HIV drugs ‘best given to SA cities’

WASHINGTON – The most effective way to use AIDS drugs in South Africa would be to concentrate on cities, although this might also be the least ethical approach, an international team of researchers said on Monday.

A computer model suggested the most efficient strategy for the country’s plan to give triple-drug therapy to half a million people by 2008 would be to focus on cities. However that would mean neglecting sick people in the countryside and widening the health divide between urban and rural areas.The computer model tested three different approaches, using real data from South Africa’s KwaZulu-Natal region including one plan that concentrated on the region’s capital, Durban.”The Durban-only drug allocation strategy would prevent the greatest number of infections (an additional 15 000 infections by 2008),” the researchers wrote in a report published in the Proceedings of the National Academy of Sciences.Health facilities are concentrated in big cities, said Sally Blower, a professor at the Semel Institute for Neuroscience and Human Behaviour at the University of California Los Angeles, who led the study.”Some places are remote and fairly difficult to get to,” she said in a telephone interview.This would worsen already bad health inequalities between Durban and the countryside.”Thus the Durban-only strategy would be the least ethical,” the researchers wrote.The model found that treating only residents of Durban, and giving no drugs to people elsewhere in the province, would reduce the number of new infections by 46 per cent.Deaths from AIDS would fall by 42 per cent in Durban but by only 0,1 per cent in rural areas.If the drugs were shared equally between city and country, transmissions would fall by between 11 per cent and 28 per cent in Durban and by 17 per cent to 37 per cent in rural areas.AIDS-related deaths would fall by 26 per cent in Durban and 34 per cent in rural communities.The government started distributing triple-drug cocktails in 2004 but Blower said it had not yet thought through the epidemiological consequences.Nampa-ReutersHowever that would mean neglecting sick people in the countryside and widening the health divide between urban and rural areas.The computer model tested three different approaches, using real data from South Africa’s KwaZulu-Natal region including one plan that concentrated on the region’s capital, Durban.”The Durban-only drug allocation strategy would prevent the greatest number of infections (an additional 15 000 infections by 2008),” the researchers wrote in a report published in the Proceedings of the National Academy of Sciences.Health facilities are concentrated in big cities, said Sally Blower, a professor at the Semel Institute for Neuroscience and Human Behaviour at the University of California Los Angeles, who led the study.”Some places are remote and fairly difficult to get to,” she said in a telephone interview.This would worsen already bad health inequalities between Durban and the countryside.”Thus the Durban-only strategy would be the least ethical,” the researchers wrote.The model found that treating only residents of Durban, and giving no drugs to people elsewhere in the province, would reduce the number of new infections by 46 per cent.Deaths from AIDS would fall by 42 per cent in Durban but by only 0,1 per cent in rural areas.If the drugs were shared equally between city and country, transmissions would fall by between 11 per cent and 28 per cent in Durban and by 17 per cent to 37 per cent in rural areas.AIDS-related deaths would fall by 26 per cent in Durban and 34 per cent in rural communities.The government started distributing triple-drug cocktails in 2004 but Blower said it had not yet thought through the epidemiological consequences.Nampa-Reuters