Aids treatment needs to expand dramatically

13 June 2006

Aids-treatment programmes need to expand dramatically in Africa, an expert said on Tuesday, suggesting nurses do some of the work of doctors and more people be trained as counsellors in order to meet the enormous need.

"We need to expand four- or fivefold from where we are now to reach all those who need antiretroviral treatment. But it will take years to train enough doctors and nurses to manage this," said Dr Mark Dybul, the United States State Department's deputy global Aids coordinator.

Dybul, who was in South Africa to attend an international meeting on the US President's Emergency Plan for Aids Relief (Pepfar), said nurses and other health workers could monitor patients instead of doctors, while people other than nurses could do HIV/Aids counselling and testing. In South Africa, only a registered nurse can conduct a test for HIV, the virus that causes Aids.

In Uganda, "clinical officers", who are neither nurses nor doctors, have been trained to monitor patients on antiretroviral therapy.

South Africa, which has won international praise for its HIV/Aids prevention efforts, refused for years to provide life-prolonging HIV/Aids treatment through its national health system, questioning the safety and cost of the medicines. It has now promised to provide free treatment to all who need it, but continues to draw criticism for delays in rolling out the programme.

Pepfar is a $15-billion, five-year initiative started by US President George Bush in 2003 to fight HIV/Aids. By the end of this year, it will have disbursed over $450-million alone in South Africa, among the countries hardest hit by HIV/Aids.

Dybul said that although Pepfar was a five-year programme due to end in 2008, it had the support of both Republicans and Democrats and "there is no question in anyone's mind that the US will continue to support the fight against Aids."

About 1 200 delegates from around the world, including the US government's implementing partners and other HIV/Aids programme representatives, are meeting for four days in the eastern coastal city of Durban to discuss successes and challenges in confronting a pandemic that has killed an estimated 25-million people.

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