JOHANNESBURG, 2 December 2009 (PlusNews) - AIDS researchers,
scientists and activists have welcomed the changes to South
Africa's HIV/AIDS treatment policy, announced by President Jacob
Zuma on World AIDS Day.
The changes will mean antiretroviral (ARV) treatment can begin
earlier for certain vulnerable groups, but stop short of raising
the treatment threshold for all HIV-positive patients, as
recommended by the World Health Organisation (WHO) in their
revised guidelines, released on 30 November.
Zuma said that from April 2010, all HIV-positive children under
the age of one would be eligible for treatment, regardless of
their CD4 count (a measure of immune system strength).
Pregnant women living with HIV, and patients co-infected with
tuberculosis (TB), will qualify for ARVs if their CD4 count falls
to 350 or less. Pregnant HIV-positive women with higher CD4
counts will be given treatment from the 14th week of pregnancy to
prevent mother-to-child transmission; currently, treatment is
only given in the final trimester.
Zuma also committed the government to ensuring that all health
facilities in the country are equipped to offer HIV counselling,
testing and treatment. At present only health facilities
accredited as ARV sites by the health department can administer
ARVs, which has created bottlenecks and long waiting lists at
However, for most HIV-positive patients, a CD4 count of 200 or
less will remain the starting point of treatment. The new WHO
guidelines suggest starting patients on ARV medication when their
CD4 count drops to 350 or less, in line with several studies that
have shown earlier initiation improves survival rates.
Mark Heywood, executive director of the AIDS Law Project, told
journalists at the Social Aspects of HIV/AIDS Research Alliance
Conference taking place in Johannesburg this week that the South
African government should aspire to eventually adopt the WHO's
new guidelines, but that the improvements announced by Zuma
targeted some of the most vulnerable groups.
Heywood, who is also Deputy Chairperson of South Africa's
National AIDS Council (SANAC), pointed out that many patients
delayed seeking treatment until their CD4 counts were well below
200. "We need to scale up the promotion of treatment," he said.
Dr Olive Shisana, CEO of South Africa's Human Sciences Research
Council, predicted that earlier ARV treatment for pregnant women,
babies and people with TB would "help tremendously in reducing
deaths". In the last decade, death rates in South Africa have
increased dramatically, largely as a result of HIV/AIDS.
Shisana said the recent controversy over conflicting estimates of
death rates from different sources should not obscure the widely
accepted fact that "AIDS is the number one cause of death in
South Africa ... If you live in any township, you know Saturdays
are for funerals."
Responding to concerns about how the government will fund an
expanded treatment programme, particularly in view of the global
economic crisis, Dr Stella Anyangwe, WHO country representative
in South Africa, said the initial costs might seem large, but "in
the long run, the country will be saving itself money" with lower
rates of hospitalization and opportunistic infections.
In his World AIDS Day speech, broadcast on national television,
Zuma appeared determined to usher in a new era of government
openness and commitment to combating South Africa's devastating
HIV/AIDS epidemic. He also announced a countrywide HIV testing
campaign and encouraged all South Africans to participate. "I am
making arrangements for my own test," he told viewers.
In the struggle to overcome AIDS, he said, "We have no choice but
to deploy every effort, mobilise every resource, and utilise
every skill that our nation possesses."