Are we doing enough to eradicate HIV/Aids?

When it comes to HIV/Aids, negative developments such as policy and programme failures or increases in deaths and infections are quick to make the news headlines, usually with a liberal dose of sensationalism. However, slipping by almost unnoticed these past few months have been some remarkable successes notched up by the South African government in its HIV/Aids campaign.

While the Department of Health and other associated departments and organisations regularly issue statements on the progress made in their various campaigns and programmes, Deputy President Kgalema Motlanthe gave some valuable insights into the current HIV/Aids picture in South Africa when he addressed Parliament’s National Council of Provinces in August.

The statistics supplied by him were augmented by statistics released at more or less the same time by various provincial health departments and other entities as well as in the 2010/2011 annual report of the Presidency.

This positive news comes as South Africa’s current National Strategic Plan for HIV and Aids, STIs and TB is coming to an end, and as consultative discussions for the drafting of the next strategic plan for the period 2012–2016 have begun.

“The implementation of the various aspects of the National Strategic Plan (NSP) on HIV, Aids & TB (2007–2011), including the extension of the provision of antiretroviral therapy (ART), the HCT [HIV counselling and testing campaign] and the prevention of mother-to-child transmission (PMTCT) programme, have already resulted in a definable positive impact on the pandemic,” notes the Presidency in its annual report.

The worst battles are far from over, however. It is clear from the annual report that “despite significant strides, South Africa’s performance on health indicators remains inconsistent with the levels of investments made in the sector, necessitating urgent interventions to ensure effectiveness and efficiencies.”

Yet, given the fact that a relatively short few years ago South Africa’s approach to HIV/Aids still was wrapped firmly in denialism and an assortment of discredited alternative treatments at the highest government levels, the latest statistics reveal a noteworthy success story.

Central to this, over the past 18 months, has been South Africa’s massive HCT campaign – the biggest such campaign in the world to date – which resulted in some 15 million people being tested, of whom two million were found to be HIV-positive. Commenting on this, Motlanthe said the impact of the current interventions “will bear fruit over a period of time”.

Minister of Social Development Bathabile Dlamini has commended the gains made in South Africa’s HCT campaign, with some 13 million having been tested in public health facilities.

“The significant achievement this campaign has attained in one year is indicative that we are slowly restoring public confidence in public health,” she said, adding that this was the first time South Africa had created a “unified, coherent and effective” public awareness drive on HIV and Aids.

It seems that an almost complete turnaround from the previous (tragic) era of denialism is being achieved rapidly.

Motlanthe told the NCOP that the government had invested “a large amount of resources into its HIV response”, and that a number of HIV-combating programmes have started having an impact.

The number of deaths due to HIV-related causes “is beginning to show a decline due to the intensification of antiretroviral treatment,” he noted. Despite this, however, Motlanthe said the rate of new HIV infections continues to outpace prevention. Consequently, the government will prioritise prevention programmes in the new national strategic plan being drawn up for the period 2012–2016, he added.

There were now an estimated 5.38 million people with HIV in South Africa, translating to an HIV prevalence of 10.6% for the overall population, and 16.6% for the 15- to 29-year age group.

Apart from the infection/prevention ratio, the picture that Motlanthe presented looked good in all other areas.

Among pregnant women tested for HIV, the rate of infection has come down gradually to just below 30%. According to data from the Department of Health’s “National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa 2009” published in 2010, 29.4% of pregnant women (aged 15 to 49) were living with HIV in 2009. This estimate was based on a study sample of 32 861 women attending 1 447 antenatal clinics across all nine provinces.

Until 1998, South Africa had one of the fastest expanding HIV/Aids epidemics in the world but, since 2006, HIV prevalence among pregnant women has remained relatively stable, now having settled at just under 30%.

And the programme for PMTCT has yielded remarkable results, said Motlanthe, with transmission rates having declined from 10% to 3.5% over the past three years.

