Durban - South Africa - despite its many developmental challenges - is well on its way to bridging the gap in the delivery of life-saving drugs to HIV-positive citizens.
This makes it a fitting host for the 21st Aids Conference, opening in Durban on Monday and whose theme this year is Access Equity Rights Now.
The conference brings together 18 000 delegates, including scientists, researchers, activists and sufferers to discuss, among other things, how to improve access to comprehensive treatment, preventive measures, care and support - while battling stigma and financial means.
“We’ve reached the goal of providing 15 million people with access to life-saving HIV treatment by 2015. Additionally, UNAids estimates that from 2002 to 2012, expanded access to HIV treatment averted 4.2 million deaths globally and contributed to a 58 percent reduction in new HIV infections,” conference organisers said.
However, many of the obstacles to effective HIV programmes in 2000 - when South Africa last hosted the conference - persisted today.
“More than 60 percent of people living with HIV remain without antiretroviral therapy.”
But South Africa is ready to address the lack of accessibility to antiretrovirals. It is preparing to roll out the life-saving pills to all HIV-positive residents, regardless of their CD4 counts, in September.
To date, only those with a CD4 count of 500 or less are eligible to receive treatment.
In tabling his budget in May, Health Minister Aaron Motsoaledi said: “We will remove CD4 count as an eligibility criterion for ARV treatment.”
While experts have lauded the move, they have also questioned how the the department plans to deal with the influx of millions more patients into our hospital systems.
The department, however, is confident it can deal with demands by employing a pick-up system for comparatively healthy patients that would create room for others.
The new programmes are expected to cost the government an estimated R1 billion.
The World Health Organisation (WHO) says the expanded provision of ARV treatment is supported by findings from clinical trials that the early use of ARVs keeps HIV-positive people healthier and reduces the risk of their transmitting the virus to partners.
“Based on the new recommendations, the number of people eligible for antiretroviral treatment increased from 28 million to all 37 million people who are living with HIV globally,” WHO said.
Expanding access to treatment was at the heart of a new set of targets for 2020, with the aim to end the Aids epidemic by 2030.
“These targets include 90 percent of people living with HIV being aware of their HIV infection, 90 percent of those receiving antiretroviral treatment, and 90 percent of people on (ARVs) having no detectable virus in their blood.”
According to UNAids estimates, extending the provision of ARVs to all people living with HIV and expanding prevention choices could help prevent 21 million Aids-related deaths and 28 million new infections by 2030. The move has been welcomed by experts, but has also left them asking questions.
Professor Hoosen “Jerry” Coovadia, an internationally renowned researcher in maternal and child health at MatCH (Maternal, Adolescant and Child Health Systems), which is affiliated to Wits University, said the move was a “good thing”.
“But my heart shudders when I think about our infrastructure. The delivery of drugs on that scale could be enormously difficult.”
The director of the Centre for the Aids Programme of Research in South Africa, Professor Salim Abdool Karim, said the health system could “not easily” cope with the influx of new health-care seekers.
“However, what is the alternative? Let people get sick and die?
“No, the solution lies in finding ways to provide Aids treatment in a way that keeps most of them out of hospitals - where they can initiate ARV therapy and continue it at primary care clinics, with GPs, etc.
“Since many of the new patients starting therapy will now be quite well and healthy with high CD4+ counts, they may not need to burden large hospitals, where they would displace other sicker patients.”
The Department of Health had estimated the country had just more than 3 million patients on treatment, Karim said.
“Once the new guidelines come into place in September, another 3 million patients will be eligible to start ART. However, many of these 3 million patients do not yet know that they have HIV. It is going to take a few years before everyone eligible for treatment receives it.”
Karim warned against people starting on ARVs and not continuing with them.
“Starting ART and then discontinuing these drugs is worse than not starting at all. Patients who start treatment and then stop are at high risk of developing drug resistance, which will mean that they will need more powerful and expensive drugs known as second-line treatment.
“For this reason, Aids treatment programmes put a lot of emphasis on patients being highly adherent to their treatment.”
Dr Yogan Pillay, the deputy director-general of HIV/Aids, TB and maternal child and women’s health, said the Department of Health estimated that 1.3 million people who were on treatment were stable (virally suppressed).
“These patients will be referred to support groups and have their medicine couriered to a pick-up point outside the health facilities, so that the facilities can cope with the new patients who need to be initiated on ARVs.”
The support groups would be used to ensure that people adhered to the treatment, said Pillay.
Sunday Tribune