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'Talk sense about Aids'
30/09/2008 08:33 - (SA)
Nathan Geffen
 News24 has asked me to say what's going to happen with the HIV epidemic in the next ten years. I'm not an investment banker or tarrot card reader, so I don't have any experience predicting the future. Instead I'll describe a future I'd like to see. I hope it's not unrealistically optimistic. I'll consider both HIV and TB because these two epidemics are so intertwined.
Politics
There will be a new Minister of Health. Almost everyday she will go on television and radio and tell people: "HIV causes Aids. Get tested for HIV and TB. Get treated at your public health facility. Use condoms."
She will work with doctors, nurses, scientists and activists to implement Aids policies informed by human rights and science. She will develop a human resources plan so that our public health system attracts many more health workers who do not feel burnt out and abandoned.
She will be more modest than her predecessors and genuinely consider advice and criticism. She will co-operate with the South African National Aids Council, UNAids and the World Health Organisation. When she speaks on international platforms, she will make us proud instead of cringe under our seats.
She will take action against the TB epidemic by improving health facilities so that TB is not so easily spread in them. She will make sure that patients with TB and HIV have a one-stop health-care service.
She will provide people with HIV a simple TB prevention regimen and invest in new drug and diagnostics development. She will make sure that patients who have to be isolated with drug-resistant TB are treated with dignity.
She will not simply pay lip service to HIV prevention. Instead, she will rescue the struggling mother-to-child transmission prevention programme from neglect. She will develop a groundbreaking programme that offers voluntary male medical circumcision, which reduces the risk of men contracting HIV.
She will work with the Ministers of Social Development and Finance to introduce a chronic disease grant. She will make sure it is advertised widely where women who have been sexually abused can receive help and post-exposure prophylaxis to prevent HIV transmission.
She will allow the Medicines Control Council to do its work independently of her and with sufficient resources. She will make sure that the numerous charlatans selling snake oils to people with HIV are put out of business.
She will make sure the targets of the HIV/Aids National Strategic Plan are met. Nearly everyone with HIV who needs treatment will get it by 2011. She will help bring down the price of the new one-pill-a-day antiretroviral regimen and introduce it into the Aids treatment programme. The president will support her and talk sense about Aids.
Science
There will be cheap and easy HIV viral load tests that don't need to be conducted in laboratories. Likewise with CD4 tests. We will learn how to use anti-retrovirals to prevent people from becoming infected with HIV, just as the pill prevents pregnancy.
We will find more accurate ways of measuring the HIV epidemic, particularly the number of new infections annually. We will find new more effective ways to reduce HIV infections.
Maybe - and this is very hopeful - by the end of the decade, anti-retrovirals will only need to be taken once a week, or even once a month. But I'm afraid even on my most optimistic days, I'm not hopeful about an effective Aids vaccine within a decade. Nevertheless, there should at least be some progress.
Scientists will develop at least two new TB drugs. They will also develop TB tests that tell you whether you have active TB within a few hours. Moreover, tests will quickly tell you what drugs will and won't work for you. The time to treat TB will be down to four months.
We all have responsibilities. Hopefully by 2011, nearly every person in South Africa will regularly find out his or her status and know the most essential information about HIV treatment and prevention.
Its realistic to say that we can turn around the HIV and TB epidemics, but it will need a large improvement in political leadership and hard work from all of us.
Nathan Geffen works for the Treatment Action Campaign.
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