Programme Supplement [International Conference on AIDS (16th: 2006: Toronto, Canada)]

ErIIIII

Late Breaker Abstracts

Results:

HIV/AIDS HIV/AIDS
HI/IS share
expenditu- share
Year res, milli- n.total...... D healthcare
ons USO..
S pppS expenditures
2003 294.1 1.57%
2004 417.2 1.89%

HIV/AIDS
spending
per
PLWHA,
USD PPP

HIV/AIDS Financing Sources:
Public House- Non- Dnor
holds profit

1,296 17.4% 66.3% 1.9% 14.3%
1,672 13.5% 56.5% 6.8% 23.1%

Households are main HIV/AIDS financiers. Household expenditures
occur out-of-pocket and are not mobilized in pre-paid risk pools,
thus creating financial barriers to access. Moreover, PLWHA spent
5.43 times more on curative care than general population. There
is significant and growing dependence on external finances with
k expectations for future public replacement. While all HIV/AIDS
S spending rose in absolute terms, increased donor financing caused
relative decreases in household and public shares. Donor funds
function independently from public financing. Spending on ART
increased from 3.8% to 7.5% out of total HIV/AIDS expenditures.
*"b#~ Compared to countries with similar epidemics Ulgaine devotes a
> smaller share for preventive/collective services.
Conclusions: Government should increase public spending
Swith major focus on targeted prevention to provide equitable
access to HIV-related care and prevent epidemic generalization.
Adequate allocations are necessary to support the strategy of
universal access to ART. More donor funds should be channelled
Late Breaker through public financing agents ensuring on-going HIV programs'
Abstracts sustainability.
THLBO403
South Africa's 'rollout' of highly active antiretroviral
therapy: a critical assessment
N. Nattrass. University of Cape Town, School of Economics (and
AIDS and Society Research Unit), Cape Town, South Africa
Issues: This paper provides a critical overview of South Africa's
'rollout' of highly active antiretroviral therapy (HAART). The
Health Minister claims that South Africa's performance has been
relatively good and that the rollout is almost entirely domestically
funded. This paper shows that South Africa's performance has
been comparatively poor, that the recent growth in HAART
n coverage has been strongly underpinned by foreign donors, and
that if the Health Minister had mobilised the resources allocated
to her by the Treasury, another 300,000 people would be on
treatment. Political will and ministerial intransigence remains a
key obstacle to improving HAART coverage in South Africa.
Description: The number of people on HAART in South Africa
has risen dramatically from less than 2,000 in October 2003, to
almost 200,000 by the end of 2005. Yet South Africa's HAART
coverage is poor both in comparison with other countries and
the targets set by the government's own Operational Plan. This
paper shows that the public sector HAART rollout has been
uneven across South Africa's nine provinces and that the role
of external assistance from NGOs and international funding
agencies has been substantial. The National Treasury allocated
sufficient funding to the Department of Health for a larger HAART
rollout, but the Health Minister has not spent it accordingly (with
the result that 300,000 fewer people are now on treatment
than originally envisaged in 2003). Failure to invest sufficiently
in human resources - especially nurses - is likely to constrain
the future rollout, thereby compromising the health and lives of
thoUnited Statesnds of South Africans.
Lessons learned: Fiscal and human resources are important
factors driving HAART coverage. However, in South Africa's case,
failure of national leadership remains a key constraint.
Recommendations: Constant monitoring of HAART coverage
is required - as well as ongoing pressure from civil society
organisations.

THLBO404
Explaining the global inequity in human resources for HIV/
AIDS: international migration, market and government
failure
S.K. Nayak, Human Resources for Health &HIV/AIDS, Health System
Strengthening, Application of Economic Theory, International
Cooperation and Globalisation. University of Birmingham (IASS),
UK and Interact Worldwide, Nysasdri, Orissa, India
Issues: The human resources for health and HIV/AIDS in the
public and NGO sectors in low-income countries have reached
a point of severe crisis and inability to provide basic health
services (WHR2006 and GHW/GHA2005). One of the major
factors contributing to this crisis is emigration of skilled health
professionals.
Description: Research on the extent of emigration confirms that
it's a major phenomenon, e.g., from Ghana, 50% and 75% of each
batch of graduates emigrate in 4.5 and 9.5 years, respectively. UNILO calculated that two thirds of Sudan's professionals had left the
country and more than half of Zimbabwe, Zambia and Uganda's
high level manpower did the same. In India, it is estimated that
40% of the doctors who work in the private sector migrate outside
the country.
Lessons learned: The present paper applies theories of market
failure, externalities, asymmetric information and global public
goods to the consequences of emigration of health professionals
in the South. Research shows that international migration leads
to internal migration: from rural to urban, public to private and
from primary to specialist care. Inequitable distribution of human
resources leads to inequity in access, utilisation and quality of
health care services. This results in unequal impact on health
outcomes and health status especially of the poor.
Recommendations: Unfortunately, human resource for health
is so far absent from global HIV/AIDS research agenda. The
persistence of the problem reflects the ineffectiveness of the
policies so far implemented to reduce it. Remittances do not
help health development because cost of training from public
purse goes to private households or investments, or conspicuous
consumption. Relevant international membership organisations,
such as WHO, ILO, IOM, UNICEF, UNFPA and WTO, provide a forum
for the potentially equitable and optimal information, negotiation
and determination of global public goods for health that potentially
affect the entire constituency of member states.
THLBO405
STIs And HIV/AIDS knowledge among vulnerable groups in
an oil and gas producing community in Nigeria's Niger Delta
- baseline findings
B. Fakunle', Y. Mosurol, O.A. Fajola2, Z. Akinyemi', O. Ladipo'. 'Shell
Petroleum Development Company, Shell Health Services,
Portharcourt, Nigeria, 2Shell Petroleum Development Company,
Department of Comunity Health, Portharcourt, Nigeria, 3SFH,
Society For Family Health, Abuja, Nigeria
Background: The new gas powered plant built by Shell (Nigeria)
in Afam, has led to an inflow of settlers into the community. The
inevitable interaction between the community, settlers and highlypaid oil workers often lead to sexual networking which may have
implications on the transmission of STIs and HIV/AIDS. Objectives
are to determine knowledge and health seeking behavior
concerning STIs/HIV/AIDS in the community, as a prelude to a
Shell initiated intervention and HIV/AIDS comprehensive care and
treatment programme.
Methods: Using multi stage stratified sampling, 2,113 males
(15-64 years) and females (15-49 years) were interviewed using
quantitative and qualitative methods.
Results: 60.2% of respondents had at least secondary education.
28% were self employed (hawkers, pettytraders), 3.5% housewives,
and 8.7% farmers /fishermen. More females (55%) compared to
males (45%) knew at least 3 symptoms of STIs in women and
men. Itching was the most commonly cited symptom in women
(26%) compared to dysuria in men (51.4%). 11.4% reportedd

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * PROGRAMME SUPPLEMENT