09/06/2010versione stampabileprintinvia paginasend

Thousands are going to South Africa in search of life-saving remedies not available in their own country, creating a highly dangerous short circuit

They move by night, under cover of darkness. Hundreds of desperate people crowding into the towns of Ndolwane and Plumtree in Matabeleland South, whose vast agricultural plains merge confusedly with the borders of Zimbabwe, South Africa and Botsawana.

The journey of desperation. They are AIDS sufferers that cannot be cured in their own country. Mainly children. The official figures say that in Zimbabwe alone there are over 160 thousand of them. Antiretroviral therapy (ART) would be free for them, but the government does not have the resources to treat them all. The statistics say that only one in sixteen has access to the therapy. For the other 15 the choice is between paying, dying in silence or escaping. And that's what many of them do.
Everything is done by word of mouth. The word spreads from village to village, thanks also to the economic support of the religious organisations and churches that finance the journey of hope. But crossing the borders illegally would be impossible without a network of operators who, over the years, have become specialists in shuttling desperate people back and forth between Zimbabwe, South Africa and Botsawana. They started by transporting men looking for work and now they take ill children. The children's parents are in search of the South African miracle, in a country that made it after the risk of being overwhelmed by AIDS.

The miracle that no longer happens. What they do not know is that miracles sometimes have a time limit and that their powerful neighbour is yet again grappling with the illness. In South Africa, a million people are being treated with antiretroviral therapy but the authorities are expecting this number to triple over the next 10 years. And this is a problem. Government figures and tables state clearly that South Africa risks not achieving its target of providing treatment to 80 percent of sufferers. Antiretroviral therapies do not lose their effectiveness but the patient has to keep taking them for the rest of his or her life. Hence, the costs are destined to increase exponentially. On the other hand, the flow of money from international donors is getting smaller every year. The alarm was raised officially at the Vienna conference in July. 7.7 billion dollars were collected for the struggle against AIDS in 2008, but this fell to 7.6 billion in 2009. Resources are decreasing just when South Africa needs an extra 272 million dollars a year in funds.

The money is going down but the number of sufferers is going up, also because the World Health Organisation has reviewed the parameters for admitting patients to ART. The CD4 reference value, based on an analysis that counts the number of healthy cells capable of combatting the infection, has changed from 200 to 350. Up to a short time ago antiretroviral therapy could not be requested with a cell count of 300. Now it can.

The emergency in figures. The peak will be in 2021, when South Africa alone will need four billion dollars. This year the government has allocated just over 600 million dollars, to which a further 500 million dollars has been added by the US PEPFAR (President's Emergency Plan for AIDS relief – editor's note), an increase of 120 million on the previous year. And this is despite the fact that the US relief programme is being cut down . The prospect PEPFAR being subject to review is nothing new. The problem is that this is happening just when international donors, under pressure from the crisis, are turning off the taps, while countries like South Africa need more resources. The World Bank has no fund allocation for ART, only for medical technology. The Global Fund allocation – originating partly from UNITAID, which is now being dismantled – has been sharply reduced. As from 2012 the flow of money into the Democratic Republic of Congo, Malawi, Mozambique and Zimbabwe will dry up once and for all.

South Africa is in the throes of what is soon to become an emergency: in Free State, a province with one of the highest AIDS and HIV rates, antiretroviral treatment has been suspended because of budget overspending. Because of this, the government is seeking to reduce costs. One of the prime targets in this is Aspen Pharma, the pharmaceutical giant that won the contract and is supplying Pretoria with drugs that cost 20 percent more than the cheapest available on the market. Its contract ended in May of this year, and although no tender has yet been proclaimed, it is known that Pretoria is looking for more economical alternatives.

Alberto Tundo