Scale up preven­tion, say ex­perts

CityPress - - News - ZINHLE MAPUMULO zinhle.mapumulo@city­press.co.za

A decade ago an HIV di­ag­no­sis was con­sid­ered a death sen­tence in South Africa.

To­day, a na­tional HIV-treat­ment pro­gramme is sav­ing lives, which is a far cry from where we have come.

Then, peo­ple were dy­ing like flies and the fu­neral par­lour in­dus­try was boom­ing. To­day, far fewer peo­ple are dy­ing of Aids and those that are HIV pos­i­tive are liv­ing longer and health­ier lives. Ex­perts at­tribute this turn­around to the na­tion­wide avail­abil­ity of an­tiretro­vi­ral drugs.

Pro­fes­sor Carolyn Wil­liamson, head of the med­i­cal vi­rol­ogy di­vi­sion at the Univer­sity of Cape Town, said if the gov­ern­ment had not taken the fight against HIV se­ri­ously and scaled up treat­ment in the past seven years, hun­dreds of thou­sands of peo­ple would have died.

“The na­tion­wide avail­abil­ity of an­tiretro­vi­ral treat­ment (ART) averted mil­lions of un­nec­es­sary deaths. Be­fore ART be­came avail­able to the pub­lic, an HIV di­ag­no­sis was sim­i­lar to a death sen­tence, be­cause doc­tors would treat op­por­tunis­tic in­fec­tions while the virus would con­tinue to spread.”

In the time Wil­liamson was re­fer­ring to, HIV was in­deed spread­ing like wild­fire. And there was no treat­ment avail­able, par­tic­u­larly for those who re­lied on the pub­lic health­care sec­tor.

At the time, sci­en­tists and ac­tivists had lob­bied gov­ern­ment to make HIV treat­ment avail­able for the pub­lic, but with­out suc­cess. It was only in 2003 that the gov­ern­ment ap­proved a plan to make an­tiretro­vi­ral treat­ment avail­able to the pub­lic. The step only ma­te­ri­alised af­ter sev­eral civic at­tempts, in­clud­ing lobby ef­forts of struc­tures such as the Treat­ment Ac­tion Cam­paign.

Al­though thou­sands of peo­ple started ac­cess­ing treat­ment in the fol­low­ing year (2004), this had lit­tle im­pact at first where it was most needed. Many con­tin­ued to die as the roll-out kicked off in ur­ban ar­eas and only slowly spread to the smaller towns, even­tu­ally reach­ing the stricken ru­ral struc­tures. At the peak of the HIV epi­demic in 2006, UNAids es­ti­mated that 350 000 peo­ple had died of Aidsre­lated ill­nesses in South Africa.

About a mil­lion more were on ART in 2009. This fig­ure dou­bled in 2012 af­ter the in­tro­duc­tion of HIV test­ing. The lat­est statis­tics show that 3.4 mil­lion peo­ple were ac­cess­ing ART in the pub­lic health­care sec­tor alone by the end of last year. This makes South Africa’s an­tiretro­vi­ral (ARV) pro­gramme the big­gest in the world.

With the test-and-treat cam­paign, which launched in Septem­ber this year, Wil­liamson said the num­ber of suf­fer­ers ac­cess­ing ARV treat­ment could in­crease sig­nif­i­cantly.

“The ad­van­tages of test­ing and treat­ing peo­ple im­me­di­ately af­ter be­ing di­ag­nosed with HIV is that you con­trol trans­mis­sion. Once a per­son is on ART and ad­heres to treat­ment, the chances of him or her trans­mit­ting the virus to their part­ner is slim, which is why we need to get ev­ery­body who is HIV pos­i­tive on treat­ment,” she stressed.

“ARV treat­ment can dras­ti­cally re­duce Aids-re­lated deaths and new HIV in­fec­tions.”

But ex­perts be­lieve more still has to be done to pre­vent new in­fec­tions. Last year an es­ti­mated 330 000 peo­ple were in­fected with HIV in this coun­try, ac­cord­ing to UNAids.

This was a mas­sive fig­ure, con­sid­er­ing that HIV was a pre­ventable dis­ease, said Dr Edith Masango, an HIV spe­cial­ist from Jo­han­nes­burg.

“I think we have be­come com­pla­cent as a na­tion be­cause of the strides made in the fight against HIV and Aids. Peo­ple now con­sider HIV as an­other chronic dis­ease that can be man­aged with treat­ment,” Masango said. While this is a good mind-set, she warned “not to nor­malise the ab­nor­mal”.

Wil­liamson added that South Africans must be care­ful not to re­verse the suc­cesses it had gained by be­ing slack.

“Treat­ment alone will not end HIV. We need to close the tap by pre­vent­ing new HIV in­fec­tions as well.

“Preven­tion is bet­ter than a cure,” Wil­liamson said.

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