Health experts in South Africa say many HIV-positive people in the country could get very sick and even die as a result of the strike by 500,000 to one million public service workers, including state nurses and pharmacists. The workers are demanding higher wages and improved benefits.
The protest action has shut down government clinics and hospitals, which usually dispense life-prolonging antiretroviral drugs (ARVs) to more than a million HIV-infected South Africans.
A spokesman for South Africa’s national health department, Fidel Hadebe, acknowledged the “gravity” of the situation but added that there is “little” it can do in the face of “massive” staff shortages.
A fieldworker for South Africa’s Treatment Action Campaign (TAC) health activist group in the Free State, Sello Mokaliphi, said some people have already died in the province because they weren’t able to access ARVs.
“Unfortunately, if you do not belong (to) a medical aid or you can access (medicine) in a private health care facility, the reality for many people now is they will go without the treatment,” said TAC chairperson Nonkosi Khumalo.
Francois Venter, the president of the South African HIV Clinicians Society, said those “most in danger” are HIV-positive people with serious tuberculosis (TB) or very low CD4 (immune cell) counts, who need to start ARV therapy “immediately,” A delay of only a few days in giving them medicine means “they could die,” he said.
A CD4 count is a measure of the strength or weakness of a person’s immune system.
Venter said, “Pregnant women who need ARVs to prevent HIV from being passed on to their babies are also at serious risk. If these mothers can’t access the drugs, their children could get HIV.”
Ill patients face ‘lock outs’
In the Free State capital of Bloemfontein, David Mokoen, who’s infected with HIV, is a “worried” man. I don’t have drugs, I don’t have drugs…. Many of us here on ARVs will die in the future,” he said. “Government nurses have been chasing me away from the clinics since last week. When they see us waiting outside, they just lock the doors,” Mokoena said.
Khumalo added that this scenario is being repeated “across South Africa” and is set to get “much worse” as the strike intensified this week, as analysts expect it to.
Another particularly badly hit province is Gauteng, where HIV-positive Fundiswa Pasmeni usually received ARV drugs from state nurses at a clinic in Daveyton in East Rand district. She spoke with VOA by cell phone while traveling many miles away from her home in a minibus taxi, desperately trying to find a clinic that would provide ARVs.
“We waited at the (Daveyton) clinic from quarter to five in the morning, until past 11. Then some nurses came out and shouted at us, ‘Go home!’ Then they just went back inside the clinic and closed the doors. They said we can’t get the tablets; there’s nobody there to give us tablets,” Pasmeni said.
She added that she was beginning to feel extremely ill, with a bad headache and pains across her chest, because she hadn’t taken her ARVs “for days now…. I haven’t got anyone to help me. I don’t know what will happen to me,” she said, weeping.
Potentially fatal drug interruptions
HIV/AIDS experts say interrupting ARV treatment is very dangerous. In order for the medicine to work effectively, it has to be taken consistently. Mokaliphi said, “When treatment’s interrupted, patients will probably develop resistance to the drugs. The medicine will stop working properly which means they’ll get very sick and will eventually die.”
TAC said that because of the ARV interruptions caused by the strike, the resulting drug resistant patients will in the near future have to be placed on “completely new” drug regimens if their lives are to be saved.
Mokaliphi stated, “This would be at great cost to the government and the South African taxpayer, not to mention being a further burden on the health system, which is already stressed and may not be able to handle further complicated ARV procedures.”
Khumalo agreed, saying, “That new regime would be very expensive for government to treat. So my advice to the state now is to rather satisfy the strikers’ demands than deal with the costs of more expensive HIV treatment.”
Mokaliphi said those most at risk at the moment are HIV-infected people who are on the last regimen of ARV drugs currently available in South Africa. If they develop resistance to this regimen, he emphasized, their lives will be in “bitter danger.”
“When they default on this (present regimen), there is nothing that can be done. So it means they are going to lose their lives because there is nothing that they can use to suppress the virus,” Mokaliphi said.
‘Government to blame’
He expressed sadness over the strike and its consequences for all South Africans. But he blamed the government, and not the trade unions, for the situation. Mokaliphi added that while the state “haggled with the unions over peanuts” many South Africans, including those who weren’t infected with HIV, were dying for lack of health care.
“We are talking about people who are diabetic here; we are talking about people who are defaulting TB treatment,” Mokaliphi said. “What about those with pulmonary TB, what’s going to happen to them? When the strike goes on and on and it gets worse, that means people going on and on to die as they are dying right now.”
Mokoena also appealed to the government to “respond (positively) to the demands of the public servants.” He remains convinced that this is “the only way” to save lives, so that nurses can return “immediately” to their posts and begin dispensing ARVs.
But Pasmeni said “no matter” whether the nurses had legitimate grievances or not, it is “inexcusable” for these “essential” workers to abandon their posts.
“People who are working with (other) people’s lives, they must think about that; they must think about it. It’s really bad. People are dying out there,” Pasmeni said.