South Africa forges on

Tuesday, 21 September 2010 12:45

Making strides in effective campaigns Although new HIV infections in South Africa dropped by 35% between 2002 and 2008, behavioural changes and implementation of HIV prevention programmes on a massive scale are imperative if the country were to have a realistic chance of achieving its goal of halving new infections by next year, as stated in its HIV and AIDS/STI Strategic Plan for South Africa (NSP 2007-2011). This was the collective view of a panel of experts interviewed by Leadership in HIV/Aids upon the announcement of a recent study by the Human Sciences Research Council (HSRC). The study revealed that new HIV infections in South Africa dropped by 35% between 2002 and 2008. These results – obtained from analysing three national HIV household surveys conducted in South Africa in 2002, 2005 and 2008 – confirm the initial findings of the 2008 survey: “South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2008. A Turning Tide Among Teenagers?” The results provide the first scientific proof that HIV prevention campaigns in South Africa, promoting condom use and HIV testing, are making a dent in the high rate of new infections. Behavioural change has definitely helped to reduce incidence among young women, said Professor Thomas Rehle, the lead author of the paper. HIV incidence may be declining, but South Africa already has a high prevalence of HIV, with about one in seven adults (15%) infected by the virus. At the time of the announcement by Prof. Rehle, Dr Nono Simelela, chief executive of the South Africa National Aids Council, stated that the findings were important. “They suggest we are making progress with behaviour change and treatment. But ours is a mature epidemic, and the pool of HIV-positive people is already high.” She suggested that the goal of halving new infections, a target in the NSP, was ambitious. Dr Olive Shisana, a director of the HSRC, told Leadership in HIV/Aids that the possible causes of the decline are high condom use rates, as well as young people knowing their HIV/Aids status. Condom use rate has increased in this age group (15-24) from 46% in 2002 to 73% in 2008. Furthermore, there has been a large increase in the proportion of the population who knows its HIV status. But Dr Shisana cautioned against too much optimism about South Africa achieving its goal of halving new infections by 2011. “This is unlikely to be achieved. More needs to be done to implement HIV prevention on a massive scale,” she urged. Behavioural changes Asked what behavioural changes are required to reduce HIV/Aids infections even further, Dr Shisana said that consistent condom use, wide-scale implementation of medical male circumcision, knowing one’s HIV status, pregnant women enrolling in mother-to-child transmission programmes, and focusing prevention on those who are already HIV positive are some of the behavioural changes that are critical. Dr Sue Goldstein, a senior executive at Soul City, said the 2008 survey had hinted at a decrease in incidence, and the latest analysis was good news. “I think the decrease, especially in the younger group, means that all the education and communication is coming to fruition. “We do know that there has been a huge increase in the use of condoms among the youth particularly; and this, with other safer sexual practices, is starting to show an effect. “We cannot let up, and it is important that older people take their role-modelling seriously and focus on all safer sexual behaviours,” she added. Co-current sexual behaviour Dr Goldstein told Leadership in HIV/Aids: “Co-current sexual behaviour is still common among men. It is probably important, as HIV spreads most easily in the early infection stages. Of course, all safe unsafe sexual behaviour contributes [to the pandemic].” Intensified and sustained prevention programmes, with commitment from all leaders, are required if South Africa wants to achieve its goals of halving new infections by 2011. “All determinants of the infection need to be addressed and funded,” said Dr Goldstein. “Testing not enough” The new governmental drive of a massive testing campaign will get people into treatment, said Dr Goldstein. “But it has not shown to change unsafe sexual behaviour. Without additional sustained prevention programming, it will have disappointing results,” she warned. “To ensure HIV reduction, everyone should have safer sex with every sexual encounter. This means decreasing sexual partners, using condoms, planning pregnancies and taking prophylactic treatment when pregnant. “Increasing gender equality, decreasing alcohol use, and changing socio-economic inequalities are all important. There is no magic bullet,” added Dr Goldstein. Diane Ritson, CEO of Siriti Africa – a network organisation that has developed a successful formula for HIV/Aids response for business in South Africa – said the most emphatic lifestyle change needed in the country is that ordinary South Africans have to take ownership of their own lives. “We need to do that irrespective of government figures and their lifestyles.” Implementation woes Dr Simelela earlier said that South Africa’s antiretroviral programme – one of the world’s largest – remained one of its greatest achievements, but she noted the recurring drug shortages, poor monitoring and evaluation, and the need to slow new infections. “We haven’t really established a robust monitoring and evaluation system across all sectors, including government. “We have the National Strategic Framework, and targets that have been set, but we need a robust tool to monitor progress so we know what needs to be done,” she said. (Additional source: IRIN/PlusNews). “The fact is that we have an epidemic that is raging, and new infections are still occurring. We need to go back to the prevention side of things to look at what we’re not doing well enough. “We have a lot of good policies, but when it comes to implementation, they falter,” added Dr Simelela. “We need to be sure provincial and district councils are able to implement their HIV/Aids plans. “It should almost be a bottom-up approach: Issues would come up at the district level and the national council would then look at ways of resolving them,” she said. Mass education required Ritson told Leadership in HIV/Aids that there is little chance that South Africa would achieve the goal of halving new infections in 2011. “We are still spending too much time on debating the document and too little time actually implementing strategies that could work, like mass education and testing which is now hopefully going to happen,” she said. If testing on a large scale – initiated by the government – is done within the context of people understanding how the virus works so that they can integrate that information in life choices, this could have a huge impact on bringing down the new infection rate, owning their HIV status early enough and managing their health appropriately. If this occurs, it could have an enormous impact on the death rate and on new infections. Ritson, and the managing director of Siriti Africa Timothy Hebblewhite, concur that HIV/Aids education of South Africans is inadequate. Educational information currently is too technical. It needs to be simplified so that South Africans of all colour and creeds can take ownership of the information and pass it on. “The average South African has not been properly educated. “The belief that we are all informed, is far from the truth,” Ritson and Hebblewhite agreed.