Question: I have heard that government will be providing HIV positive people with antiretrovirals (ARV's) in the near future. I would like to know about how the ARV programme will work so that I can also get these drugs.

Answer: You are right in saying that ARV's will be publicly available, however not all HIV positive people will need to be on ARV treatment. ARV therapy helps people living with HIV to live a longer and healthier life by lowering the amount of virus in the body (viral load) thereby enabling the immune system to get strong again. In South Africa about 5 million people have already been infected with the HI virus (1 in every 9 people) but only about 500 000 people need to take ARV's because the rest are still healthy. The only time HIV positive people will need to go onto ARV's is if they have a CD4 count below 200 (CD4 count is the test that shows how strong the immune system is) or an AIDS defining illness (e.g. extreme weight loss, meningitis, pneumonia, dementia, extrapulmony TB, cancers, fungal and parasitic infections). Therefore you would need to have met one of these two criteria before you would qualify for ARV therapy.

The Western Cape planned to have 19 sites for the ARV roll out by April 2004 and a further 14 sites starting later in the year, which gives a total of 33 sites where one could become part of the ARV programme.

The ARV programme will work as follows:
Clients will be referred to the programme when their CD4 counts are below 200 or if they are diagnosed with an AIDS defining illness. Further criteria to be met include:

The client must be committed to taking ARV triple therapy (combination of 3 drugs taken) for life.

Disclosing to someone who will be a treatment "buddy' or assistant for the client to ensure adherence. This is important, as having to take many drugs at the same time of day, every day of for the rest of your life is not easy to accomplish without help. The client needs to be adherent to ensure that they have enough of the drug in their body to make sure they do not become drug resistant.

Making sure that the client does not abuse substances, especially alcohol. The reason for this is to ensure that the person does not suffer from liver toxicity. In addition to which it will be very difficult to be compliant to treatment when under the influence of a substance. The client is also encouraged to follow a healthy lifestyle and is made aware of the dangers of drug interactions.

ensuring that the person will be able to attend 3 information sessions and 2 individual counselling sessions. This process will take about 6 to 8 weeks to complete. The purpose of this will be to educate the client on various things including, information on what ARVs are, how they work, the side effects, the importance of adherence and drug resistance. The counsellors would also need to do a social and psychological assessment of the client in order for the medical team to decide if the client will qualify for ARV treatment. If the client does qualify then ongoing counselling and clinic visits will be needed. If the client does not yet qualify then the cousellor and the client will work together on the problem so that the client will be able to qualify.

The client has to agree to take responsibility for their own health and treatment. This means taking ownership around pill taking, attending all sessions and ensuring that they comply with the conditions of the programme.

In conclusion, HIV positive people will be able to receive free ARV therapy when their immune system is weak and needs to be strengthened (CD4 below 200) and when they have been able to show that they are ready for a life-long commitment to the therapy. Therefore you will need to go to your nearest clinic to be assessed as to whether you qualify for the programme.