SA’s long road to proper care
More ARVs set to be rolled out
SOUTH AFRICA – with Health Minister Dr Aaron Motsoaledi leading the way – has done a complete about-turn in its approach to the HI virus. The Health Department recently announced as of September every person who tested positive, irrespective of CD4 count, would be supplied with ARV treatment, in keeping with World Health Organisation guidelines.
This brings to life the theme of this year’s International Aids Conference: Access Equity Rights Now.
Add to this the pilot programme initiated in June of Truvada – a pre-exposure prophylaxis drug proven to be effective in preventing HIV transmission – being given to sex workers, identified as a key sector if the world is to reach its 2020 targets of ensuring 90 percent of those with HIV are diagnosed, 90 percent of those HIV positive are on anti-retroviral treatment and 90 percent of these people are virally suppressed (commonly referred to as 90-90-90).
The department has also been instrumental in encouraging young men to be circumcised, a practice that can reduce the risk of acquiring the virus by as much as 60 percent.
To date, more than 700 000 young men and boys have undergone the procedure.
With the use of nevirapine to prevent mother-to-child transmission, South Africa has reduced this transmission rate from above 34 percent to below 2 percent. The conference, which ended yesterday, also acknowledged the efforts of civil society organisations who were critical in changing the SA government’s approach.
Activists like Constitutional Court Justice Edwin Cameron, who has been living with the virus since 1986, highlighted the plight of gay and transgendered people for whom the virus remains a major threat, in large part because of the stigma attached to seeking treatment.
South Africa is also at the forefront of research.
Organisations like the Durban-based Centre for the Aids Programme of Research in South Africa (Caprisa) presented at the conference groundbreaking findings linked to another key sector of the population – young women and girls – such as the use of tenofovir gel and the impact of organisms in a woman’s vagina on her risk of acquiring HIV.
Another study focused on the impact of some injectable contraceptives on the vaginal lining, the first barrier to the virus.
Ian Sanne, chief executive of care organisation Right to Care, said SA was now leading the charge against the epidemic.
“The Universities of Cape Town, Wits, Stellenbosch and KwaZuluNatal have all contributed to our scientific efforts in fighting the epidemic. Sites in South Africa have also been key for research.”
Motsoaledi was appointed in 2009 by President Jacob Zuma, who took office then and acknowledged the magnitude of the epidemic.
Researcher in maternal and child health Professor Hoosen “Jerry” Coovadia from Maternal, Adolescent and Child Health Systems said: “People have levelled much criticism against Zuma for many of his policies but, in this case, he comes out on top. He made many good decisions.”
Professors Salim and Quarraisha Abdool Karim of Caprisa said in a commentary piece in Spotlight (published during the conference jointly by advocacy groups Treatment Action Campaign and Section27) that the vibrancy of 2000 conference – also hosted in Durban – was no more.
“It has been replaced with calm and rational options for the future of HIV epidemic made possible by a combination of scientific discovery, innovative funding mechanisms and deep commitments from policy makers, activists, researchers, healthcare providers and many others to make Aids treatment available.”
For Nono Simelela, the former chief director for HIV and Aids in the national health department, the story of the response to Aids in SA in recent years was one of great progress after almost a decade of “complex and tragic denialism” that united the world and civil society in a way not seen since the opposition to apartheid.
Simelela shared her thoughts in a 2014 report in the South African Medical Journal, looking at the history of the country’s approach.
South Africa, she said, was home to the largest concentration of people living with HIV anywhere in the world.
Simelela said the first Aidsrelated deaths in SA occurred in late December 1981 and January 1982, but there was very limited attention paid to the epidemic over the next decade.
“The dawn of a new democracy in 1994 brought optimism regarding the future of the country, and the new administration had to re-design every tier of government in the context of a fractured governance system that included the so-called Bantustans.”
“The HIV epidemic was not an issue of major concern and therefore received very limited attention.”
But this changed when civil society created a national advisory group, Networking HIV/Aids Community of South Africa (Nacosa), to lobby for and ultimatelydraft a national Aids plan.
She said: “Tragically, between 1998 and 2008 was to prove a testing period for the country as the full extent of the epidemic’s health impact became apparent, in the face of then-president Thabo Mbeki’s increasingly apparent denialism.”
And it was this denialism, said Coovadia, that cemented South Africa’s place as a pariah.
“People were laughing at us with our talk of beetroot and garlic. More than 300 000 people died during this period, a dark part of our history.
“If it had happened anywhere else, Thabo Mbeki would have been charged with genocide.”
He said there had seemed to be a resistance to science and a need to politicise the epidemic.
“They became convinced that the cure for HIV would come from South Africa so they put together a group of scientists who had no experience in the relevant fields and came up with Virodene, an industrial strength solvent, to kill the virus. Thank goodness they were kept from the public. Who knows how many more they would have killed.”
The government also put together a play called Sarafina II, intended to encourage the conversation about HIV.
Coovadia termed this a “pathetic attempt”.
Simelela said the limited awareness campaigns of the time were hampered by stigma and fear.Civil society challenged the policy in court, arguing refusal to provide nevirapine violated the Constitution, leading to a ruling provision was an obligation of the state.
This week’s conference was a celebration of the progress South Africa has made since denialism. But the battle has not yet been won.
Commenting in Spotlight, general secretary for TAC Anele Yawa said about 17 million people living with HIV were receiving ARVs while 20 million were not.
“If we are ever to get near (this figure) then Durban has to be a turning point ... It means never again wasting money on, for example, abstinence-only programmes. It means standing up to the moral Mother Grundys and providing young people with proper education and access to condoms.”
Visitors to the ICC protested before the official opening of the 2016 International Aids Conference. The government has done a complete turnaround on HIV, but some feel that not enough is being done.