The good and the bad for Aids

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BACKER: Petra Schulte lights a candle at Christian Barnard Hospital during an awareness drive in aid of World Aids Day. Picture: Leon Lestrade

Durban - When it comes to progress in HIV treatment and prevention in South Africa, 2012 was a year of the good, the bad, and what remains to be seen.

Major developments on the HIV front this year included great strides towards a possible vaccine, the announcement of a new multibillion-rand antiretroviral therapy tender and the implementation of an exclusive breastfeeding strategy for all mothers, including HIV-positive ones.

The UNAids report on the global state of HIV and Aids, released earlier this month, shows that South Africa has reduced new adult infections by 41 percent between 2001 and 2011, and had 100 000 fewer HIV-related deaths in 2011 than in 2005.

However, South Africa still leads the world in HIV infections, with 5.1 million infected people.

South Africa also has the highest domestic investment in HIV and Aids programmes of all the lower- and middle-income countries.

This week several civil society organisations praised the government’s roll-out of the antiretroviral therapy programme in 2012.

According to the national health department, 1.7 million South Africans have access to ARVs.

In announcing the new two year, R5.9-billion ARV tender this week, health minister Aaron Motsoaledi said his department hoped to expand the number of people on treatment to 2.5m by 2014.

Spokeswoman for the TAC, Sibongile Nkosi, said the roll-out of treatment had been a major victory in 2012.

Gilles Van Cutsem, medical co-ordinator in South Africa for Médecins sans Frontières, said “the biggest achievement has been the speed of the scale-up of the ARV programme”, reaching 1.7m people in the public sector, and 2m South Africans in total.

He said an SA Medical Research Council report which showed that the life expectancy of South Africans had increased from 54 in 2005, to 60 in 2011, was “as a direct result of ARV therapy”.

Section 27 director Mark Heywood, in a speech made at Oxford University this week, also hailed the roll-out of ARVs.

“In some respects the results have been quite dramatic. Vertical transmission of HIV is now reportedly under 2.5 percent at six weeks post partum, down from 25 to 30 percent a decade ago. As a result there has been a reduction in infant and under-five mortality, he added.

Haywood, however, criticised the UNAids report’s “rosy” assertion that an end to the pandemic was in sight.

The ARV programme has also not been without its problems this year, and all three organisations also cited major drug stock-outs as one of the biggest problems experienced this year.

Van Cutsem said these shortages were “unacceptable”, blaming bad supply chain management.

Earlier this year major shortages were recorded after Sonke Pharmaceuticals had trouble meeting their agreed-upon outputs. The company was awarded more than 20 percent of the 2010 tender, reduced to a mere 1.5 percent in the newest tender.

Nkosi praised the inclusion of fixed dose ARV treatments in the new tender, saying South Africa had reached a par “with first world countries”, which had been providing the drugs for years.

Motsoaledi has since 2010 managed to slash the prices for ARVs.

The new contract for the medicines shows a further 38 percent price cut across all products. In addition, the cost of the fixed dose drugs, at R89.37 a month, was the lowest price in the world, he said.

The prevention of mother-to-child HIV transmission programme also received kudos – as the country managed to bring this rate below three percent this year.

However, Nkosi said that there were still problems with pregnant women presenting too late to clinics.

Van Cutsem said the effect of the country’s new breastfeeding policy, which phased out all free formula in clinics this year, in favour of exclusive breastfeeding, also still remained to be seen. - Independent on Saturday

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