Integrated Regional Information Networks - December 1, 2011
EAST LONDON, 1 December 2011 (PlusNews) - South African
government has chosen World AIDS Day 2011 to launch its new
national strategic plan that, for the first time, will guide not
only the national fight against HIV but also tuberculosis (TB)
until 2016. The document contains several major policy changes,
including the immediate provision of lifelong antiretroviral
(ARV) drugs to all HIV-positive mothers and TB patients, as well
as a focus on positive prevention.
The new National Strategic Plan (NSP) for HIV and AIDS, sexually
transmitted infections (STIs) and TB 2012-2016, presented in the
seaside town of Port Elizabeth, is the product of months of
national consultations after a first draft was released in
The plan marks several firsts for South Africa: It specifically
includes TB, the leading cause of natural death, and is the only
HIV plan to have been at least partially costed prior to being
introduced. An estimated US$16 billion will be needed to
implement the plan in the next five years, to be sourced publicly
South Africa's largest HIV lobby group, the Treatment Action
Campaign, has welcomed the new plan, but raises concerns that it
has not yet been fully costed, particularly in areas with
difficult-to-discern price tags, such as human rights.
In a statement the group also calls for the plan to include the
decriminalisation of sex work - a promise made by government in
the previous national strategic plan, which expired in 2011.
Under the new plan, 400,000 HIV patients per year will begin
treatment. However, this goal may be in jeopardy in 2014 if
current budgetary projections hold true, according to the
treasury. A possible tax on financial transactions to help
generate funds is being considered.
Each of South Africa's nine provinces will now create operational
plans in line with the document. By mid-November, when the
national strategic plan was approved at a South African National
AIDS Council plenary meeting, at least three provinces - Eastern
Cape, KwaZulu-Natal and Northwest - had already started
developing their plans. Provincial plans, which will be launched
on 24 March 2012 to coincide with World TB day, will also be
costed before being implemented.
TAC says the new guiding document is symbolic of the shift in
South Africa's political will to tackle HIV. "Since the last
five-year plan, we have seen a revolution in the response to
AIDS," TAC said in a statement.
"South Africa started the last plan with Manto Tshabalala-Msimang
as Minister of Health and Thabo Mbeki as president. Although the
plan was adopted... some of the key interventions it proposed...
were delayed. For several years the roll-out of ARVs was kept as
slow as possible [and] preventable infections and deaths
continued. Five years later, all that has changed."
Then and now
An emphasis on TB/HIV integration, costing, and the introduction
of provincial operational plans are not the only changes in the
new national strategic plan. The creation of the document has
also been marked by an unprecedented level of civil society and
government consultation, resulting in two previous drafts.
Informed by the new investment framework released by UNAIDS, Know
Your Epidemic, as well as the country's previous strategic plan,
the new document includes a reduced number of key activities and
indicators. It is hoped that these will improve monitoring and
New goals include reducing TB-related deaths and halving HIV
stigma, which may be measured against a stigma index being
developed by South Africa.
The government estimates that about 70 percent of all TB patients
are co-infected with HIV. Given the high rates of co-infection,
the need to integrate HIV and TB services has long been a goal
for South Africa, but integration remains poor.
TB screening will now be included in prevention of
mother-to-child HIV transmission (PMTCT) services as one way of
reaching this goal. PMTCT services will also be integrated into
sexual and reproductive health services, alongside neonatal
circumcision of boys. Medical circumcision has been shown to
reduce a man's chances of contracting HIV by 60 percent.
The plan also includes mental health services, and palliative
care for HIV patients, who sometimes suffer chronic pain.
Finally, on the heels of a ground-breaking year in HIV prevention
research, the documents also stipulates that the government and
its partners should prepare to implement new, biomedical
prevention strategies once they have passed regulatory approval.
These measures include microbicides and the use of treatment as
prevention, in which HIV-positive partners are started on ARVs
early to reduce the risk of transmitting the virus to
HIV-negative partners, or high-risk HIV-negative people are put
on ARVs to prevent infection.