‘It’s actually quite extraordinary that in 2004 we had only 47 000 people on treatment and that number has really increased. By mid 2011 we had 1.79 million people. It’s very difficult to conceive how many people 1.7 million people’¦ It’s almost a city’, is how Dr Thobile Mbengashe, head of the Health Department’s HIV/AIDS and STI’s unit, speaks of the strides the country has made to make AIDS treatment available up until 2011.
Mbengashe says the number has exceeded expectations of the 2007 ‘ 2011 National Strategic Plan on HIV/AIDS, TB and STIs, whose objective was to get 80% of all South Africans eligible for antiretroviral therapy on treatment.
‘We reached the target of the last NSP of putting 80% of all eligible South Africans on treatment. I think the most important thing is that we actually exceeded those numbers’, he says.
Of the 1.79 million people who are accessing antiretroviral therapy, about 61% are female. Mbengashe says it is of great concern that there are fewer men who access treatment.
‘Women come forward and they do respond to all our messages. But our biggest challenge is men. And one of the things, moving forward, is to find ways of finding men and actually bringing them forward so that they can actually get help’.
The remaining 8% of people accessing antiretroviral therapy are children under the age of 15 years. The majority of the people who have HIV and AIDS are in the provinces of KwaZulu-Natal and Gauteng. Mbengashe says the national AIDS response effort will improve going forward if the two provinces succeed in their respective plans to combat AIDS.
‘Gauteng, plus KwaZulu-Natal really constitute 56% of all the people who are actually living with HIV and AIDS. Both in terms of the people who are on treatment and the responses to the epidemic, what is absolutely very important with this is that if Gauteng and KwaZulu-Natal are not able to succeed all other provinces will not (be) able to achieve our objectives of reducing the infections’.
But while the country can boast reaching its targets for AIDS treatment, it cannot say the same about its track record in HIV prevention in the general population.
‘We had planned to reduce infection by 50%. At best we have reduced infections by 25%, which means, then, we still have a huge programme and a problem of really making sure that we are closing the tap. South Africa has the best possibility and a window of opportunity to make a difference in HIV/AIDS in the next five years’, says Mbengashe.
In hard economic times, it’s important to prevent new HIV infections so that the demand for treatment, which requires huge financial investments, is reduced.
‘Prevention remains the mainstay of the response to HIV. I’m looking forward to the day when we won’t be discussing shortages of ARVs because of our effective prevention programmes’, adds Dr Nomonde Xundu, head of the provincial Health Department in Gauteng province.
One area where the country’s prevention efforts have borne fruit, though, is in the prevention of HIV transmission from mother to child.
‘South Africa has actually reached what WHO calls elimination targets of having less than 5% mothers transmitting HIV to their children. This NSP says we should have less than 2% of mother-to-child transmission within the first six weeks of birth and, then, about 5% after 18 months’, Dr Mbengashe says.
The new NSP on HIV/AIDS, TB and STIs requires provinces to conduct HIV Counseling and Testing (HCT) campaigns. This is to prevent HIV infection and to absorb those who are found to have HIV into the health system so that they can start treatment early. Each province has different targets for this purpose. Dr Nomsa Mmope is head of the AIDS programme in Gauteng.
In Gauteng, for example, says Dr Nomsa Mmope, head of the AIDS programme in the province, ‘when 2012 ‘ 2013 comes to an end, as the Gauteng province, we must have counseled and tested three million people’.
South Africa has the largest AIDS treatment programme in the world. Eighty-five percent of all South Africans who are on antiretroviral therapy receive it from government health services. About 11% are managed through the private health sector and 4% through various non-governmental organisations.