The ongoing stock-out of antiretroviral medicine is at the forefront of AIDS activists' agenda at the 6th South African AIDS conference, which opened last night (18 June).
Sibongile Tshabalala, the Gauteng chairperson of the Treatment Action Campaign (TAC), believes the conference will not achieve much if it doesn't look at the crises of treatment stock-outs and access to the so-called "3rd line" of treatment.
"We continuously see major stock-outs of HIV drugs in both Gauteng and the Eastern Cape, and I believe that priority should be given to addressing the causes," says Tshabalala.
"Treatment stock-outs have a major impact on treatment adherence, and if one is not taking their treatment properly, it is very easy to develop resistance to the drugs."
Another battle for people living with HIV is the access to 3rd line regimen and resistance testing, says Tshabalala. At present, the public health service offers two "lines" of treatment, the first line being the most common three ARVs and the second line offering a further three medicines to offer more alternatives for those who develop drug resistance or side-effects.
Tshabalala, who also works at a clinic, says she has witnessed many patients who are not responding on first line and second line regimen.
For the first time, South Africa has included the third line regimen into its 2013/2014 ARV tender.
"While we are happy that the new tender has included 3rd line ARVS for both adult and children, more attention to be paid on how they get to all the facilities in the country," says Tshabalala.
The conference's theme is "Building on Successes: Integrating Systems". The integration of tuberculosis (TB) and HIV services in public health is also important an important discussions for HIV activists.
"TB is still the number-one cause of death in South Africa, and this shows that major epidemic is TB and for us the most important discussion is how do we deal with both epidemics" says Dr Francesca Conradie, chairperson of the SA Clinicians' Society.
TAC researcher Simonia Mashangoane says the integration of TB and HIV services have been slow in many parts of the country.
"In a country where 70 percent of people who have TB are HIV positive, and where TB is the leading cause of death for people living with HIV, we need to accelerate the integration of these two epidemics," says Mashangoane.
"From this conference, we hope to see commitment from the Department of Health to increase its capacity to respond to and monitor stock-outs at both a national and provincial level," says Gilles Van Cutsem, Medicins sans Frontieres Medical Coordinator for South Africa.