treatment failure, drug resistance, general ill-health and death.

A severe shortage

Health department spokesperson Popo Maja told New Frame that the public health sector, which serves 87% of those living with HIV, has been severely hit by the shortage.

The department has faced ARV supply problems before. In 2008, the Free State was short of ARVs owing to budget difficulties. In 2013, a medical depot failed to distribute ARVs for weeks in Mthatha, Eastern Cape.

Activist Lebogang Motsumi, 29, who has been living with HIV for 10 years, said: “It’s quite embarrassing and disappointing that we find ourselves in a place where we are experiencing stock-outs on ARVs.”

Motsumi is among 7.6 million South Africans living with HIV, as reported by Statistics South Africa in 2017. “I wonder what the loopholes are and what is creating this mess because it is really messing with people’s lives,” said the HIV activist and mother of one.

“The government is letting people down, not everyone can afford R700 or R1 000 a month for medication.”

Dr Kamela Mahlakwane, a virology registrar at Stellenbosch University, warned that while people wait for the health department to supply health life-saving ARVs, the virus transforms. “If [ARVs are] not taken consistently, one may develop a resistance,” he said, adding: “Irrespective of which regimen one is taking, if the person is not adherent to their treatment, the virus is bound to emerge resistant to those particular drugs, effectively rendering the medication useless.”

A 2008 study by Pride Chigwedere at Harvard, titled Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa, shows that former president Thabo Mbeki’s denialist approach to the HIV/Aids pandemic in South Africa between 2000 and 2005 claimed more than 300 000 lives, with at least 35 000 babies born with HIV. This was mainly because of stalling on programmes to supply ARV treatment and mother-to-child transmission prevention.

But there was a dramatic shift after the Mbeki administration. Statistics South Africa reported that the number of Aids-related deaths between 2006 and 2017 dropped dramatically from 345 185 in 2006 to 126 755 in 2017. In sum, providing accessible ARV treatment has vastly increased the quality of life of many South Africans.

According to Maja, the shortage has been caused by new legislation in China relating to industrial pollution, which resulted in the closure of manufacturing sites that produce Lamivudine and Abacavir, which are required in the production of ARVs.

China introduced air pollution control policies in 2013. Last year, it was reported that tens of thousands of factories there had been shut and more than 80 000 either fined or facing criminal charges.

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