Three-quarters of people on antiretroviral treatment at a clinic in Khayelitsha were also being treated for hypertension. Yet there is not enough information about how HIV and common NCDs such as hypertension and diabetes interact, or how medicines to treat them interact.
This is according to Dr Tolu Oni from the University of Cape Town, who is investigating the “collision” between HIV and NCDs.
“As people living with HIV are living longer, we are facing a new challenge. NCDs pose a new threat to people with HIV but there are many unanswered questions,” Oni told the international AIDS conference.
These questions include the extent of NCD co-infection, medicine interactions and how to co-diagnose and co-treat these.
Fattest nation
Aside from having the largest HIV population in the world, South Africa is the fattest nation on the continent.
Up to 70% of South African women and a third of men are overweight or obese, while a quarter of girls and one in five boys between the ages of 2 and 14 years are overweight or obese. Obesity is associated with type 2 diabetes, heart disease, stroke, hypertension, joint pain and certain cancers.
“Some NCDS are related to HIV infection itself and to the side effects of some of the medicines used to treat HIV infection,” according to UNAIDS. “Several of the opportunistic illnesses associated with HIV infection are NCDs in their own right, such as HIV-associated lymphoma and cervical cancer.”
Australian Professor Andrew Grulich reported that “the pattern of cancer and HIV is beginning to collide” as the population of people with HIV ages.
“There is an exponential increase in cancer as a person ages,” said Grulich.
A skin cancer called Kaposi’s Sarcoma was common in people with low immunity, but could be treated once a person was on ARVs. However, lymphoma was the most common cancer in people with HIV with mildly suppressed immunity, he said.
Californian epidemiologist Dr Melissa Frasco reported that two classes of ARVs were associated with an increase in diabetes, while “untreated HIV could lead to metabolic syndrome” (including obesity), which put patients at risk of heart attacks and strokes.
Supporting this, a Kenyan study has shown that HIV positive people who were not on treatment had significantly higher rates of hypertension than HIV negative people.
“Ageing with HIV is a huge issue in Europe, where people started ARV treatment earlier. Addressing this needs both a medical and psycho-social approach,” said Tamas Bereczky, who is both living with HIV and a researcher with the European AIDS Treatment Group. – Health-e News.
Numbers don’t lie, especially if you take a look at the place of NCDs in the draft health budget. The words about NCDs imply commitment to solving a huge health problem. That is superficial though when it comes to NCDs. There a heaps of great sounding words (policies and plans) but a clear lack of money. Especially for screening and treatment. Words, even printed ones, are cheap. Little has changed:
Whilst the Minister in the preamble of the Annual Performance Plan highlights importance of tackling non-communicable diseases (NCDs) there doesn’t appear to be any dramatic shift in budget allocation over the Medium Term. Can the department provide reasons for this?
Issues for consideration Parliament Research Unit. Vote15: Health Budget 2014/15 p.6
Health is allocated less than 5% of the proposed national budget (Figure 1). Defense get more yet SA loses more people to NCDs each day than in armed conflicts. Where are our national priorities?
Figure 1:
Looking at the details of the health budget
The smallest by far is Programme 4 for Primary Health Care (PHC) services (R 225 -million)
Most People Living With NCDs get care at primary health care (PHC) clinics and this appears to be the reasoning why NCDs are placed within Prog 4 . People living with HIV/AIDS
Our information comes from the draft Annual Performance Plan (APP) and its accompanying budget. – see pages 61-63. Click here to download the draft APP 2015/2016-2017/8
Fast facts stacking up Programme 4 vs other NDoH Programmes 2015/16
Smallest programme
budget by far |
See Figure 2 |
| 1st place people costs |
Programme 4 cost of PEOPLE EMPLOYED R186.2 million = ↓ money available for implementation |
2nd largest # people
employed |
458 by only 10 people short of no 1 placed Programme 1 (p. 27) |
| Only programme to increase personnel costs |
Leaving less to spend on implementing programmes/ plans |
3 NCDs issues related to HIV/AIDS and Maternal Child health appear in Prog 3 budget (cancer cervix, breast cancer policy, immunizations.) Cancer of the prostate does not warrant a mention in the APP.
The key to the APP is words not allocation of funds. Again NCDs screening and treatment is left high and dry.
Fast facts about NCDs Prog 4 budget
Where is the money for implementation of the NCDs plan in this budget?
| 89.37% for people working on projects – personnel, contractors and consultants |
0 for screening of target of 8 million people for high BP and blood glucose OR
NCDs Commission/ Health Commission (more next week on this) |
1.3 % NGOs or non-profits (< R 3-million) > 50% goes to 2 of 6 NGOs
National Council Against Smoking & SA National Council for the Blind. |
NCDs prevention and treatment cross cuts all Programmes especially at the PHC level. So we need to look at inside other programmes. However, without exception there is no separate financial allocation for stated NCDs targets like for example breast cancer policy development and cancer of the cervix screening in Programme 3 (HIV/AIDS & TB.) Innovations like “ideal clinics” which are supposed to include NCDs take place without consulting NCDs civil society organisations.
Examples from Programme 2: NHI
- Drug procurement and stock out management (all drugs including ARVs)
- National Cancer Registry (words no money)
Programme 3: HIV/AIDS & TB
- Cervical cancer screening
- Breast cancer policy (more words no money)
- Vaccinations against hepatitis & human papilloma virus
- Obesity policy (more words no money)
Watchdogs must bark. An NCDs advocacy series. This is the first in a series on NCDs in policy documents.
A quick review of where issues related to NCDs may be found in the National Department of Health’s (NDoH’s) strategic plan 2014/15- 2018/19.