End to Aids in - and out - of reach
The world is talking about stopping the Aids virus within decades – and it is not simply a pipe dream but a very real possibility. After years of toying with the alphabet – A for abstain, B for be faithful and C for condoms – we finally have some grown-up options.
While modest, this array of new weapons against HIV gives us a fighting chance to stop the virus. The weapons in the arsenal are:
* Successful antiretroviral (ARV) treatment makes HIV-positive people with undetectable viral loads virtually non-infectious. This means that if we get as many HIV-positive people as possible on ARVs, it will have a massive impact on lowering HIV transmission.
* Circumcised men have a 60 percent lower chance of getting HIV than uncircumcised men, hence the government’s intention to give 4.2 million men the snip by 2015.
* There are early signs that a vaccine might be possible. The Thai vaccine was only 31 percent successful, but at least it showed that the human immune system can be trained to defend itself against parts of the devious HI virus.
* ARV pills before sex reduced HIV transmission by 44 percent, according to a trial involving gay men taking Truvada (a combination of two ARVs) before sex.
* ARVs in a vaginal gel may help to prevent women from getting HIV when used shortly before and after sex (although a big study in which the women used the gel every day instead of shortly before and immediately after sex, failed to confirm this).
These interventions don’t concentrate on changing sexual behaviour, which hasn’t exactly been successful over the past decade.
Locally, our policy-makers have also finally realised that shunning groups who are at high risk of contracting HIV – such as homosexuals, sex workers and drug users who mainline – is counter-productive if HIV is to be stopped.
Russia has spent vast amounts of money on HIV over the past few years but with little effect, because it has failed to target the group which has the highest number of HIV cases – drug users who mainline.
But, ironically, these advances have arrived just as the world is mired in a recession and lacks the funds needed to deal the disease the killing blow.
Ten days ago, the Global Fund to fight Aids, TB and malaria cancelled its next round of funding, citing financial problems.
The fund currently supports 3.2 million people on ARVs, mostly in Africa and Asia, via 510 grants worth a combined $22 billion (about R185bn).
While the fund has set up a transitional mechanism to help those who are already receiving grants until 2014, there is no guarantee that it can sustain this.
Obviously no new grants are being given, so it is not possible to expand countries’ response to HIV – yet over seven million people still need ARV treatment.
Former UNAids envoy Steven Lewis, addressing Yale University this week, damned the developed countries that support the fund, accusing them of murder and racism.
“Hiding behind the banner of the financial crisis, the donor countries have clearly decided that if budgetary cuts are to be made, the Global Fund can be among the first to go,” said Lewis.
“It’s terribly important to recognise the moral implications. It’s not just the fact that people will die; it’s the fact that those who have made the decision know that people will die. How does that get rationalised?”
Over two-thirds of those living with HIV are in Africa, prompting Lewis to ask: “Do (the donor countries) regard Africans themselves as casually expendable?
“Is it because the women and children of Africa are not comparable in the eyes of Western governments to the women and children of Europe and North America? Is it because Africans are black and unacknowledged racism is at play?
“Is it because a fighter jet is worth so much more than human lives? Is it because defence budgets are more worthy of protection in an economic downturn than millions of human beings?”
Jeffrey Sachs, professor of health policy at Columbia University and an adviser to the head of the World Health Organisation, accused the US government of a “collapse of morality, decency and common sense”.
“The Obama administration had pledged $4bn during 2011-13 to the Global Fund, or $1.33bn per year,” Sachs wrote in the Huffington Post this week. Now it is reneging on this pledge.
“For a government that spends $1.9bn every single day on the military ($700bn each year), Washington’s unwillingness to follow through on $1.33bn for a whole year to save millions of lives is a new depth of cynicism and recklessness.”
So despite scientific advances, the historical possibility of stopping HIV is enormously hindered by the lack of money to deal with it.
Back in South Africa, however, our government is about to unveil a new National Strategic Plan that will see a projected R131bn spent over five years.
Thus, it appears, our government has made fighting Aids a priority.
This is a bold move that requires courage, commitment and a lot of health workers to implement it. It also requires some donor funds.
A huge obstacle to our HIV policy is that most people don’t realise that they have HIV until they’re sick. Yet scientists say the optimal time for HIV-positive people to go onto ARVs is when their CD4 count is 350 – in other words, before their immune systems are too damaged to rebuild.
In the Western Cape, Premier Helen Zille is trying to entice people to take an HIV test by offering R100 000 in prizes.
While this may well, for all the controversy, succeed in getting people to know their status, should they prove HIV-positive their prize might be a jail sentence.
“There is absolutely nothing wrong with society requiring people to know their status, and acting appropriately on the basis of that knowledge – or face the appropriate criminal sanctions,” says Zille.
Thus, Zille seems to be saying, if you are HIV-positive, know your status and infect a partner, you can be charged.
The responsibility for safe sex seems to lie solely with the HIV-positive partner, or rather the one who knows their status.
By trying to police the most intimate sphere of people’s lives, Zille is opening up a hornet’s nest and she can get stung by a range of things, including vindictive ex-lovers.
Her approach will inevitably, drive HIV-positive people underground. Why test if you can face criminal charges?
Yet if an HIV-positive person is on ARVs and has an undetectable viral load, they have a tiny chance of infecting anyone.
So the object of mass testing should not be to mete out punishment for the sexually active, but to encourage people to go onto ARVS when their CD4 count reaches 350 so that the community-wide infectiousness is reduced.
Aside from Zille’s questionable campaign, however, South Africa’s HIV epidemic has been stable since 2006 and our government is putting a sound plan in place.
Eighteen percent of the adult population is living with HIV, which is way too high, and every effort needs to be made to prevent new infections. – Health-e News Service.