KwaZulu-Natal, once the worst HIV-inflicted province in South Africa, has reported a further infection rate decline – down to 2%.

The decline in this area over the past year, from around 8% to the current 3.5% level, translates to the lives of some 67 000 babies having been saved.

After years of government denialism, when alternative Aids activists seemed to have a hold over the government’s thinking, South Africa now has the world’s largest ART programme, with more than 1.5 million people currently receiving treatment. Access to ART has been extended to 427 995 additional people, including 380 835 new adult and 37 160 new child patients.

The results are showing as the number of deaths due to HIV-related causes is beginning to show a decline due to the intensification of ART, said Motlanthe.

Research by the Human Sciences Research Council had shown that young people increasingly are engaging in safer sex practices by using condoms, leading to a slight decrease in new infections among young people.

Following South Africa’s massive HIV/Aids counselling campaign launched last year, which saw some 15 million people tested for HIV and other chronic diseases, the deputy president expressed concern about the number of men who go for HIV testing.

Motlanthe told a South African National Aids Council (SANAC) plenary session held in Bloemfontein recently, that SANAC will embark on a targeted campaign to encourage more men – and people at a high risk of contracting HIV – to present themselves for counselling and testing. He added that there are still important sectors such as the religious and private sectors that need to demonstrate visible leadership in testing for HIV.

As part of the campaign to test more men, health workers will intensify visits to factories, farming areas, constructions sites, hostels, and various institutions of learning,

Minister of Health Aaron Motsoaledi told the same conference that the government had increased its capacity to take care of people living with HIV, and that SANAC has endorsed the National Health Council Policy to initiate treatment for all those who tested positive with a CD4 count of 350 or lower.

He was happy with the reduction of mother-to-child transmission.

For a country with the highest HIV infection rate in the world – with nearly one in 10 people being infected – the success rate of the government’s current HIV/Aids programme is very encouraging and deserves much praise.

In its annual report, the Presidency further noted that significant investments have been made in TB control and management, including intensive case finding, use of new GeneXpert® technology, and the opening of new facilities for in-patient treatment of multi-drug resistant (MDR) TB. A total of 19 MDR facilities are now in place.

As at the end of March 2011, the TB cure rate for South Africa had improved to 71.1%. The TB defaulter rate decreased to 7%.

“Currently, the country’s ART expansion programme covers 1 668 facilities, thus giving more people access to treatment. The programme to encourage medical male circumcision has seen increasing numbers in the uptake of the programme. As part of the comprehensive package of services, both male and female condoms are being distributed nationally, and a further commitment has been made to increase its rollout,” stated the report.

“In terms of combating TB, efforts to increase the response to TB will be strengthened, and SANAC will continue to ensure targeted responses are adequately geared toward achieving health targets.

“Consultative discussions on the National Strategic Plan on HIV, Aids & TB for the years 2012 to 2016 have begun,” it added.

The government has been tackling awareness and testing among university students. An HIV testing campaign targeting first-year students at universities across the country saw some 21 000 students being in the first four months of the campaign up to June.

The campaign, dubbed “First Things First”, is the voluntary HIV testing, counselling and education campaign launched by Health Minister Motsoaledi at the University of the Witwatersrand on 14 February 2011. The aim is to help South African students, as future leaders, to be responsible, get tested for HIV, know their status, and commit to behaviour that will benefit themselves and their peers.

SANAC noted at its meeting in August that the state has increased its capacity to care for people living with HIV and requiring ART. The number of public facilities now providing comprehensive ART has increased from 490 to 2 001.

More than 1 750 nurses have been trained on nurse-initiated and -managed ART, making it possible for professional nurses to put people onto treatment.

SANAC endorsed the government’s policy of initiating treatment for people who tested positive with a CD4 count of 350 or less. Previously, state-sponsored treatment was available only when one’s CD4 count was less than 200.

It seems that after years of floundering in the dark, South Africa’s HIV/Aids programmes and campaigns are finally on track to making a positive difference.

Stef Terblanche