Like the South African government, the medical scheme industry does not have a proud record of being proactive in addressing the costs of HIV/AIDS. Prior to the Medical Schemes Act of 1998, which came into effect in 2000, schemes were trying to avoid paying for this very costly disease.
Advertisement
They used two key mechanisms to contain the costs of treatment for HIV-positive members. The first was “underwriting” [link to Dictionary] which meant that schemes could assess a patient’s risk prior to admission. They could send a patient for a medical check-up or HIV test before admission to the scheme, and then refuse membership on the grounds of perceived risk. They could also adjust the patient’s contributions according to his/her risk profile.
The second mechanism was “exclusion” (Dictionary of terms). If a scheme could not get rid of an HIV-positive patient by it’s underwriting methods, it could set very low limits on the patient’s benefits.
When the government implemented the Medical Schemes Act in 2000, most medical schemes put up a fight but eventually surrendered. It became clear to schemes that they can minimise HIV-related costs by keeping patients out of hospital for as long as possible through the use of medication which can keep full-blown AIDS at bay or up to 15 years. But still some smaller schemes did not provide any cover at all for its HIV-positive members.
Then, in January 2005, all medical schemes were forced to provide benefits for members who have HIV/AIDS, according to an amendment made to the Medical Schemes Act of 1998. This meant that HIV/AIDS became a Prescribed Minimum Benefit.
Today, all medical schemes are legally obligated to provide some benefits for members who are HIV-positive, but they can still determine the extent of the cover and the medicine they will cover. Schemes may also require members to register on a HIV/AIDS programme in an effort to manage the disease. According to the new amendment, all HIV-patients who belong to a medical scheme have the right to:
counselling and testing
co-trimoxazole [link to Dictionary] as preventative treatment
screening and preventative treatment for TB (Tuberculosis)
diagnosis and treatment of sexually transmitted infections
pain management in palliative care
treatment of opportunistic infections
prevention of mother-to-child transmission of HIV
post-exposure prophylaxis following occupational exposure or sexual assault
and medical management and medication, including the provision of anti-retroviral therapy as well as ongoing monitoring for medicine effectiveness and safety to the extent provided for in the national guidelines applicable in the public sector.
The HIV/Aids epidemic is still a highly debated issue in South Africa, who’s got the sixth highest prevalence of HIV in the world (5,5 million or 18,8% of the population is estimated to be infected). The country is regarded as having the most severe HIV epidemic in the world. With hundreds of new infections daily, both the public and private sectors are finding it increasingly difficult to handle the serious impact of the virus.
In 1987 the apartheid government recognised that HIV/AIDS had the potential to become ‘a major problem’. Chris Hani, speaking from exile, also warned that however at the beginning of the AIDS epidemic, unattended AIDS could result in untold damage and suffering by the end of the century.
Nobody paid attention to this warning – neither the outgoing regime in the early 1990’s, nor the incoming democratic government. A National AIDS Convention of South Africa (NACOSA) was established in 1992 and the new ANC government accepted its strategy for fighting AIDS in 1994. But from the beginning, the HIV/AIDS issue was clouded in controversy, over issues such as:
the allocation of R14.3 million to a play about HIV/AIDS
the refusal of the government to make HIV/AIDS the responsibility of the President’s Office
government support for a so-called AIDS treatment that turned out to contain an industrial solvent
government’s refusal to provide the drug AZT to prevent mother to child transmission of HIV.
In 1998, then Deputy President Thabo Mbeki launched a Partnership Against AIDS to mobilise South Africans to fight the disease. But soon after, activists frustrated by the failure of the government to respond effectively to the increasing death toll from HIV/AIDS, formed the Treatment Action Campaign (TAC).
The TAC demanded access to treatment (including ARV’s or anti-retrovirals) for all who needed it. The government responded by opposing the use of AZT (the most effective ARV) [Link to Dictionary], as a ‘danger to health’. The Department of Health began to consult with AIDS rebels (people who rejected the orthodox HIV/AIDS science) and Thabo Mbeki questioned the link between HIV and AIDS, declaring that ‘a virus cannot cause a syndrome’ (Parliament, September 2000).
In 2001, President Mbeki also questioned the statistics on HIV infection and AIDS-related mortality, and again said that racist perceptions are the driving notions about the AIDS epidemic. He attacked the TAC, its supporters and opposition politicians who were demanding that the government provide ARV treatment. The TAC had to take government to court to force the Minister of Health to implement a mother to child transmission prevention programme.
It was only in April 2002 that Cabinet agreed that ARV’s should be made available to all rape survivors as post-exposure prophylaxis, and that government should consider introducing ARV’s into public health. On 19 November 2003, Cabinet announced the rollout of a comprehensive AIDS treatment plan that would offer free ARV’s.
In the mean time, Health Minister Tshabalala-Msimang continued to advocate a diet of beetroot, olive oil, African potato and garlic for people with HIV. President Mbeki told the Washington Post that he didn’t know anybody who has died of AIDS.
Despite all these setbacks, the rollout of ARV’s is gathering momentum and the Treasury has dramatically increased the budget allocation to the treatment plan and other HIV/AIDS initiatives.
The South African government continues to invest in prevention efforts and promotes good nutrition as well as traditional medicine. At the same time, there is a range of social benefits available to people living with HIV/AIDS and impoverished households.
Bookmark with:
What are social bookmarks?