A woman uses an oral test for HIV. File picture: Jacquelyn Martin

Cape Town - Once upon a time, being HIV-positive in South Africa was like a death sentence, with no adequate treatment available and a huge stigma attached to the disease.

But Aids experts all agree that the country has made great strides since antiretrovirals (ARVs) were introduced almost a decade ago.

Today, the country has one of the largest anti-Aids programmes in the world, including an ARV programme with nearly 2 million people on it, an HIV counselling and testing campaign that saw more than 15 million people tested. Also, more than 600 000 males have been circumcised as part of the campaign.

But experts say challenges including a bubbling TB epidemic, side-effects of treatment and the HIV link to some non-communicable diseases remain a concern.

Professor Linda-Gail Bekker, the head of the UCT-based Desmond Tutu Foundation, said while “awesome progress” has been made on the treatment front, TB remained the biggest challenge that needed close monitoring to ensure that the gains made on HIV treatment weren’t lost.

“TB remains a significant and major challenge that we have just never got under control. There has always been a generalised TB epidemic prior to HIV infection and this has been fanned by HIV. We need new in-country solutions to this epidemic. We will still have a TB epidemic if we don’t tackle this in its own right,” she said.

Faiza Steyn, spokeswoman for the provincial Health Department said almost 50 000 people in the Western Cape had active TB with about 38 percent co-infected with HIV.

About 1 250 cases of multi-drug resistant (MDR) TB are registered in the province, including 160 cases of extremely-drug resistant (XDR) TB.

Bekker said another gap was in the country’s sexual and reproductive health with a lack of school health such as testing, frank sexual counselling and adolescent programmes including cervical cancer screening and vaccination.

While South Africa needed to be commended for its work on HIV/Aids, huge gaps needed to be addressed.

“Challenges continue to exist in reaching out to older South Africans to encourage them to prevent new infections and discourage the ‘sugar daddy’ and ‘sugar mommy’ syndromes. There is also a need to focus on HIV and non-communicable diseases.

“This is a neglected area because South Africa is experiencing these dual epidemics [HIV and TB].”

Mark Heywood, director of Section 27 and executive member of the Treatment Action Campaign, said: “There is no doubting significant progress. In South Africa, as in the world, strides have been made.

“The 2012 Aids landscape is unrecognisable from that of 2000. There now exists an armoury of interventions for combination HIV prevention including condoms, medical male circumcision, post- and pre-exposure ARV prophylaxis of ARVs. The problem, however, is that human behaviour remains stubborn and complex.

“The take-up of HIV prevention cannot be demonstrated with the same confidence that we have seen in the take-up of ARV treatment,” he said. Heywood also raised concerns about the continuation of certain ARVs such as Stavudine (d4t), which had adverse side-effects. - Cape Argus