South Africa is sending a strong team, including two of the main speakers, to the 19th International Aids Conference (Aids 2012) starting in Washington, DC on Sunday, confident that it has one of the world's most comprehensive HIV prevention and treatment programmes - and that it is showing significant progress.
The largest and most important global gathering on HIV/Aids, the week-long, biennial International Aids Conference plays a key role in shaping the global response to HIV and in keeping HIV/Aids on the international political agenda.
Aids 2012 is expected to attract some 25000 delegates from around the world, including HIV professionals, activists, global and community leaders and people living with HIV.
Motlanthe to address two sessions
On Tuesday, the organisers announced its lineup of high-level speakers for the conference, with South African Deputy President Kgalema Motlanthe getting third mention after US Secretary of State Hillary Clinton and former US First Lady Laura Bush.
Motlanthe will address two special sessions at the conference. The first, "How do we get there? Country planning for maximum impact", takes place on Monday, while the second, "China, India, South Africa, Brazil: How will they use their leadership to advance the Aids response?" takes place on Tuesday.
South African Health Minister Aaron Motsoaledi will also address the conference.
Genuine opportunity to 'turn the tide'
According to Elly Katabira, international chair of Aids 2012, the conference theme of "Turning the Tide Together" emphasizes "how a global and decisive commitment is crucial to change the course of the epidemic now that science is presenting promising results in HIV treatment and biomedical prevention."
In the last few years various trials - in which South Africa played an important role - including HPTN 052, TDF2, Partners PrEP, CAPRISA 004, and iPrEx have demonstrated with solid evidence the efficacy of treatment as prevention, while other studies are currently investigating the possibility of a cure for HIV.
"Thanks to these scientific advances, for the first time we have a real opportunity to put a major dent on the epidemic," Katabira said in a statement earlier this year.
Aids 2012 US co-chair Diane Havlir said the conference offered a unique opportunity "to mobilize policy makers, governments, NGOs, scientists, people living with HIV and civil society to join forces.
"Even though we are currently going through a global turbulent economic climate, we cannot miss this historic moment, and it is vital to continue to attract funding and promote programmes based on effectiveness and efficiency in order to optimize the use of resources," Havlir said.
South Africa's bold policy shift
South Africa comes to Aids 2012 having made major progress in its HIV response, along with far-reaching adjustments to its policy on the epidemic, since the previous conference in Vienna in 2010.
In December 2009, under the leadership of President Jacob Zuma, the South African government shifted its basic policy stance towards HIV/Aids, massively expanding access to state-sponsored treatment, care and support for groups including pregnant women and HIV-exposed infants who tested positive at birth.
In December 2011, Zuma's administration went further, announcing a new national HIV/Aids plan that aims to drastically cut new infections by further extending antiretroviral treatment while, for the first time, tackling the epidemic together with tuberculosis (TB) and addressing related human rights and stigma issues.
Prevention is at the heart of South Africa's new National Strategic Plan (NSP) for HIV, sexually transmitted diseases and TB 2012-2016, which aims to reduce new HIV infections by 50% by taking a holistic approach, while tackling related issues of violence against women.
South Africa's HIV profile
The NSP responds, in part, to standout features of South Africa's HIV profile relating to women and HIV and TB co-infection.
According to Statistics South Africa, 16.6% of the country's adult population (aged 15-49) years was living with HIV in 2011 - an estimated 5.38-million people, including about one-fifth of South African women in their reproductive ages.
At the same time, South Africa has the third-highest level of TB in the world, after India and China. New infections have increased by 400% over the past 15 years, reaching 970 new infections per 100000 people in 2009.
About 1% of the South African population develops TB every year. In addition, more than 70% of patients are co-infected with both HIV and TB.
Research also shows that South Africa could often prevent HIV infections in young women if they were not subjected to violence and intimidation by their partners.
"Government is prioritising the fight against the abuse of women and children through law enforcement as well as education and awareness," Zuma said at the NSP's launch in December.
"We must also enhance our socioeconomic interventions to deal with poverty, unemployment, food insecurity, and inequality ... These either contribute to the spread of HIV or worsen the impact of the epidemic."
Tracking progress: HIV-related deaths
There are already clear signs that South Africa's NSP is having an impact.
Part of the plan is to provide free antiretroviral (ARV) treatment to 80 percent of those who need it by 2016, a major extension to an ARV programme that is already the biggest of its kind in the world.
The NSP recommends that all HIV-positive TB patients, irrespective of their CD4 count, and all infants under 24 months who test positive for HIV, be placed on ARVs. Infant children of HIV-positive mothers are treated regardless of their CD4 count.
Other treatment protocols, which have been in place since April 2010, include:
HIV-positive pregnant women, and people co-infected with TB and HIV, receive free antiretroviral (ARV) treatment at CD4 counts of 350 or less.
Antitretroviral treatment for prevention of mother-to-child transmission of HIV starts at 14 weeks into pregnancy, instead of only during the last term of pregnancy.
In 2004, approximately 47 000 South Africans were on state-sponsored ARV treatment; by mid-2011 this had increased to 1.79-million people.
The number of public facilities providing comprehensive ARV treatment has increased from 490 to over 2000 countrywide, while more than 1 750 nurses have been trained on nurse-initiated and managed ARV treatment.
The increase in treatment has been accompanied by a reduction in the number of people dying as a result of HIV infection. By 2010, HIV-related deaths in Gauteng, the country's most populous province - where life expectancy is 57 years - had dropped by 20%.
Mother-to-child transmission rates down
There is a strong emphasis in the NSP on reducing the rate of mother-to-child transmission of HIV/Aids.
The government now integrates all aspects of its HIV programme with its maternal and child health programmes, and campaigns vigorously for women to report for ante-natal visits as soon as they suspect that they are pregnant in order to do the necessary tests on time.
According to the Medical Research Council, studies on prevention of mother-to-child transmission of HIV show the rates of transmission from mother-to-child have been reduced from around 10% to 3.5% nationally.
HIV Counselling and Testing campaign
In April 2010, the government launched its HIV Counselling and Testing campaign, which offers free testing to all patients at public hospitals and clinics across the country.
The campaign seeks to promote voluntary HIV counselling and testing, encouraging all South Africans to know their HIV status and to be screened for TB at the same time.
While providing people with the information and interventions they need to manage their health and to prevent further HIV transmission, the campaign aims to ensure that people in need are fast-tracked onto the treatment programme.
It also seeks to raise awareness of the issues around HIV/Aids, foster a culture of collective responsibility among South Africans, and remove the social stigma attached to HIV/Aids.
By mid-2012, Health Minister Aaron Motsoaledi announced that almost 20-million South Africans had been tested knew their status. Millions has also been screened for TB.
Male medical circumcision
According to the World Health Organisation, there is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by up to 60 percent.
South Africa first launched its ongoing campaign to promote and conduct medical circumcision in April 2010. Since then, about 250000 men have been circumcised. The target for 2016 is to have more than 4.3-million men circumcised.
Health Minister Aaron Motsoaledi has said that the campaign has many added benefits: "A lot of counselling of the young men takes place there, with traditional advice imparted to the young people, together with the technical aspect of HIV/Aids on male and female sexuality."
One of the points strongly emphasised is that condoms should be used regardless of circumcision, with the Health Department continually increasing access to free condoms at public health facilities and other public centres.