SA’s long road to proper care

More ARVs set to be rolled out

Weekend Argus (Saturday Edition) - - LIFE - KAM­CILLA PIL­LAY

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.

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