World AIDS Day 2009 will be remembered as the day that the AIDS denialism that has hampered the country’€™s response to AIDS was officially declared dead. Breaking away from the past, President Jacob Zuma led the commemoration of World AIDS Day and reassured the nation that government was earnest in its approach to dealing with the epidemic. Addressing a packed auditorium at the Pretoria Show-grounds, the president made four significant announcements.    

From now on all children under one year of age will get treatment if they test positive. All patients with both TB and HIV will get treatment with antiretrovirals if their CD4 count is 350 or less. TB and HIV/AIDS will now be treated under one roof. All pregnant HIV-positive women with CD4 counts of 350 or with symptoms, regardless of the CD 4 count, will have access to treatment. All other pregnant women not falling into this category, but who are HIV-positive, will be put on the treatment at 14 weeks of pregnancy to protect the baby.              

These policy changes will be implemented from April 2010.

The revised criteria for ARV treatment means that the country’€™s target of treating two million people with ARVS by 2011 will actually increase. But South Africa’€™s health care system is already under strain from a variety of diseases, not just AIDS. So, how will the country’€™s already struggling health system cope with the increasing AIDS demand?

‘€œWe don’€™t have any option. We just have to build that capacity because the alternative is too ghastly to contemplate,’€ states Health Minister, Dr Aaron Motsoaledi.

 ‘€œYes, I know, in terms of the SANAC Strategic Plan we need to cut the rate of infection by 50% by 2011 and 80% of people who need ARVs need to be covered. That is like climbing Mount Everest. We have got no option, but to climb. I know that there are people who climb Mount Everest for recreation, but in our case in South Africa, we are going to have to climb it for survival because if we don’€™t do so, the country won’€™t survive’€ he continues.      

Added to insufficient institutional capacity to provide services is the problem of finances. Recently, the country’€™s ARV programme almost collapsed because of a R1.2 billion shortfall to purchase drugs. Now the new treatment protocol obviously means that more patients will need treatment, which in turn means that the budget allocation for ARVs will also balloon. Asked where the money will come from for this project, the Minister said:  

‘€œI’€™ll repeat’€¦ It’€™s not as if we have any choice or any option where we’€™ll say we’€™ve got no money. If we don’€™t do anything, then it means we have chosen to succumb – and we can’€™t allow the nation to succumb. So, we are going to do everything in our power’€.

Senior policy advisor for UNAIDS’€™s eastern and southern Africa regions, Dr Mbulawa Mugabe, says South Africa can afford to put more people onto ARVs. However, he says, in the current economic climate, the country might not meet its obligations. Thus, the need for donor support is more crucial at this stage.

‘€œIn fact, if there’€™s a time that you need the donor community and everybody else to come to the party, it’€™s today’€, Mugabe says.

He called on foreign donors to honour their commitment to less developed countries to fund efforts towards reaching universal access to AIDS treatment. A number of key rich nations and donor agencies such as the Global Fund to fight AIDS, TB and Malaria and the American President’€™s Emergency Plan for AIDS Relief (PEPFAR) have either reduced or not increased their funding for AIDS services in the developing world.

In a twist of good fortune, however, the United States government, through PEPFAR, announced this week that it will give South Africa R900 million over the next two years for its treatment programme for AIDS.