ARV compliance--the new battle terrain.

Key players in the drugs war between public and private medicine are taking to the HIV/AIDS trenches as the antiretroviral drugs battlefield shifts from accessibility to compliance. This comes after the government successfully countered, with costs, the high-stakes combined legal bid by the National Convention on Dispensing and the Affordable Medicines Trust to declare invalid the new law stripping doctors of dispensing powers. Doctors now have to write and pass the new Pharmaceutical Council exam before dispensing drugs. A separate challenge to the single-exit price and maximum dispensing fee regulations was in process at the time of writing while the State roll-out of ARVs is irretrievably underway in eight of nine provinces. These developments coincide with a dramatic price drop in life-prolonging HIV/AIDS medicines. The State view of the private sector being more interested in their pockets than the patient again emerged, with at least one top drug official implying that cavalier prescribing and poor monitoring of therapy by some private doctors was contributing to drug resistance. South African Medical Association (SAMA) Chairperson, Dr Kgosi Letlape's rebuttal was that the private sector was providing and sourcing ARV drugs long before the State. Clinicians had gone to 'tremendous lengths' to make sure patients had ongoing supplies of difficult-to-get ARV drugs. Sweeping statements now by officials who had very little to do with the battle against HIV and AIDS were 'short-sighted and unfortunate'. 'I'm not saying there aren't problems on the ground, but this kind of talk is destructive,' he added. Letlape said the court ruling on dispensing would have serious repercussions on the continuing private treatment of people living with AIDS and on medication for other chronic diseases. Many were cash-paying patients with no medical scheme cover and relied on the package deals that doctors offered. Others simply ran out of medical aid benefits, creating a compliance nightmare. SAMA hoped to meet with the Ministry of Health 'very soon' to ensure that patients were not adversely affected. Letlape called on doctors to record difficulties of drug access with a view to finding interim solutions. `We hope government will take responsibility for providing access to drugs for vulnerable communities. SAMA urges the profession to help find solutions to ensure continuity of therapy.' Another ARV compliance problem is the cross-border smuggling of cheap ARV drugs. Unchecked, this activity would aggravate what Chief Director of Pharmaceutical Services and Planning, Humphrey Zokufa, describes as a …