But Dr Thobile Mbengashe, Chief Director for HIV/AIDS in the health department, says that by going big, the NSP has the potential to halt HIV over a period of 20 years.
‘If we continue to implement the current narrow plan, we will double expenditure from R16 million to R32 billion by 2030. But infections and death will continue to increase so this is unsustainable,’ Mbengashe told a recent meeting.
‘But if we have a rapid expansion of services in the next five years and achieve universal access to prevention, treatment, care and support, we have the potential to halt the epidemic for the same amount of money,’ said Mbengashe.
Addressing the same meeting, Reverend Zwoitwaho Nevhutalu, acting CEO of the SA National AIDS Council (SANAC), said the plan is based on ‘key game-changers’.
‘Our interventions will focus greater coverage and improved quality. We are going to stop doing those small activities that don’t make a difference to the overall impact of HIV,’ Nevhutalu told the meeting.
The new NSP has very similar aims to the previous one, including:
- Halving the rate of new HIV infections
- Ensuring that 80% of eligible patients are on antiretroviral treatment (ART), with 70% of those who have started still alive and on treatment 5 years after initiation
- Halving the number of new TB infections and deaths
- Ensure that the rights of people living with HIV are protected
- Halving the stigma related to HIV and TB.
Provinces and government departments have until March next year to develop their own operational plans explaining how they will implement the NSP.
Aside from universal access to antiretroviral treatment, the plan aims to ensure all South Africans have ‘universal access to prevention’. This includes access to condoms, male circumcision (which cuts HIV risk by 60 percent) and any vaccines or vaginal gels that cut HIV.
By 2015, the aim is to have:
· 3 million people on ARV treatment
· 4.3 million men circumcised.
· mother-to-child HIV transmission reduced to two percent (now at around 4 percent) at six weeks and five percent at 18 months.
The plan targets ‘key populations’ most likely to get or transmit HIV. These include young African women aged 15 to 24, people living in informal settlements and close to main roads, young people who have dropped out of school, migrant populations and uncircumcised men.
Sex workers, estimated to account for almost one in five new infections, are also targets, as are men who have sex with men, who account for about one in 10 new infections.
Intravenous drug users, those who abuse alcohol and transgender people are also particularly vulnerable to HIV.
The plan also places heavy emphasis on testing for HIV and tuberculosis, stressing that everyone in the country should have access to annual tests.
The new plan concedes that the country’s HIV strategy has lacked ‘robust monitoring’, failed to develop a multi-sectoral response and hasn’t co-ordinated the efforts of the public, private and non-governmental sectors.
To remedy this, a special unit is going to be set up in SANAC to monitor implementation, based on a number of ‘core indicators’. These are based mainly on HIV infection rate of young people aged 15 ‘ 24, babies and ‘key populations’.