Brian Hayward firstname.lastname@example.org
OVER the past 12 years the rate of new HIV infections in the Eastern Cape has almost halved, thanks in large part to a recent surge in coordinated efforts to curb the pandemic by churches, NGOs and various government departments.
Meanwhile, spending on HIV/Aids has increased in leaps and bounds, with the provincial Health Department quadrupling its budget to deal with the pandemic over the past five years, to R878-million for 2011/12.
According to the Actuarial Society of SA (ASSA), the projected number of new infections in the province for this year is about 49600, dramatically down from the peak of more than 93000 in 1999.
Provincially, deaths resulting from the pandemic are also down, at 22500 for this year compared with 32500 in 2005, although ASSA predicts that the number will increase to about 35000 annually by 2025 – a projection modelled on the population increase, and the uncertain long-term life-span of HIV patients receiving antiretroviral treatment (ART).
What the projections have not taken into account is the government’s widening of ART earlier this year. Instead of just treating patients with a CD4 count of 200 and under, it extended treatment to pregnant women and children, and people with a tuberculosis/HIV co-infections, all with a CD4 count of 350 and below. This move could drive down the country’s infection rate, as well as the number of people dying from Aids, say researchers.
Nationally, according to ASSA, almost 188000 people will have died from HIV/Aids this year – roughly 515 people a day, or 21 people every hour.
“One major advance which we had this year is that [most] HIV-positive people with CD4 counts of 350 or lower are starting to be treated,” said Treatment Action Campaign (TAC) researcher, Marcus Low.
“That has been the major advance and something we have been campaigning for for a few years. Firstly, if you start [ART] earlier, your long term prognosis is better. The second thing is that [studies show] when an HIV-positive person is being treated, they are 96% less likely to infect their partner. What that [study] showed us is that providing treatment is an essential tool in preventing new infections.”
Low said that although the pandemic was stabilising, “it’s at an extremely high level”.
With 5.64-million residents living with HIV, South Africa is home to the highest number of HIV-positive people out of the global HIV-positive population of 34.6-million, according UNAids, a United Nations HIV/Aids watchdog.
“There’s a risk that when people hear the stats are a bit better, they think the fight is over, but that’s far from the case. One major issue is that even though we have about 1.5-million people [nationally] on ART, there are probably double that number who need treatment,” Low said.
“We need to deal with the human resource crisis, like the lack of nurses, doctors and community health workers. There is a push towards primary health care and having health teams [go out into communities to treat patients at home], but making it happen will take an enormous amount of will.”
Researchers believe that part of the reason the infection rate has declined is because of a successful NGO and government HIV/Aids awareness campaign.
The health department said it was spending R2.9-million on HIV/Aids awareness campaigns in the media during 2011/12, while the Education Department has spent R19-million on its HIV/Aids life skills programmes for schools in 2010.
Around the country, the government has spent more than R100-million on HIV/Aids awareness, although this excludes money spent on peer educators or mass media campaigns.
Researcher at health watchdog Section27, Dagan Eagar, said although some programmes had worked, the province had underspent its HIV/Aids budget by 11% – the highest underspending countrywide.
“On the whole our response to HIV/Aids would not be as effective in the absence of these programmes. What we need to do, however, is establish what works and what needs to be improved upon.
Eagar said the impact of mass media campaigns were more difficult to determine.
“My sense is that some have been effective in conveying information and educating people about HIV, but have been less effective in actually changing behaviour. Behaviour change has been a real challenge which needs more than education. It requires an improvement in people’s living conditions and real opportunities to get out of poverty.”