Public health improvements over the last few years have been impressive, especially in the area of HIV management. On the other hand health systems have also reached a crucial turning point. Despite unprecedented advances in providing the much needed antiretroviral treatment to people living with HIV, we need to ensure the AIDS epidemic does not 'ruin the realization of our dreams'.
When, on 19 November 2003, the late former health Minister Dr Manto Tshabalala Msimang officially announced the adoption of the Operational Plan for Comprehensive Treatment and Care for HIV and AIDS; it marked progress in the fight against HIV and AIDS in South Africa. To many, this represented the logical phase in civil society's struggle for the provision of ARTs.
This year marks a decade since government announced the national antiretroviral treatment (ART) programme - which was launched in April 2004 - as such we need to celebrate the achievements that we have made thus far. Most importantly, we must convey national gratitude to the heroes and heroines who have continuously provided a humane and responsive service.
But the history of HIV and AIDS in South Africa was perhaps the most controversial of any country. International observers described it as 'littered with examples of government inaction and harmful interference, pseudoscience, and conflict between politicians, HIV/AIDS organizations and scientists'.
What most usually miss in this sort of characterization is the admittance that the late eighties and early nineties was a period which saw the first steps of a more rational, coherent response to the epidemic. The Maputo Statement on HIV and AIDS in Southern Africa was issued following the 1990 Fourth International Conference on Health in Southern Africa, which brought together ANC representatives, other anti-apartheid figures and health workers as well as those involved in tackling the epidemic in other countries. The document outlined the necessary features for tackling the epidemic including a focus on prevention and the rights of infected individuals.
At this meeting, the late General Secretary of the Chris Hani and Chief of Staff of uMkhonto weSizwe said: "We cannot afford to allow the AIDS epidemic to ruin the realization of our dreams."
Let us also convey our gratitude to the pioneers who started the first project to routinely offer ART in the public sector and on a district-wide basis in South Africa which was started in 2001 as a partnership between the provincial government and Médecins Sans Frontières in the Cape Town township of Khayelitsha. At that time, several local clinicians had already been involved in ART provision through clinical studies and private funding and were able to support this and subsequent initiatives. These early sites can be considered as “innovator sites” in as far as they were able to grapple with many of the logistics of setting up services in anticipation of a more rapid scaling-up of ART services. By the time the national programme was launched in South Africa in April 2004, there were 16 discrete sites offering ART in the province, eight of which were in primary care.
We cannot forget to mention the thousands of forceful campaigns in favour of the provision of antiretroviral drugs widely lauded and even credited with the dramatic policy turnaround in South Africa. The history of the civil society movements on the ART issues has been one of refusing to accept that ‘it can’t be done’ and leading the country towards taking the bold steps necessary to combat the unprecedented threat of HIV and AIDS. For that we are dearly indebted!
In the spirit of the statement by the late Chris Hani, President Zuma giving a speech in October of his first year of Presidency acknowledged that HIV and AIDS is one of the two most important challenges in South Africa. In his speech he said; “We need to move with urgency and purpose to confront this enormous challenge…most importantly, all South Africans need to know their HIV status, and be informed of the treatment options available to them."
His leadership has been described as 'exceptional' by UNAIDS. He has been credited for leading the country towards a scaled up provision of state-sponsored antiretroviral therapy by 75% between 2009 and 2011, ensuring that 1.7-million people had access to the life-saving treatment.
In July 2012, the Health Minister Dr Aaron Motsoaledi announced that there had been an increase in the number of people receiving free antiretroviral treatment, with 20% more people living with HIV having been put on treatment between 2010 and 2011. Speaking at the launch of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2012 Global Aids Report in Pretoria he told journalists gathered there that South Africa had "significantly increased the number of new patients on ARV treatment - an additional 300 000 patients on treatment - between 2010 and 2011". The number of people receiving ARTs in South Africa stands at over 2 million, over 900 000 of these in the Gauteng Province.
On the 1st of April 2013, the public health service will have commenced with a fixed-dose combination drugs. It said clinical studies had shown that fixed-dose combination drugs (FDCs) improved patients' treatment adherence, which would improve treatment outcomes and reduce onward transmission of HIV. FDCs would also make prescribing, dispensing and monitoring treatment easier for nurses and pharmacists, while simplifying procurement and supply chain management. Furthermore; South Africa had managed to reduce the cost of the FDC tender by 38%, a massive saving of R2.2-billion.
Studies measuring changes in adult life expectancy between 2000-2011 for 101,000 individuals living in rural KwaZulu-Natal showed that in 2003, the year before ART became available in the public-sector health system, adult life expectancy was only 49.2 years. A mere 8 years later in 2011, adult life expectancy increased to 60.5 years: that’s an extra 11.3 year gain. This gain in adult life expectancy signify the social value of ART and has implications for the investment decisions of individuals and governments.
Indeed, the milestone marking the start of the ART programme deserves a celebration and renewed commitment. At this juncture, South Africa is facing up to the necessary challenge of finding greater resources for the epidemic. Understanding that Public health is influenced by a complex interplay of physical, social, economic, cultural and environmental factors, it is therefore important that it is seen in a broader context, with all stakeholders involved.
There is a need for health systems not only to provide universally accessible, effective and scientifically sound health care, but also to ensure that services are designed and delivered in ways that respect people’s rights, needs and preferences for information, psychosocial support and participation in decision-making for their own health and health care. The need for innovative, balanced, and holistic approaches have become a matter of urgency for ART provision.
Let us all use this moment to be a source of inspiration and energy. When there are still those who say ‘it can’t be done’, we must stubbornly assert that it must be done. We must realise that it is morally, ethically, politically and even economically unsustainable for people living with HIV to have no access to the treatments that can save their lives. It is everybody's role to ensure that people living with HIV step back from the edge.
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