A third of all HIV-positive South Africans are accessing antiretroviral therapy (ART), far exceeding the enrolment targets of the National Strategic Plan (NSP) for 2007 to 2011.

According to Dr Leigh Johnson, UCT actuarial scientist, the number of patients receiving ART in the country by the middle of last year had increased to 1.79 million from under 50 000 in 2004.

This was more than the 80 percent target of patients who were eligible for ART. It was also found to be much higher in women than in men and children.

“ART is a powerful tool for reducing both Aids mortality and HIV transmission. The monitoring of access to ART is therefore critical to the evaluation of the impact of HIV treatment and prevention programmes,” Johnson wrote in last month’s issue of the Southern African Journal of HIV Medicine.

Johnson’s research shows that from mid-2004 to the middle of last year, the total number of patients receiving ART in SA increased from 47 500 to 1.79 million.

Of those, 85 percent were receiving ART via the public sector, 11 percent through disease management programmes in the private sector and 4 percent through community treatment programmes run by NGOs.

Most of the patients (61 percent) were women aged 15 or older.

Men accounted for 31 percent, and children under the age of 15 for the remaining 8 percent.

KwaZulu-Natal and Gauteng were the two provinces with the largest number of patients, together accounting for 56 percent of all patients receiving ART.

Johnson writes that the low rate of ART initiation in men relative to women may be a reflection of gender differences in health-seeking behaviour and perceptions that men who seek care are “weak”.

Alternatively, the high rate of ART initiation in women may be due to higher rates of HIV diagnosis through antenatal screening.

The relatively low rates of ART initiation in children are probably attributable to the lower rates of HIV testing in children and the greater complexity of paediatric ART relative to adult ART, says Johnson.

The new NSP for the 2012-2016 period proposes targets that are far more ambitious than those in the previous NSP: the ART enrolment target in 2016 is 80 percent of the new ART need in that year plus 80 percent of the unmet need from previous years.

High levels of HIV testing and counselling, as well as expansion of the capacity to deliver ART, will be required to meet these targets.