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Antiretroviral treatment in the Western Cape:
A success story facilitated by the Global Fund

CSSR Working Paper No. 161

Trude Holm Naimak

Centre for Social Science Research (CSSR)
University of Cape Town

August 2006

SARPN acknowledges UCT's Centre for Social Science Research as a source of this document:
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Access to performance-based funding from the Global Fund to fight AIDS, Tuberculosis and Malaria, has enabled the Western Cape Province to race ahead with its antiretroviral (ARV) rollout. As of 2005, The Global Fund’s contribution helped enable the province to provide antiretroviral treatment to 65% of those people who desperately need it (a figure in stark contrast to the then South African national average of 10%). This paper illustrates how the Global Fund grant, in its first year, clearly met and in some cases, exceeded its targets particularly in relation to ARV treatment. Based on the research carried out as part of the preparation for this paper, it becomes clear that the Western Cape’s progressive and committed management team was a key contributing factor in successfully providing increased access to medical treatment. Other factors that have contributed to the success of the grant project include: the fact that in 1999, the province first initiated provision of ARV drugs to help prevent HIV-positive women transmitting the infection to their infants; and the experiences gained from both the introduction of treatment drugs and from the three-year ARV rollout projects in Khayelitsha and Gugulethu. This paper discusses the factors that have contributed to the success of the Western Cape ARV treatment programme and how, through funding from the Global Fund grant and other national funds, a foundation has been created for a successful programme.


More than 40 million people worldwide are HIV-positive and since AIDS was first discovered, more than 25 million people have died as a result of the disease. Antiretroviral treatment is widely available in developed countries, while access to antiretrovirals (ARVs) in poorer countries has been historically inadequate. The World Health Organisation estimated in 2005 that out of the 6 million people needing life saving medication, only 1 million people are receiving the drugs (WHO, 2005).

This access to life prolonging ARV treatment has caused much controversy in South Africa. With more than 5.2 million South Africans affected with HIV/AIDS, South Africa is the country with the highest number of people infected in the world, and AIDS is the country’s number one killer (Dorrington et al, 2001). The arrival of highly active antiretroviral treatment (HAART) has given hope to millions of people living with HIV/AIDS, however access and commitment from the South African government to provide the life saving drugs has been limited.

The Provincial Department of Health in the Western Cape was the first to start providing HAART in South Africa. As funds for HAART in South Africa were limited, the department applied for external funding from the Global Fund to fight AIDS, Tuberculosis and Malaria in 2003. The proposal was successful, allowing the Western Cape to scale up its HAART programme. This has resulted in the Western Cape rollout being hailed as the ARV success story of the country, with more than 11 000 people living with HIV/AIDS receiving ARV treatment in July 2005, a quarter of whom are funded by the Global Fund.1 It was further estimated that, at the end of 2005, 65% of those in need of ARV treatment in Western Cape would have access to the lifesaving drugs, a figure considerably higher than the South African national average of 10% (Herman, 2006).

This paper explores and demonstrates the success of the HAART rollout in the Western Cape supported and enabled by the Global Fund.

  1. Keith Cloete, 30 Aug 2005, pers. comm.

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