31 Aug 2006: ISS Today: ANC: Aids Struggle not Helped by Climate of Discord

25 August 2006: ANC: Aids Struggle Not Helped By Climate Of Discord
Mail & Guardian

Whatever criticisms anyone may have of South Africa’s policies on HIV/ AIDS, whether valid or not, the current climate of heightened discord does not serve the interests of the common struggle against the epidemic.

 

Commentary

 

The explosion of issues relating to the treatment and prevention of HIV/ AIDS has cut to the core of civil society – government relations in an emerging democracy. Civil society, in this instance the Treatment Action Campaign (TAC), has placed public pressure, both locally and internationally, on government to deliver on the prevention and treatment of HIV/AIDS. Government, in turn, has become more defensive and seems unable to clearly articulate what their comprehensive plan for the prevention, treatment and management of HIV/AIDS is. At this point civil society and government seem to be poles apart on the issue, which will inevitably prevent the necessary co-operation between these sectors and lead to more confusion in the public arena. At the heart of the discord is a lack of strategy, on the part of both civil society and government, to effectively address the HIV/AIDS pandemic. This has shifted the focus (at least in the media) from addressing the constraints and acknowledging the successes in the fight against HIV/AIDS to that of personlised battles between TAC and the Minister of Health.

 

There seems to be three core issues, namely the prevention, management and treatment of HIV/ AIDS. On the prevention side, we have the infamous Love Life campaign, which sought to increase knowledge of high-risk behaviour through the mass media campaigns, life skills training in schools, voluntary counseling and testing, the prevention of mother-to-child transmission (PMTCT) and the use of post-exposure prophylaxis. The government has made impressive inroads in the PMTCT programme and it is reported that approximately 78.7% of pregnant HIV positive women received nervirapine in 2005 with 3064 facilities offering PMTCT services. Given the capacity and resource constraints faced by the national department, this is a noteworthy achievement.

 

In terms of the management of the disease, most contention surrounds the government’s approach to nutrition and life-style management as a means to prolong life. Of course, eating healthily, be it on a diet of garlic, lemons and beetroot, will not cure the disease. But as anti-retro viral prophylaxis (ARVs) can only be administered in patients with a CD4 count of less than 200, it is beneficial to maintain a healthy lifestyle and prolong the period before having to embark on extensive drug treatment. The department has failed to clearly articulate to the public that nutrition and lifestyle management is not a cure to HIV and has been severely criticized for this aspect of HIV treatment. As Dr. Kgosi Letlape of the South African Medical Association commented earlier this week, although the medical profession fully acknowledges the fact that optimal nutrition is important, the Minister’s emphasis of the exaggerated value of nutrition as a preferential means to manage and treat AIDS is confusing to a vulnerable public.

 

ARV role out has been an issue of public debate over the past few years. From civil society’s perspective, the government has failed to provide people with medical services that can save their lives. On the other hand, the government is severely constrained to provide these services. Of the approximately 600 000 people with AIDS-defining illnesses in need of anti-retro viral treatment (ART), about 200 000 are on ARVs through public and private facilities. The government estimates that by 2009 all South Africans who require treatment will have access to ARVs. The operationalisation of this goal has acute implications for the health system and can only be realized through improved human resource management, improved budgeting and expenditure management as well as addressing issues surrounding procurement and corruption in the health sector. A primary issue of concern remains human resources with only a quarter of facilities offering ART having the core team of professionals needed to administer the treatment.  

 

The HIV/ AIDS crisis cannot simply be solved through the increased role out of ARVs. The spread of the disease is far more dependent on changing social behaviour than medical treatment. Astonishingly, according to an HSRC study in 2005, 24.4% of respondents aged 15-24, disagreed that having fewer sexual partners could reduce the risk of HIV.  TAC estimates that 1000 new infections occur everyday and yet no party, from government or civil society, is clearly articulating a comprehensive plan of action to address the continuing spread of the disease. Nor are the parties seriously engaging on how we treat those infected with and affected by the virus, given our current fiscal and human resource imitations. Calling for the faster roll out of ARV’s in the absence of addressing prevention and management, is not the solution, nor is asking people to eat more lemons and beetroot. It is time to deal with the issues publicly and squarely and present a united front, responsibly informing the public on how to prevent, manage and treat the disease.

 

Lauren Hutton and Koko Sadiki, Southern African Human Security Programme, ISS Pretoria