AIDS

On 13th Aug 2009 the Rural Health Advocacy Project was launched at the University of the Witwatersrand in Johannesburg, coinciding with the launch of the Wits Centre for Rural Health. A renewed focus on access to health care in rural areas is vital in a context of worsening key health indicators in South Africa, a 34% national vacancy rate for doctors, and inequitable access to quality health care.

A commentary by David Patient- Person living with AIDS since his diagnosis with GRIDS back in March, 1983.

Venu: ICC, Durban

Our theme this year: Scaling up for success recognises that there is an urgency to take stock of best practices in treatment and prevention and to scale these up sufficiently to begin to roll back the onslaught in numbers and impact that the epidemic is currently waging in Southern Africa.

HIV is thought to have a kill rate of close to 100%, higher than even the notorious haemorrhagic diseases such as Ebola. But, unlike such virulent attackers, HIV kills its hosts through a steadily attrition of the immune system, giving ample time for new infections to occur. The result is a slow-burning epidemic steadily destroying lives and eroding South Africa's development potential. HIV/AIDS was regarded as effectively untreatable in South Africa. The drugs were too expensive: Supreme Court of Appeal Judge Edwin Cameron had to have financial help to afford the antiretrovirals that have now kept him alive for so many years. Effectively, antiretroviral therapy (ART) was seen as something for the wealthy elite - and, so the argument went, even if it were affordable, then poor and unsophisticated people were unlikely to be able to take it properly.

It is a truth universally acknowledged, that a country in possession of economic growth will find the health of its citizens improving. But almost uniquely, South Africa's growing financial strength has been accompanied by a fall in key indicators of health. The tie between health and wealth has held true for most of the world, and for as long as there appear to have been economists to notice it. Wealthier countries tend to be healthier at least until they start to encounter the diseases of affluence such as obesity. In South Africa, and some other surrounding countries, this link has broken. South Africa's Gross Domestic Product per capita has increased by an average of 3% per year for the last decade. Yet the most obvious indicators of health are falling. The easiest way to get snapshot of a nation's health is to look at key indicators: life expectancy at birth, maternal mortality and infant mortality. These are such fundamental markers that they were written into the Millennium Development Goals (MDGs), which South Africa signed in 2000.

Rarely in South Africa can a minister have come to power carrying such a weight of expectation as Barbara Hogan. Her first major public speech at the Aids Vaccine Conference in Cape Town in October was greeted with enthusiasm, and even international delegates speculated about the bright future that seems to lie ahead at last for South African healthcare. Her speech was reminiscent of one of those games where one has to bash crocodiles on the head as they pop up apparently randomly through holes in the floor. Politely, and without naming names, Hogan took a baseball bat and bashed all the major crocodiles on the head: Matthias Rath and his vitamins, for instance. Most of all she asserted the fact that HIV causes Aids.

With just a few months to do the job before the next general election, the new Minister of Health, Barbara Hogan, has her job cut out for her and she is quick to admit that its a tough job ahead one fraught with problems. The Health Minister position has mostly been controversial, largely because of the countrys less than impressive track record in dealing with the issue of HIV/AIDS. Remember the Sarafina! and Virodene scandals under Nkosazana Dlamini-Zuma, the first Health Minister in post-apartheid South Africa? The less said about the shenanigans of her successor, Manto Tshabalala-Msimang, the better. Barbara Hogan, the third Health Minister since 1994 has inherited a legacy that she does not want to continue and there is very little time to prove herself. During this period, she says, her main focus is on two priorities.

More than 330,000 lives were lost to HIV/AIDS in South Africa between 2000 and 2005 because a feasible and timely antiretroviral (ARV) treatment program was not implemented, according to researchers from the Harvard School of Public Health. The study was published online by the Journal of Acquired Immune Deficiency Syndromes (JAIDS). In addition, an estimated 35,000 babies were born with HIV during that same period in the country because a feasible mother-to-child transmission prophylaxis program using nevirapine (an anti-AIDS drug) was not implemented, the authors write. The paper estimates the consequences of the HIV/AIDS policies followed by the South African government for a five-year period when neighboring countries ramped up their HIV-prevention programs. The paper may have broader implications for the evaluation of consequences of public health programs.

AIDS activists are hoping that the country's new administration will make good on promises to urgently improve access to affordable HIV/AIDS treatment and services at state hospitals. The country's three political parties - ZANU-PF and the two factions of the majority Movement for Democratic Change (MDC) - signed a power-sharing deal on 15 September, ending one of the worst periods of inter-party political violence since Zimbabwe gained independence in 1980. Despite scepticism that the three parties will be able to work together, the deal has brought hope to many ordinary Zimbabweans, particularly those living with HIV, who have been battling to cope in the current harsh economic and political environment. Of the estimated 320,000 people in need of antiretroviral (ARV) treatment, only about 100,000 are accessing the medication at public health facilities. Besides the treatment gap, government hospitals are struggling to deliver services in the face of shortages of drugs, medical staff and foreign currency.

This is a fixed term position for an initial period of 2 years, renewable based on performance and availability of funds.