HIV/AIDS remains by far the biggest killer of South Africans, but there seems to be an assumption in many sectors ‘€“ the media included ‘€“ that President Zuma’€™s government has it under control so we can move on.

But while the beetroot-mad old guard have left the centre stage, government is very far from being in control of the epidemic and needs all the help it can get.

Last year, 43% of South Africans who died ‘€“ over 280 000 people ‘€“ were killed by an AIDS-related infection.

In Vulindlela, a semi-rural area in KwaZulu-Natal’€™s Midlands, two-thirds of the women are HIV positive by the age of 30. Public hospitals in Durban and Pietermaritzburg report that over half the women who give birth are HIV positive.

In Johannesburg General Hospital, the majority of babies who die in the neonatal ICU are HIV positive.

We are very far from turning the tide of the epidemic because we are failing to stop new infections.

Our prevention efforts aren’€™t big enough, bold enough or consistent enough. We still have a high teen pregnancy rate, which obviously means lots of unprotected sex, despite the fact that an entire school subject, life skills, is supposed to help prevent just this.

But instead of focusing on prevention, we keep thinking that we can treat our way out of the epidemic with antiretroviral medication.

The plain, ugly truth is that we can’€™t. We are going to run out of money for ARVs if people keep getting infected at the current rate. Last year, an estimated 370 000 people over the age of 15 and 40 000 children were infected with HIV. More people are getting infected every year than are getting treated and as our treatment programme grows, so too will problems of drug resistance and negative side-effects grow.

This year’€™s budget allocated a conditional grant of R26.9-billion to the country’€™s ARV treatment programme, which is almost a quarter of the current health budget. About 40% of this will go to buying ARVs.

But scenario planning by Treasury indicates that the demand for ARV treatment and care will only peak in 2021, meaning that spending will go up every year until then. The Treasury estimates that we will need an additional R2-billion every year until 2021 just for ARVs.

Treating only those who are currently infected for ten years will cost in excess of R400-billion at current drug prices.

At the same time, donor funding is drying up. In the 2009/10 budget year, the US President’€™s Emergency Plan for AIDS Relief (Pepfar) donated over R4,3-billion to our treatment programme, while government’€™s total contribution was R5-billion, according Treasury official Dr Mark Blecher.

This means that almost half of the cost of our treatment programme comes from Pepfar, which pays for the salaries of doctors and nurses running treatment centres and clinics, as well as ARVs.

Yet Pepfar donations are flatlining, while other donors are cutting funding ‘€“ some drastically. The effects are already being felt. New Start, which provides HIV testing and counselling, is closing its Durban and Cape Town offices and retrenching staff. New Start has been playing a pivotal role in the health department’€™s HIV Counselling and Testing (HCT) campaign, which aims to test 15 million people by next month (June 2011)

Another donor organisations, Care International, which supports HIV/AIDS orphans, recently pulled out of the Motheo district in the Free State.

In 2013, there are rumoured to be further significant cuts to Pepfar.

At the same time, renewed effort is needed to meet the country’€™s target of getting 80% of those who need ARVs onto treatment by 2012. Last year, there was already a backlog of about 600 000 people.

Any complacency about South Africa being on top of the epidemic is thus misplaced.

The biggest challenges remain to prevent new infections, ensure that those who need treatment are able to get it and to combine HIV and TB treatment, as over 60% of those living with HIV are also infected with TB. Groups with high prevalence of HIV but who have been neglected until now, such as gay men and older women, need to be brought into national prevention campaigns.

At the moment, our health system is not up to the challenge ‘€“ something that health Minister Dr Aaron Motsoaledi is acutely aware of.

Government’€™s HIV/ AIDS and TB communication campaign, Khomanani, is also defunct but was very ineffective in the past two years anyway ‘€“ despite being allocated large amounts of money.

Our HIV/AIDS national strategic plan comes to an end this year and as a new plan is drafted, new partnerships to prevent HIV, as well as new strategies to fund our campaigns, are urgently needed.

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http://www.lovelife.org.za/research/30_annivesary_web.pdf  or http://www.lovelife.org.za/research/conferences.php.