Preventing new AIDS-related deaths and new HIV infections is at the heart of the new National Strategic Plan (NSP) on HIV/AIDS, TB and STIs, which came into effect at the beginning of April.
Over a period of eight years the number of South Africans receiving antiretroviral treatment in the public health sector has increased immensely.
“It’s actually quite extraordinary that in 2004 we had only 47 000 people on treatment and that number has really increased. By mid-2011, we had 1.79 million people. It’s almost a city. Tshwane has two million people – and that’s really the image that one needs to think about the response of government since 2004 in relation to dealing with the problem of HIV and AIDS”, says Dr Thobile Mbengashe, head of the HIV and AIDS programme in the national Health Department.
Mbengashe says the government will increase its budget allocation for ARV treatment to ensure that it covers 80% of people who need ARVs by 2016.
“This year alone, the government has spent over R5 billion just to manage the HIV programme and accessing treatment. In this current year we will spend another R6 billion. In the ultra year – over R8 billion will just be put on treatment”, he says.
Putting more people on AIDS treatment will help prevent more people from dying as a result of HIV infection. In Gauteng, for example, by the year 2010, deaths from AIDS-related complications had gone down by 20%. The reduction follows a period before the introduction of ARVs when AIDS was certainly a death sentence. Reverend Gift Moerane, a member of the Gauteng AIDS council, remembers a time when he buried hundreds of people in his community of Evaton, in the district of Sedibeng.
“Death from HIV and TB has reduced life expectancy in Gauteng to 57 years. You will remember how many people we buried in the past years and we were not sure whether life expectancy will end at 40. I know Evaton cemetery because I’m from Sedibeng… It was supposed to close in 2014, but it closed four years before that time because of the mortality rate in the area. And we had to ask the Sedibeng (municipality) to do a study on what causes death rates in that area and we established that it (AIDS) is really a serious problem and that gave rise to unscrupulous people who started to open mortuaries... business(es) of undertaking because they had business to conduct”, says Moerane.
He adds that some pockets of the church community need to be educated about AIDS and ARVs so that they could aid the country’s efforts in preventing AIDS-related deaths.
“There are some churches that are creating a crisis for us by encouraging people not to take treatment, promising that they will lay hands and, miraculously, people will be healed. And that, actually, we want to address. It is a fallacy to say when you lay hands on people they will be healed. HIV/AIDS has no cure. We know that very well”, he says.
Dr Thobile Mbengashe says prevention programmes also need to be strengthened. He says the last National Strategic Plan had set itself a target of reducing new HIV infections by half, but it failed to achieve that.
“At best, we have reduced infections by 25 %, which means, then, we still have a huge problem of really making sure that we are closing the tap. As we move forward, this NSP still makes a commitment to reduce new infections by 50%”.
The new NSP views medical male circumcision as one of the strategies that should be promoted to prevent new infections, specifically in men.
“This does not mean men shouldn’t be using condoms. The national government has made a commitment that between now and 2016, we should actually have over 4.3 million men circumcised. To date, we have about 400 000 people who have actually been circumcised in the programme”, says Dr Mbengashe.
He adds that condom use will continue to be promoted. This time it will also focus on older population groups where HIV infections are increasing – in part because people infected at a young age are living longer because of treatment. For instance, the latest antenatal survey measuring HIV levels shows that prevalence among older women between the ages of 30 – 34 is increasing. In 2009, HIV prevalence is this age group was 41.5 % and it grew to 42.9 % in 2010. Condom usage seems to be low in older age groups of men and women.
“Our biggest challenge is older men – over 50 year-old men - who actually still feel that they are not exposed to HIV and AIDS… they don’t have to use condoms. We really think that these are the people we need to capture and actually deal with them”, he says.
The NSP will also seek to reduce the levels of HIV transmission from mother to child to below 5%.