19 July 2016

South Africa: How SA Got Its HIV Response Right

Photo: Abhi Indrarajan/AIDS Society
Activists for sex workers protesting outside the Durban ICC on the morning of the International AIDS Conference.

Durban — It was former President Nelson Mandela at the Aids conference in the year 2000, who used his influence to unite more than 12 000 delegates under one common goal.

The delegates had been debating for days with no hope of reaching consensus on a number of issues. These included, among others, the thorny issue of the effectiveness of Antiretroviral drugs for HIV positive people. There were other debates of a political nature.

At that time, stigma, and to some extent discrimination against people living with HIV, was rife in South Africa. There was no clear policy on the treatment for those infected by the virus. Those who needed treatment included pregnant women as well as children. There was no hope. South Africans were dying in their numbers. The country and the region were the worst affected by the epidemic in the world.

Mandela cautioned the delegates at that conference that the never ending arguments and disputes were not helping in dealing with the real life issues that the country and Africa was dealing with at the time.

Mandela noted: "Let us not equivocate: a tragedy of unprecedented proportions is unfolding in Africa. AIDS today in Africa is claiming more lives than the sum total of all wars, famines and floods, and the ravages of such deadly diseases as malaria. It is devastating families and communities; overwhelming and depleting health care services; and robbing schools of both students and teachers."

He further added: "HIV/Aids is having a devastating impact on families, communities, societies and economies. Decades have been chopped from life expectancy and young child mortality is expected to more than double in the most severely affected countries of Africa. Aids is clearly a disaster, effectively wiping out the development gains of the past decades and sabotaging the future."

Mandela made those painful statements 16 years ago. There is no doubt that the situation in South Africa in 2016 has changed. Government has described the 21st International Aids Conference underway in the City of Ethekwini as a moment of hope in the fight against HIV/AIDS.

Minister in the Presidency Jeff Radebe describes the gathering as the beginning of a new journey. The conference, he said on Tuesday, was "a moment that all of us need to tell our good story in the journey we have travelled".

"If Durban 2000 was a moment characterised by pain... Durban 2016 marks a moment of hope," said Minister Radebe.

Health Minister Aaron Motsoaledi said the South African exhibition stall at the conference is telling a story of a country that has turned the corner in its HIV fight.

"Here we are displaying a positive story of how far we have come as country. It is a moment of pride," he said.

United Nations Secretary General Ban Ki Moon said South Africa has made massive gains in preventing mother-to-child HIV and Aids infections' but a lot more needs to be done.

Perhaps it is indeed a moment of hope and pride for South Africa considering how far the country had come since the gloomy picture of a decade ago, although challenges remain. Too many people are still being infected by HIV every day. Too many children still don't have access to treatment. Too many pregnant women in rural areas have never heard of the mother-to-child prevention of HIV transmission and are still infecting their children with the virus during pregnancy and childbirth.

But, today less South Africans are dying from AIDS thanks to access to treatment and prevention campaign. President Jacob Zuma's 2009 World Aids Day speech marked the beginning of a firm commitment by government to the fight against Aids. Several international editors and delegates alike are now singing South Africa's praises at the Durban conference. Their attitude is showing direct contrast to the damning editorials of 2000. But South Africa did not just wake up and all was well in the fight against the Aids problem.

As the United Nations agency UNAIDS notes, South Africa's positive turnaround in HIV response was driven largely by a massive campaign to get South Africans to test for HIV. That was the beginning.

The joint campaign driven by the South African National Aids Council 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 have taken an HIV test since the launch of the government's HIV counselling and testing.

The HIV Counselling and Testing (HCT) campaign set a target of testing 15 million sexually active South Africans from aged 15 and older in all nine provinces. There are two things that are significant about the campaign that need to be highlighted. First, the test gave the government an idea of the number of people who needed to be put on treatment and thus save lives. Secondly, the massive amount of people who came out to test put paid to the decades long stigma surrounding HIV. People were suddenly at ease when they saw their friends and neighbours testing. It became a competition to test, as one Aids researcher was quoted as saying recently.

Thanks to this bold campaign, South Africa has turned the corner in its fight against the HI Virus. South Africans owe this turnaround to the decision by the Department of Health to make all public health facilities available to every person who needed HCT.

The United Nations has expressed doubt that the world will achieve the target of eradicating Aids by 2030. But very few will doubt the contribution made by Mandela in the fight against the pandemic in his own country and his influence to inspire many around the world to take action. Very few will doubt the contribution to the fight against new Aids deaths and infections arising from the 2010 decision to launch that massive campaign HCT campaign.

South Africa today has 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.

Studies are now showing that HIV positive South Africans are living longer. However, a significant drop in the number of HIV infections is probably the only victory that would carry weight for many South Africans. Until such time an effective vaccine is found, campaigns such as the HCT are probably the most effective way to put the breaks to the spread of HIV/AIDS.

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