Global Fund Director's South African visit highlights country's HIV/AIDS challenge
In his first official visit to South Africa as Executive Director of The Global Fund to Fight AIDS, Tuberculosis and Malaria, Mark Dybul met with President Jacob Zuma to discuss advancing the fight against these infectious diseases in the country. South Africa has made significant gains in the fight against HIV and AIDS and the Global Fund has been a major partner in the country's efforts. Recently, South Africa's government has stepped up domestic financing of HIV programmes to cover approximately 82 per cent of the country's total HIV and AIDS expenditure. It has been supplemented by further support from international funding mechanisms such as the Global Fund and the President's Emergency Plan for AIDS Relief (PEPFAR). These investments have resulted in important health gains for the country.
With 1.9 million people on treatment as of June 2012, South Africa has the largest antiretroviral therapy (ART) programme in the world. By local standards, ART is relatively expensive and many have questioned whether scaling up such treatments could be justified. However, co-ordinated action by South Africa and external supporters has helped to increase life expectancy from 54 years in 2005 to 60 years in 2011. In fact, in a recent study published in Science (2013;339:961-965), researchers analysed the effectiveness of a US$10.8 million campaign in KwaZulu-Natal province in South Africa and found that as well as considerably increasing life expectancy, treatment scale-up was also in fact very cost-effective. The investment of US$1,593 for ART in this community saved one life year. For investments in health interventions to be considered cost effective, the spending must be less than the annual per capita gross national income to save one life year; South Africa's per capita gross national income in 2011 was US$6,960.
However, with hundreds of thousands of additional South Africans now entering ART programmes, as well as the cost of HIV prevention and care of orphans, the financial challenge is mounting into a major risk for South Africa, particularly at time when the country is suffering due to the global economic recession and is struggling to maintain its government budget for varying needs, beyond HIV and AIDS. This is why the ongoing commitment by global partners is crucial. While the exact amount is not known, the South African Treasury estimates that total external funding for HIV/AIDS amounts to R5 to 6 billion per year, with The Global Fund and PREPFAR having been major contributors in recent years. The Global Fund Board recently approved an additional R216 million for HIV programmes in South Africa. An estimated additional R1.95 billion is available to South Africa for programmes to be implemented between 2013 and 2016. Further funding amounting to R296 million for HIV will be available through the new funding model that the Global Fund recently launched. South Africa is also helped considerably by PEPFAR. In 2010, a Partnership Framework between the US and South Africa was signed, providing a five-year joint strategic plan to fight HIV/AIDS. By the end of this period, the collaboration is expected to result in greater prevention efforts and expanded services for HIV, as well as a strengthened national health system.