It’s been 13 years since antiretroviral therapy (ART) was rolled out in the public health sector across South Africa, and 16 years since the treatment programme was first initiated in the Western Cape.
And from days where HIV-positive patients took five tablets a day (three in the morning and two at night) to today, where patients take only one pill a day, much has clearly changed.
But arguably the most important change that has always been on top of people’s minds, including drug developers, health ministers and activists alike, was the toll these pills would take on patients.
Since ARVs were first introduced in SA in 2001, it hasn’t been easy. Patients reported numerous side-effects on various first line and second line drugs - and often people defaulted on these treatments.
The first line regimen then was mainly Stavudine (d4T), taken with Lamiduvine (3TC) and Efavirenz. While pregnant women would be given Nevirapine, adults who couldn’t tolerate Efavirenz would be put on Zidovudine.
“A person would take five different pills a day and if you were on Nevirapine it was six different pills a day. But around 2011, our country phased out d4t because of the severe side-effects it had on people. A person’s entire body would change - through fat redistribution, people would lose fat in some areas of their body and unnaturally gain fat in others”, Luckyboy Mkhondwana, the Treatment Action Campaign’s (TAC) treatment literacy co-ordinator, explained.
But in 2011 treatment improved a bit when the country introduced emtricitabine (FTC).
“Then the dosing went down a bit, we did away with d4t and ftc was introduced as a fixed dose combination (two tablets in one tablet) so instead of five pills a day, patients then took two which made things easier,” Mkhondwana recalled.
In 2013, Minister of Health Dr Aaron Motsoaledi introduced an even further change in the course of treatment, the "fixed-dose combination" - three pills combined in one, namely, Emtricitabine, Efavirenz and Tenofovir.
“Because the drug Efavirenz affected one’s central nervous system and had side-effects such as hallucinations, dizziness and nightmares, it was recommended that the pill be taken at night”.
Fast forward to 2017, as the world prepares to commemorate the 29th World Aids Day, UNAIDS says “remarkable progress” had been made on HIV treatment. The organisation recently released a new report showing that access to treatment had risen significantly.
The new report, "Right to Health", highlights that the people most marginalised in society and most affected by HIV are still facing major challenges in accessing the health and social services they urgently need.
In 2000, just 685 000 people around the world living with HIV had access to antiretroviral therapy. But this number has since ballooned and by June this year, almost 21 million people had access to these life-saving drugs.
“Many people do not remember that in 2000 there were only 90 people in South Africa on treatment,” said Michel Sidibé, executive director of UNAIDS.
“Today, South Africa has the biggest life-saving treatment programme in the world, with more than four million people on treatment.”
As treatment access improved among pregnant women, new HIV infections among babies also dropped, going down by 56% between 2010 and 2016 in southern Africa. And as SA looks forward to the introduction of yet another new ARV drug on the market, Dolutegravir, early next year, gains in HIV treatment look primed to increase.