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Local success story sets example for treatment

Lesley Odendaal

The successes of SA's first public-sector ARV programme shows governments what can be achieved ahead of the United Nations High-Level Meeting on Aids.

The successes of South Africa’s first public-sector antiretroviral (ARV) programme shows governments what can be achieved ahead of the United Nations High-Level Meeting on Aids and the 5th South African Aids Conference, both being held this week, in New York and Durban respectively.

Khayelitsha’s unique ARV programme, which celebrated its 10th anniversary last week, resulted in national policy changes by providing evidence that antiretrovirals were safe, effective and could be provided in resource-poor settings.

In spite of being located in a poor township outside Cape Town where half of the population is unemployed, 20 000 people have been put on the lifesaving ARVs since 2001 and the death rate has decreased from 10% in 2002 to 2.2% last year.

“Although much remains to be done, the programme’s achievements demonstrate that it is possible to turn back the tide of HIV and tuberculosis (TB).

“Khayelitsha’s accomplishments are important lessons to bring to upcoming global negotiations on the future of HIV response at the United Nations Aids conference in New York,” said Eric Goemare, of the South African medical unit of Médecins sans Frontières (MSF) .

Activist groups, including MSF, have called on the South African government to lobby for the global ARV treatment target to be raised to 15-million people on antiretroviral therapy by 2015 and to provide critical leadership in ensuring increased access to HIV services at the UN High-Level meeting.

According to the Treatment Action Campaign (TAC), UN member states are already shying away from committing to treatment targets in spite of UN secretary general Ban Ki-moon calling for at least 13-million people to be placed on treatment by 2015—a target that amounts to less than universal access, which the world committed to in 2006.

“We call on the South African government to place at least three million people on ARTs by 2015. South Africa reaffirming this treatment target before and during the high-level meeting will be an integral step in encouraging other actors and the international community as a whole to set an ambitious treatment target,” wrote MSF, TAC, Section 27 and the Aids and Rights Alliance of Southern Africa (Arasa) in a letter to President Jacob Zuma and the health department.

The groups also called on government to ensure that at least 80% of public-sector facilities provide integrated TB/HIV services, including ARVs, and to implement immediately and fully World Health Organisation treatment guidelines for ART initiation at a CD4 level of 350, as only 37% of those eligible under new WHO guidelines are receiving ARVs in South Africa.

“We need a strong declaration which includes measurable, ambitious targets stemming from the 2011 UN High-Level Meeting in order to continue to scale up access to HIV prevention, treatment and care services and capitalise on the tremendous gains made in the last decade in order to ensure that millions more lives are saved in the next 10 years,” wrote MSF, the TAC, Section 27 and Arasa in a letter to global leaders ahead of the meeting.

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