By Charlene Smith
On Monday South African university researchers will present evidence at an international Aids conference in Buenos Aires, Argentina, that widespread poverty and lack of clinical resources do not make it impossible to extend anti-retrovirals to all.
Last month, Manto Tshabalala-Msimang, the minister of health, reiterated the government's refusal to extend anti-retroviral therapy to all because most people were poor and illiterate and would, as result, not take their drugs properly.
Tshabalala-Msimang also cited inadequate medical infrastructure, the alleged toxicity of anti-retrovirals and the dangers of drug resistance if medication is not taken correctly.
But evidence from more than 16 clinical trials involving almost 800, mostly impoverished, HIV-positive people in Johannesburg, Cape Town and Soweto show there is no reason why anti-retroviral therapy cannot be given to poor people successfully.
The trials were conducted in "resource-poor settings from three academic clinical trial units".
The trials were conducted by the peri-natal HIV unit at Chris Hani Baragwanath hospital, the Clinical HIV Trials Unit of the University of the Witwatersrand and the HIV Research Unit of the University of Cape Town, all headed by Aids experts, including doctors Ian Sanne, Glenda Gray, Lerato Mohapi and Robin Wood.
The trials, conducted since 1995, show that of the 763 people who were involved, only 26 (less than 3,5 percent) dropped out. Toxicity to anti-retrovirals was marginal. The average age of people in the trials was 35 years and treatment discontinuation was highest among those in the 20 to 30 age group.
The researchers surmised that people in this group discontinued treatment because they may have had feelings of "invincibility" but also because they experience the most "poverty, unemployment and dislocation".
Those who dropped out tended to be women who fell pregnant (and the parameters of the trials study said pregnant women could not participate) or those with alcohol problems.
In another study conducted by Dr Adrienne Wulfsohn of Netcare clinics in Johannesburg, anti-retroviral therapy given to nearly 700 women and children after being raped - including a significant percentage from informal settlements - has shown a 100 percent compliance with the 28-day course by rape survivors.
It also showed almost no side-effects and not one woman became HIV-positive after being on the medication after rape. But a fair number of women who were too late to be given anti-retrovirals sero-converted and became HIV-positive after rape.
In addition, the provision of antiretrovirals to HIV-positive pregnant women by the Western Cape department of health to prevent transmission to their infants has proved so effective that the province plans to expand the programme to 90 percent of mothers.
Next, the department plans to put the mothers on anti-retrovirals for life and expand voluntary counselling and testing services, which it believes act as a preventative mechanism too.
In the Netcare study - the largest study in the world into the relationship between rape, HIV and anti-retrovirals - just more than 15 percent of raped women were already HIV-positive on the day they were raped. Although they stuck to the 28-day treatment and reported for their six week HIV test, very few completed a full year's worth of tests to ensure they were completely free of risk.
Wulfsohn said she believed increasing transport costs made it hard for poor people from informal settlements far from clinics to return for follow up tests.
The results of the studies are likely to arouse international interest because a number of foreign research bodies, mostly based in the United States, are already making plans to conduct similar research in South Africa, Lesotho and Swaziland.
Research in Haiti has also shown that it is possible to give anti-retroviral therapy at a low cost and with a high success rate among very poor people.