Question:
There is considerable toing and froing over the issue of providinganti-retroviral treatments to those in need, and there is an article in theLeader Page of today's Daily Dispatch www.dispatch.co.za , written by PeterBarron which discusses what could be the most crucial issue in this context.

Essentially what he points out is that no matter what decisions are made,the current situation on the ground is such as to make any meaningfuldistribution impossible and that, at the end of the day, funds which shouldbe being used for essential primary care are going to be eaten into evenmore than they are presently being eaten into by wastage and inefficiency.His conclusion, based on an obvious and logical argument is that it isbetter to do nothing in this regard and rather to concentrate on getting theprimary healthcare system into some effective form.

Such an argument is not going to please the various action groups around thecountry, but it does make sense because the essential problem ofimplementing an effective system of anti-retroviral treatment is that theinfrastructure not only does not exist where it is most needed, but that,even where it does exist, in rudimentary form, it is in a state of collapse.The other factor which must be of basic importance is that of knowing whoare the people to whom the treatment should be administered. As things areright now certain victims of HIV/AIDS are identified but I believe that thenumbers currently not identified are considerably greater and how is one totreat them?

Answer: Compliance rates are low in California. They can be expected to be at leastas low, and, given the infrastructure differences, probably lower here.

Witch finding so as to mark those found with the tag 'racist' is, I know, avery popular South African sport these days, but it isn't going to altercompliance levels one iota however smugly satisfying it might be to thewitch finders themselves. The problem is that there really isn't the money available for aproper health care system for all our needs in South Africa. Markmentions the problems of infrastructure. He is not exaggeratingthem in the slightest. But the problem with ARV treatment vssymptomatic treatment is that ultimately ARV treatment is more costefficient. However one can anticipate a vast variety of problems.The situation is complex. We are agreed that health is one of the areas which is in urgentneed of resources. HIV can only be effectively treated within a holistichealth scenario, including nutrition.