The evolution in antiretroviral therapy has often been marred by slow, staggered progress, but has always been dynamic.
1998 - 2000: The battle for access begins. In early 2000 it was announced that a trial using a short course of an ARV drug Zidovudine (AZT) in Thailand had cut the mother-to-child transmission (MTCT) rate in half. South African Aids activists and researchers called on the government to distribute an ARV drug to pregnant women. But most provinces rejected the use of AZT, arguing that it was too expensive to distribute.
2001: The Médecins Sans Frontières and the Western Cape Department of Health initiated antiretroviral therapy to HIV-positive individuals in Khayelitsha.
The government successfully defendeda law to allow the domestic production of cheaper, generic brand medicines - including ARVs - against a lawsuit filed by transnational pharmaceutical companies.
The government provision of ARVs through public health after this victory remained remarkably low until the Constitutional Court ordered the government to make Nevirapine available to HIV-positive pregnant women.
2002: The government established a Joint Health and Treasury Task Team to propose options for expanding the HIV treatment response beyond PMTCT. Clinicians in the joint task team quietly developed HIV treatment protocols that included ART for adults and children. In August 2003 the cabinet received the joint Health and Treasury Task Team report.
2003: The cabinet approved a plan for universal ARV treatment.
2004: Rollout of ARVs began, and 47000 were put on treatment.
2005: By the end of the year more than 5 million South Africans were HIV-positive, and the country had the highest rate of HIV infections in the world.
2006: In May the national Department of Health initiated the development of a new five-year National Strategic Plan by SA National Aids Council under the leadership of then deputy president Phumzile Mlambo-Ngcuka, pictured below left, on its response to the HIV pandemic. The plan was launched in 2007 with heavier emphasis on ARV provision.
2008: In September, then president Thabo Mbeki, pictured below right, resigned from office after losing support within the ANC. One of the things that resulted in his loss of support was his long-held view that HIV did not cause Aids.
2009: President Jacob Zuma’s cabinet committed to test all children exposed to HIV and provide all HIV-positive children with ARVs. Moreover, as per the target set by the National Strategic Plan of 2007-2011, coverage of HIV-positive mothers with AZT treatment was estimated at about 95% by 2010.
Transmission from mothers to their children was thereby reduced to just 3.5%.
2010: By the end of 2010 only 55% of people who were eligible for ART received it, falling significantly short of the government’s goal of 80% coverage. Similarly, only 36% of South African children who were deemed eligible for ART had access to these life-saving drugs.
2011: In May, Health Minister Aaron Motsoaledi announced that 11.9 million South Africans were tested for HIV every year.
The country committed to half the number of new HIV infections, half the number of new TB infections and deaths from TB and ensured that the rights of HIV-positive people be protected.
2013: SA begins a fixed-dose combination of antiretroviral (ARV) medication, reducing default rates significantly. The dose contained
Emtricitabine, Efavirenz and Tenofovir.
2018: A single-pill HIV treatment called Dolutegravir is expected to be introduced and is projected to save SA about R11bn over the following six years. Not only is the new treatment well tolerated, but it’s said to be more potent in suppressing HIV’s viral load.