An expanded arsenal against HIV ‘€“ but money short to implement it

After years of toying with a baby’€™s preventative alphabet ‘€“ A for abstain, B for be faithful and C for condoms ‘€“ we finally have some grown-up options.

While modest, this array of new weapons against HIV gives us a fighting chance to stop the virus. The little arsenal goes like this:

  • Successful antiretroviral treatment makes HIV positive people with undetectable viral loads virtually non-infectious. This means that if we get as many positive people as possible on ARVs, this will have a massive impact on lowering HIV transmission.
  • Circumcised men have a 60 percent lower chance of getting HIV than uncircumcised men, hence government’€™s intention to give 4.2 million men the snip by 2015.
  • There are early signs that a vaccine might be possible. The Thai vaccine was only 31% successful, but at least it showed that the human immune system can be trained to defend itself against parts of the devious HI virus.
  • ARVS in a pill before sex reduced HIV transmission by 44 percent, according to a trial involving gay men taking Truvada (a combination of two ARVs) before sex.
  • ARVs in a vaginal gel may help to prevent women from getting HIV when used shortly before and after sex (although a big study in which the women used the gel every day instead of shortly before and immediately after sex, failed to confirm this).

These are based on medical interventions such as pills and cutting off foreskins rather than getting people to change their sexual behaviour, which hasn’€™t exactly been successful over the past decade.

It’€™s precisely the lack of trust scientists have in humanity’€™s ability to change behaviour that has made them so excited about the new opportunities being presented by the latest research.

Locally, our policy-makers have also finally realised that shunning groups at high risk of HIV ‘€“ such as men who have sex with men, sex workers and injecting drug-users ‘€“ is counter-productive if HIV is to be stopped.

Russia is an example of the futility of bureaucrats shunning groups they are not comfortable with. The country has spent loads of money on HIV over the past few years but with little effect because it has failed to target the population where most HIV transmission is occurring ‘€“ injecting drug-users.

After being ignored for years in official AIDS policies, gay men’€™s clinics have actually been set up on Cape Town and Soweto and are making a significant impact on preventing HIV.

But ironically, these medical advances and attitude shifts come when the world is stuck in a recession and we can’€™t get enough money to knock the virus out.

Ten days ago, the Global Fund to fight AIDS, TB and Malaria cancelled its next round of funding, citing cash problems. The fund currently supports 3.2 million people on ARVs through 510 grants worth $22-billion, mostly in Africa and Asia.

While the Fund has set up a transitional mechanism to help those who are already receiving grants until 2014, there is no guarantee that it can sustain its current grantees. Obviously no new grants are being given, so it is not possible to expand countries’€™ responses to HIV ‘€“ yet over seven million people still need ARV treatment.

Former UNAIDS envoy Steven Lewis, addressing Yale University this week, lashed the developed countries that support the Fund, accusing them of murder and racism.

‘€œHiding behind the banner of the financial crisis, the donor countries have clearly decided that if budgetary cuts are to be made, the Global Fund can be among the first to go,’€ said Lewis.

 ‘€œIt’s terribly important to recognize the moral implications. It’s not just the fact that people will die; it’s the fact that those who have made the decision know that people will die. How does that get rationalised?’€

Over two-thirds of those living with HIV are in Africa, prompting Lewis to ask: ‘€œDo [the donor countries] regard Africans themselves as casually expendable? Is it because the women and children of Africa are not comparable in the eyes of western governments to the women and children of Europe and North America? Is it because Africans are black and unacknowledged racism is at play? Is it because a fighter jet is worth so much more than human lives? Is it because defense budgets are more worthy of protection in an economic downturn than millions of human beings?’€

Jeffrey Sachs, professor of health policy at Columbia University and an advisor to the head of the World Health Organisation, accused the US government of a ‘€œcollapse of morality, decency, and common sense’€.

‘€œThe Obama Administration had pledged $4 billion during 2011-13 to the Global Fund, or $1.33 billion per year,’€ Sachs wrote in the Huffington Post this week. ‘€œNow it is reneging on this pledge. For a government that spends $1.9 billion every single day on the military ($700 billion each year), Washington’s unwillingness to follow through on $1.33 billion for a whole year to save millions of lives is a new depth of cynicism and recklessness.’€

So despite scientific advances offering the world the historical possibility of stopping HIV, without the necessary funds this possibility remains far off.

Back in South Africa, however, our government is about to unveil a new National Strategic Plan with a price tag of R131-billion over five years.

After doing the maths ‘€“ including factoring human lives into their equations ‘€“ our government has decided to go big as fast as possible to knock the virus on its head.

This is a bold move that requires courage, commitment and a lot of health workers to implement. It also requires some donor funds.

A huge obstacle to our HIV policy is that most people don’€™t realise that they have HIV until they’€™re sick. Yet scientists say that the optimal time for HIV positive people to go onto ARVs is when their CD4 count is 350 ‘€“ in other words, before their immune systems are too damaged to rebuild.

In the Western Cape, Premier Helen Zille is trying to entice people to take an HIV test by offering R100 000 in prizes in a lucky draw.

Although she has been widely condemned for doing so, the lucky draw doesn’€™t bother me if it encourages people to get tested for HIV and gets more people into treatment faster.

The part that bugs me, however, and takes us staggering backwards is what Zille aims to do to those who don’€™t test, or who know their status, then pass HIV on to others.

‘€œThere is absolutely nothing wrong with society requiring people to know their status, and acting appropriately on the basis of that knowledge – or face the appropriate criminal sanctions,’€ says Zille.

From what Zille is saying, if you are HIV positive, know your status and infect a partner, you can be charged. The responsibility for safe sex seems to lie solely with the HIV positive partner, or rather the one that knows their status.

By trying to police the most intimate sphere of people’€™s lives, Zille is opening up a hornet’€™s nest and she can get stung by a range of things including vindictive ex-lovers.

Her approach will inevitably, drive HIV positive people underground. Why test if you can face criminal charges?

Yet if an HIV positive person is on ARVs and has an undetectable viral load, they have a very, very tiny chance of infecting anyone. So the object of mass testing should not be to mete out punishment for the sexually active, but should rather be trying to encourage people to go onto ARVS when their CD4 count reaches 350 so that the community-wide infectiousness is reduced.

Aside from the Zille silliness, however, South Africa’€™s HIV epidemic has been stable since 2006 and our government is putting a sound plan in place.

But 18 percent of the adult population is living with HIV, which is way too high and every effort needs to be made to prevent new infections.


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    Health-e News is South Africa's dedicated health news service and home to OurHealth citizen journalism. Follow us on Twitter @HealtheNews

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