More needs to be done to reduce HIV and TB infection rates in SA

As South Africa celebrates World Health Day on Sunday, April 7, the fight against HIV/Aids epidemic and TB infection continues.

South Africa has the largest HIV epidemic in the world, according to UNAids, with more than 7.2 million people living with HIV.

As a result, the country also has the largest anti-retroviral therapy (ARV) programme in the world. Part of the efforts to ensure that infection rates decrease has been the treatment of those who are HIV positive to be exposed to ARV treatment.

The South African Medical Research Council (SAMRC) has over the years been a leading organisation in helping to reduce the prevalence of HIV and TB in the country.

Dr Fareed Abdullah, director of the AIDS and TB Research Unit, says that compared to a decade ago, there has been a significant decline in the mortality rates and a “large increase of more than ten years in life expectancy” in the country.

“Though the number of new HIV infections has also declined since the peak in 2003, we still have a high number of new infections. In 2017 alone, it is estimated that there were 270 000 new infections in South Africa and one third of these were in young women aged 15 to 24,” Abdullah told City Press.

According to an HIV household survey which was conducted by the South African Human Sciences Research Council in 2012, the prevalence of HIV infections in girls aged between 15 to 24 was five times higher than males in this age group.

Abdullah cautioned that more needs to be done to reduce infection rates.

“The trends described are in keeping with global trends and South Africa is not reducing new infection rates as quickly as other countries in the region such as Zimbabwe, Malawi, Zambia, Namibia and Mozambique. Much more needs to be done to reduce new HIV infections,” Abdullah said.

Due to the interventions which have been set up by the SAMRC, TB cases have also declined.

A Think Tank, which has been set up by the council together with the department of health, reviews TB research in the country and is aimed at the implementation of new drugs, diagnostics or vaccines which are developed for TB.

“The number of TB cases in South Africa is also declining. This is mainly due to the impact of antiretroviral treatment in patients who are HIV positive. HIV patients are at the highest risk for contracting TB and ARVs significantly reduced this risk,” Abdullah said.

In 2017 there were 322 000 new TB infections in the country, a number Abdullah says is too high to claim success.

The Aurum Institute, a non-profit organisation, has been providing HIV and TB treatment to communities in South Africa for 21 years.

CEO Professor Gavin Churchyard told City Press that through the institute’s work, they have over the years managed to identify barriers to treatment within communities and have worked around this to ensure that people from all walks of life are able to access treatment when it comes to HIV and TB screening at the various facilities.

“Through our Pepfar funded work we have provided support for the health system, strengthening it to better deliver for HIV, and even provide services and HIV-testing as well as circumcision services,” he said.

The institute has also provided medical male circumcisions in order to help prevent the spread of HIV infections, something that has seen great uptake, but was a challenge at first.

Some of the barriers Churchyard discussed included how men felt uncomfortable standing in a queue with adolescent boys who were waiting to be circumcised.

“Once we gave them their own space, they were much more likely to access circumcision services. For young women, there were barriers for them, so to create a facility that they could come to, and have their needs addressed is also very important,” he said.

Two HIV vaccine trials are currently underway, with the first set of results set to be released in 2021. HVTN 702 is a large-scale study that was launched in 2016 and is being led by SAMRC president Dr Glenda Gray.

Based on a study which was conducted in Thailand in 2009, it showed that a particular vaccine regime could reduce HIV transmission by 30%.

Read: Forward to major discoveries with new HIV vaccine trial

“HVTN 702 is testing a new vaccine candidate and is in the process of recruiting 5000 HIV negative participants into the trial. More than half of the participants have been recruited and the study is going well at more than 15 sites throughout South Africa,” Abdullah said.

Should the trial yield positive results, Abdullah says “it will change the face of the epidemic and lead to the reduction of hundreds of thousands of new infections in South Africa”.

The second vaccine trial is HVTN 705, known as “Imbokodo” and is being conducted on 2 600 women in southern Africa.

Abdullah says that efforts aimed at targeting young women with the management and delivery of HIV treatment and prevention programmes needs to be increased by government.

“The social drivers need to be addressed and gender violence in particular. There should be increased funding for HIV prevention technologies and interventions and more funding for improving our diagnosis, treatment and prevention for TB.

Statistics

• In 2017, there were 270,000 new HIV infections

• In 2017 110,000 South Africans died from AIDS-related illnesses

• In 2017 7.2 million people living with HIV

• In 2017, an estimated 280,000 children (aged 0 to 14) were living with HIV in South Africa, only 58% of whom were on treatment

• 61% of adults living with HIV were in 2017 on antiretroviral treatment

• 58% of children living with HIV were in 2017 on antiretroviral treatment

*Data from UNAids


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