When I was in South Africa in 2005, there was one policy that always had me completely befuddled – one that was aimed at supporting people with poor health, but may have been inadvertantly encouraged them to stay sick.
That policy is as follows: when someone’s CD4 count drops below 200 (at which point they are considered to have full blown AIDS), they qualify for disability grants. When/if their CD4 rises above 200, their grant is revoked.
In this policy, there is clearly huge potential for misuse: people deliberately keeping their CD4 count low so that they do not lose their grant. Anecdotally, this was happening on a sizable scale. People would quit taking their anti-retroviral drugs in order to keep their CD4 count low, obviously endangering their lives in the process.
One day while at the Hillcrest AIDS Centre in South Africa, I accompanied a patient to the nearby TB clinic, to retrieve their sputum samples. Upon arrival, we were told that the sputum samples were not available – when we probed further, we found out that they had been stolen! Someone had broken into the laboratory fridge, and took all of the sputum samples! Why would someone do this, I ask Cwengi, the Hillcrest nurse? Because, amazingly, samples of sputum that test possible for mycobacterium tuberculosis qualified the producer of said sputum for a grant, and as such, were a hot commodity on the black market. In addition, people would often sell or steal “hot” blood samples of HIV+ blood that showed a CD4 below 200. Amazing, hey?
A disability grant is typically R400 a month – the equivalent of about $70. In many cases, this is the only income available to an entire family. Thank goodness for income-generation projects like that of the Little Travellers!
Here is an exerpt from an article on this matter from the Sunday Times.
Dying for a grant
Gabisile Ndebele
Government is paying disability grants to people living with Aids, but it’s difficult to get
A disability grant was approved for people living with Aids in 2002, but there are still many people who are not getting access to it. One person like this is Moepone Shakwane, from Hillbrow. She discovered she was HIV positive late in 2003 and has been applying for a grant since October 2004, but she has still not received it.
She is just one of many struggling with the policies being applied to the grant.
Marine McCalla-Kay, the executive director of the Aids Consortium, says there is another problem too: “Social grants and affordable healthcare are a constitutional right, but with the way grants and Aids treatment policy is being interpreted at present, a person receiving a disability grant because of Aids loses that once they start treatment and their CD4 count (the body’s capacity to fight infections) rises above 200”.
People can get anti-retroviral treatment from government hospitals once their CD4 count drops to 200 or below. Usually within a few weeks of starting the ARVs their immune system improves and their CD4 count rises to above 200.
The Social Services Department then tells those people that they no longer qualify for the disability grant.
“Some people would also rather die of Aids than lose the disability grants they were able to access in the first instance because of the disabling effects of full-blown Aids,” says McCalla-Kay. So they stop ARV treatment.
McCalla-Kay says Minister Zola Skweyiya says he is going to be addressing this problem.
The Aids Consortium is also calling on the government to include transport costs to enable people to access treatment sites “at least until their CD4 count exceeds 500”.
In a report in August 2005 the Aids Consortium highlighted some of the challenges facing people living with Aids regarding disability grants. It said the government, by using the CD4 200 count to decide on grants, was being prejudicial to people who may still be sick even though their CD4 count is more than 200. It also noted that it was taking so long to process applications for grants that by the time approval came through the recipient may have died.
