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Putting a ring on it helps close HIV loop

<p>Kerry Cullinan</p>


June 25, 2013

Marriage apparently has a condom effect, with the HIV rate amongst married South Africans half that that of unmarried people.

Almost one-fifth (19.2%) of unmarried South Africans are living with HIV as opposed to 9.8% of married people. In addition, unmarried people were five times more likely to have had more than two sexual partners in the past year.

These findings were part of the Human Science Research Council's 2012 Household Survey, conducted nationally every four years, the highlights of which were released in the past week at the national AIDS conference.

Given that seven out of 10 South Africans over 16 (when marriage becomes legal) are unmarried, this is a challenge for government HIV experts.

The AIDS conference was in many senses a straw poll of Health Minister Dr Aaron Motsoaledi's four-year term in the ministry, but the significant national progress reported was partly undermined by ongoing provincial problems.

Concluded in Durban on Friday, the conference was told that over two million people were on antiretroviral (ARV) treatment by mid-2012. In addition, only 7.3% of young people aged 15-24 were now living with HIV, in comparison to 10.3% in 2005. These finding were also part of the Household Survey.

Releasing select survey highlights (the full report will only be ready in about eight weeks' time), HSRC head Dr Olive Shisana said "at last the glass is half full".

While the proportion of South Africans now living with HIV has increased from 10.6% in the 2008 to 12.3% in 2012, this is partly because people with HIV are on treatment and living longer.

This is supported by HIV prevalence which now peaks five years later for men and women than in the three previous surveys, indicating that the worst-affected age groups of years gone by are alive and aging.

The highest HIV prevalence rate in women is now in the 30-34 age group (36.8% living with HIV) and in men aged 35-39 (24.2%).

"I am pleased to see that more people with HIV are living longer because of the large ARV treatment programme of government. I am equally delighted to see that there has been a decline of HIV prevalence among youth aged 15 – 24 years," said Shisana.

The start of the long-awaited AIDS vaccine trial to be headed by Professor Glenda Gray was also announced at the conference.

Since a vaccine trialed in Thailand was found to be partially effective in 2009, offering 31% protection after a year, South Africa has been in line to test the vaccine further. There is some skepticism about whether the Thai vaccine will work in places with a high HIV rate, which made South Africa the right place to test it further.

Delayed in part by the mammoth cost of the 10-year study (around R1.2-billion), Prof Gray announced that it had finally started this week with safety trials on around 100 volunteers in Soweto, Cape Town and Klerksdorp. Should it prove safe in South Africa (and there is no reason why it shouldn't as it was tested on over 10 000 Thai people), proper efficacy trials should begin by 2016.

The conference also discussed government's decision to use a device called PrePex to conduct mass male circumcisions. PrePex has been approved by the World Health Organisation (WHO) unlike the controversial Tara Klamp, which is being used in KwaZulu-Natal. However, PrePex has already courted controversy with Cosatu claiming that it will boycott the "Israeli device".

Government also announced that it will allow patients with multi-drug resistant (MDR) TB to get access to an experimental drug called bedaquidine, which is still in clinical trials. While there are significant side-effects associated with the drug, Phase 2 b trials found that it was effective in treating MDR TB – offering hope to those who are either not responding to the MDR TB drugs currently available or suffering unbearable side-effects.

But punching a hole through the progress are the problems of medicine stock-outs, particularly in the Eastern Cape and Gauteng.

Last month, 40 percent of the 70 public health facilities surveyed by Medecins sans Frontieres and the Treatment Action Campaign in districts served by the Mthatha medicine depot had experienced shortages of HIV and TB drugs which lasted 45 days on average. Patients at a quarter of these facilities had been sent home empty handed.

HIV policies aren't worth the paper they're written on if government cannot ensure that those on HIV treatment have a steady supply of antiretroviral medicine. Without this, our HIV programme risks going the same way as our TB programme which for years has been poorly administered and is now plagued by drug-resistant TB that is hard and expensive to treat.

The ongoing failure of the Eastern Cape government, and its tendency to deny the extent of the problem, does not inspire confidence that all the provinces are marching together with Motsoaledi in his anti-AIDS crusade.

As implementers of policy, the weaker provinces will always be the Achilles Heel of national government and continue to feed the Health Minister's growing tendency to centralise service delivery.



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