SA’s journey of HIV treatment, prevention

Wednesday, November 29, 2017

By Chris Bathembu

It was on World Aids Day in 2011, two years into the current administration, when President Jacob Zuma announced a bold plan to scale-up South Africa’s fight against HIV/Aids.  Plans to integrate Tuberculosis into the health system’s efforts against the epidemic were announced for the first time on 1 December of that year.

The plan marked the beginning of a firm and unambiguous commitment by government to upscale the fight against HIV and Aids.

A year before, in April 2010, the government launched its HIV Counselling and Testing campaign, which offers free testing to all patients at public hospitals and clinics across the country.

The campaign seeks to promote voluntary HIV counselling and testing, encouraging all South Africans to know their HIV status and to be screened for TB at the same time. By mid-2012, Health Minister Aaron Motsoaledi announced that almost 20-million South Africans had been tested and knew their status. Millions were also screened for TB.

Prevention has been at the heart of government’s plan to fight HIV since 2010 and the National Strategic Plan (NSP) for HIV, Sexually Transmitted Diseases (STDs) and TB 2012-2016, aimed to reduce new infections by 50% by 2016. The National Strategic Plan (NSP) on HIV is based on a 20-year vision for reversing the burden of disease from HIV, STIs and TB in South Africa.

With just under two years before the current term of government expires, and on the eve of World Aids Day, SAnews takes a look at some of the major milestones achieved over the past eight years in South Africa’s battle against HIV.

There was a time when stigma, and to some extent discrimination against people living with HIV, was rife in South Africa. People cringed just from hearing the letters H-I-V. Those infected were  too ashamed to come out and affected family members were equally too ashamed to discuss the disease in their households.

There is no doubt that mistakes were made in the manner in which South Africa’s initial response to HIV/Aids was handled.

Drop in HIV/Aids deaths

It took drastic changes in policy and approach to reduce HIV/Aids related deaths in South Africa.

The South African National Aids Council (SANAC) says 681 434 people died of HIV/Aids in 2006. This number dropped to 150 375 in 2016.

Deaths due to TB dropped from 69 916 in 2009 to 37 878 in 2015.

The number of new HIV and TB infections has fallen and a higher proportion of people living with these infections has been diagnosed and treated, says SANAC in its 2017-2022 NSP.

South Africa's positive turnaround in HIV response was driven largely by the massive campaign to get South Africans to test for HIV.

The joint campaign driven by SANAC and the Department of Health held between April 2010 and June 2011 is considered by experts as the most successful HIV response in the whole of the Southern African region to date. By December 2010, 4.6 million South Africans had taken an HIV test since the launch of the campaign.

The campaign set a target of testing 15 million sexually active South Africans from age 15 and older in all nine provinces. The tests gave the government an idea of the number of people who needed to be put on treatment and thus save lives. Also the massive amount of people who came out to test proved that the decades’ long stigma surrounding HIV was no longer there.

South Africa today boasts the largest antiretroviral treatment programme globally and its efforts have been largely financed from own domestic resources, spending around R15 billion annually to run its HIV/Aids programmes.

South Africans living longer

Studies show that HIV positive South Africans are living longer.

In another bold move, the Department of Health Prevention of Mother-to -child Transmission (PMTC) policy was amended to provide all HIV positive pregnant and breastfeeding women with life-long antiretroviral triple therapy (ART).  It also recommends that infants are tested for HIV at birth, six weeks, ten weeks, after breastfeeding stops and at 18 months. 

The country’s prevention of mother-to-child infection programme has been one of the flagship programmes in government’s efforts to curb the spread of HIV, in particular among the vulnerable of society - women and children.

The prevention of HIV infection from mother-to-child is likely to remain high on government’s agenda for the next few years because the number of people receiving life-long antiretroviral therapy (ART) in South Africa is still increasing and is predicted to rise at around three million this year.

In 2005, slightly fewer than 50% of all pregnant women were routinely tested for HIV infection. By 2009, this had changed. Testing became universal and maternal treatment regimen used for PMTCT has also changed over the past 10 years, from single-dose Nevirapine to either dual therapy with Nevirapine and Azidothymidine from the 14th week of pregnancy onward or highly active antiretroviral therapy.

Despite the remarkable successes in South Africa’s HIV response programme, many challenges remain, says SANAC.

The NSP 2017-2022 reveals worrying figures which indicate that in 2016, an estimated 270 000 people became newly infected with HIV and the 2015 estimate of new TB cases was 450 000.

“We have 3.7 million people on antiretroviral treatment (ART) for HIV but we are only reaching 53% of those who are eligible for treatment under the new Test and Treat policy,” reads the document. The number of deaths due to HIV and TB is still massive and underscores the gravity of the epidemics.

 Public health facilities treated about 1.14 million new symptomatic STIs in 2015/16.

The current NSP sets out intensified prevention programmes that combine biomedical prevention methods, such as medical male circumcision (MMC) and the preventive use of antiretroviral drugs (ARVs) and TB medication, with communication designed to educate and encourage safer sexual behaviour in the case of HIV and STIs, and environmental interventions to control TB infection.

Other goals include:

  • Reducing new HIV infections from 270 000 per year to less than 100 000
  • Reduce new TB infections from 450 000 per year to less than 315 000
  • Reduce new STI infections and Identify ASYMPTOMATIC INFECTIONS
  • Focus on key and vulnerable populations in each province or local area
  • Focus on municipal districts with highest disease burden. 

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