a0dbf3d36703.jpgThe 2009 national antenatal survey shows that HIV prevalence in the country has remained constant over the last three years at around 29%. The Joint United Nations’€™ Programme on HIV/AIDS (UNAIDS) report, which shows the level of HIV infection around the world, also shows that South Africa has reduced new HIV infections by 25% over the last decade. But the war on AIDS is not over yet. While infection levels in the general population remain unchanged, certain groups such as women older than 30, men who have sex with men and injecting drug users still remain at greater risk of HIV infection.      

‘€œUrban data, for example in Zambia, suggest that 50% of people who are newly infected through heterosexual transmission actually acquired it within marriage or cohabitation and, indeed, in a whole lot of other countries we are seeing statistics of 60%, 55% where it’€™s among people who are cohabiting. Evidence also indicates that paid sex work, sex between men and use of contaminated needles by intravenous drug users are significant factors in the HIV epidemic in a number of countries ‘€“ even those with generalized epidemics. We still have pockets of key populations that need to be taken care of when it comes to access to treatment, care, prevention and support services’€, says Professor Shelia Tlou, Director of the Joint United Nations’€™ Programme on HIV/AIDS (UNAIDS).

Tlou also pointed out that many people still do not know their HIV status. This lack of knowledge poses a risk factor for HIV acquisition and transmission in relationships where partners don’€™t know of each other’€™s HIV status.

‘€œThe prevalence of sero-discordant (couples), that is, couples where one is positive, the other is negative is actually high in our region ‘€“ as high as 35% to 85% – hence, there is a need for couples’€™ counseling and testing. We have a large proportion of people who are in long-term relationships. We need to make sure that we have couples’€™ counseling and testing to ensure that they access services ‘€“ prevention, treatment, care and support’€, she said.

The discovery of new technologies, such as microbicides, is crucial to prevent HIV infection in women, added the Treatment Action Campaign’€™s Nonkosi Khumalo.        

‘€œIt’€™s one thing to be looking forward to as women because it puts power in our own hands. Availability of female condoms is still very, very low. Women still rely largely on whether their male counterparts want to use the male condoms that are largely available’€, said Khumalo.                

Deputy Health Minister, Dr Gwen Ramokgopa, urged South Africans to test for HIV. Currently, the government is running a massive campaign which began in April and will end in June next year to test about 15 million citizens.    

‘€œWe believe that knowing one’€™s status is the beginning of a sustainable prevention as well as treatment programme’€.

But as gains in HIV prevention and treatment programmes now start showing, concern abounds over AIDS funding.   Governments in Africa are not spending enough to deal with the challenge of AIDS, despite promises to increase their spending on health. For too long they have relied on donors, who are now holding their purses very tight.

UNAIDS’€™s Professor Sheila Tlou said: ‘€œThe AIDS response is fragile. It needs to be kept alive. It needs to be kept alive with funding. Domestic funding is still very low. A lot of our countries had said that they would devote, at least, 15% of their budgets to health and HIV/AIDS and very few countries in Africa have done so. However, we need to ensure that that investment is there. AIDS programmes can be made sustainable and affordable. We need to rely less on international donors. Right now we are estimating that $15. 5 billion was available for the AIDS response in 2009, but this was $10 billion short of what was needed. We need international funding, but we also need domestic funding’€.

The last decade has been characterised by the fight for access to AIDS treatment in poor countries. Now more than five million people are receiving life-saving antiretrovirals as a result. The fight these coming years should rightly focus on more access to treatment, but also on strengthening HIV prevention efforts. This will need money and our governments need to come to the party to continue the gains achieved in the response to AIDS.