Improvements in HIV policy, at last

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 some hospitals.



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."



ks/he