How equitable is the scaling up of HIV service provision in South Africa?
OBJECTIVE
To assess the extent of inequalities in availability and utilisation of HIV services across South Africa.


METHODS
Cross-sectional descriptive study.


METHODS
Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled.


METHODS
Availability and utilisation of HIV services and management and support structures for programmes were assessed through the collection of secondary data supplemented by site visits.


RESULTS
There were marked inequalities in service delivery between the three sites. Compared with two poorer sites, clinics at the urban site had greater availability of HIV services, including voluntary counselling and testing (100% v. 52% and 24% respectively), better uptake of this service (59 v. 9 and 5.5 clients per 1000 adults respectively) and greater distribution of condoms (15.6 v. 8.2 condoms per adult male per year). Extra counsellors had also been employed at the urban site in contrast to the other 2 sites. The urban site also had far more intensive management support and monitoring, with 1 manager per 12 health facilities compared with 1 manager per more than 90 health facilities at the other 2 sites.


CONCLUSIONS
The process of scaling up of HIV services seems to be accentuating inequalities. The urban site in this study was better able to utilise the extra resources. In contrast, the poorer sites have thus far been unable to scale up the response to HIV even with the availability of extra resources. Unless policy makers pay more attention to equity, efficacious interventions may prove to be of limited effectiveness.
Scott
Vera E
VE
School of Public Health, University of the Western Cape.
Chopra
Mickey
M
Conrad
Liz
L
Ntuli
Antoinette
A
D000328:Adult; D017280:Condoms; D003376:Counseling; D003430:Cross-Sectional Studies; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy* / Q000635:transmission; D006297:Health Services Accessibility; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011203:Poverty; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D019037:Urban Health Services / Q000592:standards / Q000706:statistics & numerical data