Health

South Africa: HIV positive

30 November 2010

Even with all the money that has gone into finding a cure or at the least finding some surefire method of prevention, when it comes to HIV, we are essentially in the same place we were 10 years ago.

Written by Juliana Thornton, CSI practitioner at Tshikululu Social Investments and Joshua Murphy, who works with Medical Care Development International in KwaZulu-Natal.

There are an estimated 5.7 million people in this country living with Aids, more than any other country in the world. The most recent statistics of South Africa’s HIV/Aids epidemic from the annual HIV Antenatal Clinic Survey released this month is that our prevalence rate for pregnant women is “œstable” at 29.2%.

This means about 1 in 3 women walking into an antenatal clinic are HIV+, a condition which has major implications for their unborn children, if untreated. Prevention of mother-to-child HIV transmission through delivery of antiretroviral drugs can reduce the risk of HIV transmission to below 2%. But there are major gaps in delivery of this effective intervention.

To address this most clinics in South Africa now implement “œroutine testing” for all women – which means that if you are a pregnant woman in a public health clinic you will be given an HIV test in the same way as they normally test blood and urine. While some commentators have argued over the human rights aspects of this, and there is no doubt that with similarly high rates of gender-based violence in this country that a positive diagnosis may place women at risk, it is still imperative that we test and treat ALL pregnant women. Ideally clinics should also have in place strong referral mechanisms to social workers and even legal assistance.

Billions of dollars in international aid
Foreign governments, most notably America’s “œPresident’s Emergency Plan for AIDS Relief “œ(PEPFAR) has, since 2004 poured over a billion dollars of aid into this country in an attempt to stem the tide of rising infections, treat those already infected and provide care and support to affected children and family members. This does not include the huge amounts of money that have also come from charitable foundations such as the Bill and Melinda Gates Foundation, who have contributed considerable funding to vaccine and prevention research.

Current State of Research
So even with all the money that has gone into finding a cure or at the least finding some surefire method of prevention we are, essentially, in the same place we were 10 years ago. The surest method we have is using a condom for every sexual act. Most recently circumcision has been proven, through 3 independent randomized controlled trials in Kenya, Uganda and South Africa to reduce the risk of transmission by 50-60%. Condoms reduce your risk by 90%.

More recently, after a number of failed trials, there has also been some good news from vaginal microbicide gels (a gel that is inserted into the vagina prior to sex and which either kills the virus or prevents the virus from entering the bloodstream). This July CAPRISA, a South African research organization announced a 39% protection rate for the tenofovir gel. This microbicide is still years away from being released to the public and even then women would have to use it each and every time they had sex to ensure limited protection.

Government Efforts
While he has a checkered history in terms of sending the right message with regards to safe sex, Jacob Zuma has been publicly tested and has called for all South Africans to get tested and know their status on 1 December 2009 World AIDS Day. We are currently under a national campaign to test 15 million people by June 2011. King Goodwill Zwelithini supported the KZN provincial MEC expressing support for male medical circumcision. In short, there’s growing political support to de-stigmatise and address the epidemic. However the South African government has a dodgy history regarding HIV/AIDS denialism and while recent efforts are commendable they come too late.

What you can do
The bottom line is that we need to treat this disease as endemic. The same as we would treat TB or diabetes. We need to talk about it openly and encourage each other to get tested. HIV is 100% treatable and if you find you are positive you can still live a long healthy life, and you can have children who are HIV-.

You can get tested for HIV for free at any public clinic and at a number of NGOs around the country. You should talk to your children and friends about it. You should use condoms and encourage your children and friends to use condoms. This is not a disease that we can afford to be complacent or silent about. Moreover we cannot afford to continue to stigmatise friends and relatives with the disease.

Recent statistics have shown marginal decreases of HIV prevalence among teenagers and among pregnant women, we need to encourage this trend and continue to fight the disease, through open conversations, active testing and prompt medical treatment.