South Africa introduces world's largest AIDS treatment plan

BMJ 2003; 327 doi: (Published 27 November 2003) Cite this as: BMJ 2003;327:1246
  1. Pat Sidley
  1. Johannesburg

    The South African government has reversed its previous refusals to use antiretroviral drugs to treat AIDS and will introduce what is likely to be the world's largest comprehensive AIDS treatment plan.

    While President Thabo Mbeki was out of the country a long awaited cabinet meeting on 19 November agreed to a plan to introduce the treatment throughout the public health system. President Mbeki is credited with being the main obstacle to having appropriate treatment offered to South Africa's five million people who have tested positive for HIV.

    The shift came after a combination of intense pressure from AIDS activists in the country, leadership from former president Nelson Mandela, and pressure from prospective donors outside the country, who were becoming increasingly reluctant to back the country's HIV/AIDS programmes while its political leadership was seen to be prevaricating on the question of treatment.

    The move has been greeted by a wave of relief–reflected in the media–by activists, doctors, nurses, and others.

    The plan adopted by the government will provide for the training and recruitment of staff, the acquisition of drugs, the upgrading of the health system in general, and the monitoring of the effects of the programme. A budget has already been allocated by the Treasury: expenditure will begin at around 300 million rand (£27m; $46m; €39m) in 2003-4 and grow to 4.5 billion rand within five years.

    The plan is to treat some 1.4 million people with antiretroviral drugs within five years. About 53 000 people are expected to start the programme in the current financial year which ends in April 2004. Actuarial models project that about 400 000 people with HIV will develop an AIDS defining illness during 2003.

    Thus far only people with access to private health care have been able to get antiretroviral treatment–around 30 000 people–and the experience in the private sector is of a low uptake of treatment, largely because of the stigma. The plan aims to be able to treat everyone who needs treatment by 2009.

    Eligibility for the programme will depend on a CD4 count of 200 or an AIDS defining illness and the willingness to be treated with antiretrovirals.

    South Africa already has a large programme for prevention of mother to child transmission of the virus.

    A cabinet statement and an executive summary of the plan are available at

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