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South Africa's HIV/Aids battle plan

On World Aids Day, 1 December 2009, South African President Jacob Zuma took the lead in the fight against HIV/Aids in the country, announcing bold and life-changing policies for people living with HIV/Aids.

The government's new, scaled-up HIV/Aids prevention and treatment plan aims to reduce the rate of infection in the country by 50 percent by June 2011, while providing free antiretroviral (ARV) treatment to 80 percent of those who need it – a major extension to an ARV programme that is already the biggest of its kind in the world.

Finance Minister Pravin Gordhan, in his Budget speech in February 2011, said government expenditure on its comprehensive HIV conditional grant would amount to R26.9-billion over the next three years, based on an increase in the number of people on antiretroviral treatment from 1.2-million in 2011 to 2.6-million in the next two years.

The scaled-up HIV/Aids plan places more emphasis on prevention through a range of measures, including the mobilisation of all South Africans to know their HIV status, coupled with promotion of behavioural change through extensive awareness campaigns, as well as:

• Male medical circumcision.
• Widespread condom distribution.
• Prevention of mother-to-child transmission.
• Early treatment of sexually transmitted infections.
• Post-exposure prophylaxis for survivors of sexual assault.

New treatment protocols

Following President Zuma's announcement, South Africa introduced new HIV/Aids treatment protocols in April 2010 in terms of which:

• HIV-positive pregnant women, and people co-infected with TB and HIV, now receive free antiretroviral (ARV) treatment at CD4 counts of 350 or less. (Previously, state-sponsored treatment was available only when one's CD4 count was less than 200.)
• Antitretroviral treatment for prevention of mother-to-child transmission of HIV now starts at 14 weeks into pregnancy, instead of only during the last term of pregnancy.
• Infant children of HIV-positive mothers are now treated regardless of their CD4 count.

All public TB treatment sites in South Africa now also have to test and treat for HIV, and vice-versa – recognition of the fact that approximately one percent of South Africa's population suffers from TB, while the co-infection rate between TB and HIV/Aids stands at around 73 percent.

"TB and HIV and Aids will now be treated under one roof," Zuma said in announcing the new policy. "This policy change will address early reported deaths arising from undetected TB infection among those who are infected with HIV."

The plan also places increased emphasis on reducing the rate of mother-to-child transmission of HIV/Aids. The government now integrates all aspects of its HIV programme with its maternal and child health programme, and campaigns vigorously for women to report for ante-natal visits as soon as they suspect that they are pregnant in order to do the necessary tests on time.

HIV Counselling and Testing campaign

In April 2010 the South African government launched its HIV Counselling and Testing campaign, which offers free testing to all patients at public hospitals and clinics across the country, with the aim of getting up to 15-million South Africans tested by June 2011.

The campaign seeks to promote voluntary HIV counselling and testing, encouraging all South Africans to know their HIV status and to be screened for tuberculosis (TB) at the same time.

While providing people with the information and interventions they need to manage their health and to prevent further HIV transmission, the campaign aims to ensure that people in need are fast-tracked onto the treatment programme.

It also seeks to raise awareness of the issues around HIV/Aids, foster a culture of collective responsibility among South Africans, and remove the social stigma attached to HIV/Aids.

In February 2011, Health Minister Aaron Motsoaledi announced that more than six-million South Africans had so far been tested since the launch of the campaign.

Motsoaledi said the government had reached out to 6 2087 157 South Africans since April 2010, with around one-million testing positive – constituting an 18% prevalence rate.

"The HCT campaign will be accelerated and extended to all sectors in 2011," the minister said. "It will be extended to universities, to schools, to farms, villages, major factories and industries like mining.

"We want, during that period, sustained discussion and mobilisation so that people can get used to testing, and at the end of that period, we want them to continue testing.

"That's why we are insisting that every health facility must be able to provide this service. We want people to test as many times as possible."

Male medical circumcision

Starting in April 2010, South Africa's nine provinces launched ongoing campaigns to promote and conduct male medical circumcisions, with KwaZulu-Natal taking the lead – by February 2011, over 17 000 circumcisions had been conducted in that province alone.

According to the World Health Organisation, there is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by up to 60 percent.

According to Health Minister Aaron Motsoaledi, the campaign has added benefits: "A lot of counselling of the young men takes place there, with traditional advice imparted to the young people, together with the technical aspect of HIV/Aids on male and female sexuality."

One the points strongly emphasised is that condoms should be used regardless of circumcision, with the Health Department continually increasing access to free condoms at public health facilities and other public centres. Between April 2010 and February 2011, over 400-million male condoms and over four-million female condoms had been distributed countrywide.

SAinfo reporter