“Let there be no more shame, no more blame, no more discrimination and no more stigma,” says President Zuma.

In the midst of all the economic struggles facing many South Africans, the country is still in working tirelessly to fighting the HIV/AIDS epidemic in order to create a better future.

According to media reports, South Africa is experiencing the largest HIV and AIDS epidemic in the world. An estimated 5.6 million South Africans are HIV positive1 in 2008, the largest number of any country in the world. Different provinces in South Africa however experience different levels of HIV infections and AIDS related deaths. This illustrates the fact that the epidemic is in different stages of development in each province and that a different approach to addressing the epidemic in each province is necessary to stem the course of new infections and deaths.

South Africa as a country is experiencing a mature epidemic with total new HIV infections and AIDS deaths converging to a level of between 400 000 and 500 000 per annum (see Graph 3). As the HIV epidemic progresses over time, the new infections will peak and then decline until it reaches a stable level per annum (mature epidemic). The growth in AIDS deaths typically lags that of new infections and converges at the same stable level over time. The SA epidemic has peaked in the late nineties and is approaching a stable level at the moment. Although new infections in all the provinces have peaked, the different provinces are in different stages of decline.
The Eastern Cape, Western Cape, Northern Cape and Limpopo are further away from reaching the number where new infections and deaths will level off. The gap between new infections and deaths are higher in these provinces (see graph 4). The HIV epidemic is still rapidly growing in these provinces where as in the other provinces the epidemic has stabilised with new infections and deaths canceling out.

Bringing hope to these astonishing findings, President Jacob Zuma introduces a plan that will boost protection of the affected individuals and prevent further infections. Late last year during the World Aids Day event in Pretoria, Johannesburg, his announcement focused on fast-tracking the distribution of antiretroviral drugs (ARVs) in the country – a move praised by the Treatment Action Campaign lobby group and the South African National Aids Council, which makes HIV/Aids policy recommendations to government.

Under the new plan, ARVs will be made available to HIV-positive South Africans with a CD4 cell count of 350, as opposed to the current qualifier of a CD4 count of 200 or less. Experts say that by starting treatment earlier, chances of success are higher and people can live longer.
A CD4 cell count indicates the strength of a person’s immune system, and helps determine how advanced the HIV infection is and predict the risk of complications.
Normal CD4 counts in adults range from 500 to 1 200, but when a person has HIV his or her count slowly decreases. ARVs help the body build up its CD4 count which, in turn, help fight against opportunist infections.

Zuma also said that tuberculosis (TB) and HIV/Aids “will now be treated under one roof” instead of patients having to travel to different centres, and those with both illnesses will receive ARVs when their CD4 count is 350, not 200.
“This policy change will address early reported deaths arising from undetected TB infection among those who are infected with HIV,” the president said at the event, which was attended by thousands of South Africans and many international dignitaries.
TB is a prime example of opportunistic disease and government’s new approach is significant because the co-infection rate among affected South Africans is as high as 73%, Zuma added.
The plan also focuses on curbing mortality among infants who test positive for HIV at birth. Zuma announced that all such babies under one year of age will now receive ARV treatment.

In this case “initiating treatment will not be determined by the level of CD4 cells,” he said. “This decision will contribute significantly towards the reduction of infant mortality over time.”
HIV-positive pregnant women will also now be eligible for ARVs when their CD4 count is 350 or when they start showing symptoms. Presently such women can only access treatment if their CD4 count is 200 or less, Zuma said.
In addition, symptom-free HIV-positive pregnant with a CD4 count above 350 will be put on treatment at 14 weeks to reduce the chance of mother-to-child transmission. “In the past treatment was only started during the last term of pregnancy,” he added.
At the event US Ambassador to South Africa Donald Gips announced that his country will donate R900-million (about US$123-million) to broaden access to ARVs in South Africa over the next two years.

WORDS OF ENCOURAGEMENT
On 1 December 2009 Zuma called for the “depoliticisation” of the HIV/Aids debate. “Let there be no more shame, no more blame, no more discrimination and no more stigma,” he said. “Let the politicisation and endless debates about HIV and Aids stop.”
Government’s new plan will be effective from April 2010 and it will work towards increasing the number of treatment centres across the country.
“Institutions are hard at work to ensure that systems are in place by the 31st of March,” the president said.
The policy shifts mean that “we will be treating significantly larger numbers of HIV-positive patients. It means that people will live longer and more fulfilling lives,” Zuma said. “But it does not mean that we should be irresponsible in our sexual practices.
“It does not mean that people do not have to practice safer sex. It does not mean that people should not use condoms consistently and correctly during every sexual encounter.”

Encouraging response

The South Africa National Aids Council (Sanac) commended government’s commitment to it’s action plan for HIV. “We can change behaviour if we reach out to every person in South Africa,” said Sanac deputy chairperson Mark Heywood. “I believe that starting from today, with the leadership of government, we will defeat HIV.”
The Treatment Action Campaign (TAC) also welcomed government’s announcement. “The changes to the treatment guidelines are all based on strong medical evidence and will significantly reduce mortality,” it said in a statement.
Hundreds of young people queued up to be tested at the World Aids Day event. New Start, one of the centres, tested more than 50 people within six hours, according to programme manager Ncamsile Nhlabathi. “People will respond positively to this new campaign. It shows that they do want to get tested,” she said.
Octovia Kebareng Maditse from Pretoria was among those who got tested. “I wanted to know my status. I feel free now that I know,” she said.

The plan also aims to reduce the HIV infection rate among children under the age of five by expanding the prevention of mother-to-child transmission programme and providing antiretroviral therapy for pregnant women.
On treatment, the aim is to increase the reach of the country's antiretroviral treatment programme from the current estimated one-quarter of HIV-positive people to at least 80% of people living with HIV/Aids as well as their families. In order to lessen the impact of Aids on familes and communities, the plan also aims to expand community-home-based care and palliative care programmes, as well as social safety network programmes for orphans and vulnerable children.
Fikiswa Majikela

Sources: South Africa.info, Summary of provincial HIV and AIDS statistics for South Africa