JOHANNESBURG, 19 November 2008 (IRIN) - South Africa's newly sworn-in Health Minister, Barbara Hogan, came head-to-head with her first real crisis when antiretroviral (ARV) treatment was withheld from hundreds of people in Free State Province. Some may give her an "A" for effort, but others say the health department's response is way off mark.

A province-wide shortage of vital medicines, including ARVs, made national headlines early last week when the AIDS lobby group, Treatment Action Campaign (TAC), said that ARVs were being withheld from about 400 people at the behest of Dr Mvula Tshabalala, head of the province's HIV and AIDS management programme. 

In emails leaked to the TAC, Tshabalala instructed doctors to prioritise giving the dwindling supplies to those already on treatment, pregnant women and children, while suspending baseline blood work and drug-readiness training, saying this would only raise false hopes because it was impossible to speculate when the province would receive the necessary funding to allow more patients to begin treatment.

Two days after the news broke, Hogan dispatched a team of high-level national health department officials, including its chief financial officer, to the provincial capital, Bloemfontein, to investigate the shortage and allegations of financial mismanagement made by TAC. The province stated that a funding shortfall of R63 million (USD$6,300,000), coupled with higher numbers of patients on treatment and the introduction of more expensive dual therapy for the prevention of mother-to-child transmission, led to the shortages.

Too early to tell?

The deaths of more than 330,000 HIV-positive South Africans have been attributed to delays in treatment by Hogan's predecessor, former health minister Dr Manto Tshabalala-Msimang, according to a recent study by Harvard researchers.

In a country with the world's highest number of people living with HIV, Hogan's appointment carried the hope that a changing of the guard in the Ministry of Health might mean swifter action on the ground.

"We're extremely unhappy; this is a severe setback, and the funding was made available to avert the treatment shortages," said Rebecca Hodes, TAC's director of policy, communications and research.

"Because of the delay in the programme nationally, the rollout has been very slow to get off the ground, so people present at clinics with very poor health, with CD4 counts [measuring the strength of the immune system] of 2 and 3," she said. "To say you are going to stop ARVs is almost certainly consigning those people to die from AIDS."

The national health department has maintained that the treasury transferred R9.5 million (USD$950,000) to the province and its drug procurement partners to alleviate the shortage, but provincial health spokesperson Elke de Witt said the province had yet to see any of the money, and that it would require about that much every month to sustain its HIV/AIDS programmes.

Concerned local doctors have been calling TAC because they fear the money will go into comprehensive care rather than ARVs and other drugs. "Doctors are afraid to speak up because they afraid of victimisation from their department," Hodes said. "We just received a call from a northern Free State doctor who said she had to turn away 30 patients and that she is running out of ARVs."

Although TAC is not aware of other provinces experiencing shortages of ARVs, the group is asking for more money to be devoted to providing treatment, and for an emergency plan of action to be drafted to ensure a quick and effective response should similar shortages arise in the future, Hodes said.

Dr Francois Venter, president of the Southern African HIV Clinicians Society, said Hogan had never struck him as someone likely to sit back and watch a crisis unfold, and he expected she was watching the situation with a hawk's eye.

"Needless to say, it's a complete disaster, and it's absolutely bad planning on the part of the provincial government. It's all very well and good to say that patients have been reassured, but for people who need ARVs this is a matter of life and death," he said. "I think the action taken by the national health department was rapid and decisive; whether it was enough, we don't know."

The national department of health was unavailable for comment at the time of publication.

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