Aids war reaps positive results

Southern Africa is responding to its Aids pandemic with new programmes that promoters say must be as adaptable as HIV itself.

“Just as HIV mutates, frustrating efforts to come up with a vaccine, so do our prevention, mitigation and treatment efforts have to be flexible and innovative. We are not yet crippled by this crisis,” says Sylvia Kunene, a counsellor with a voluntary testing centre in Nelspruit, South Africa.

Kunene is increasingly employed by businesses that are setting up programmes to assist workers who want to know their HIV status, and to help them cope medically and psychologically if they find they are infected.

“Aids is an economic issue in South Africa, and no longer seen as just a health issue. President [Thabo] Mbeki points out that poverty is a breeding ground for the disease. The manufacturing companies are worried about factory-floor workers and banks and service industries are concerned about white-collar and management employees,” Kunene says.

In its Report on the Global Aids Epidemic released this month, the United Nations Joint Programme on HIV/Aids (UNAids) notes that Sub-Saharan Africa has just more than 10% of the world’s population, but is home to close to two-thirds of all people living with HIV — about 25-million.

The report credits Uganda with “inspiring efforts” to reduce an HIV prevalence rate that peaked in 1992, through community action, strong political leadership and education campaigns.

On the subject of political leadership, UNAids notes that Botswana’s President Festus Mogae was instrumental in the decision to provide free anti-retroviral medicines and develop a national prevention of mother-to-child transmission programme.

Malawi’s former president, Bakili Muluzi, appointed a minister for Aids health to improve coordination of the national response.

In Lesotho, in March this year Prime Minister Pakalitha Mosisili led a delegation of government officials to take HIV tests in public. The effort was to set an example for others and attack the stigma and fear that has attached itself to HIV in Lesotho.

In Swaziland, where nearly 40% of adults are HIV-positive, all key projects — both new ones and those that are an expansion of some pilot projects from last year — deal in some way with HIV/Aids.

Dr John Kunene, principal secretary for the Swazi Health Ministry, says: “We plan to achieve our goal whereby any Swazis living anywhere can have access to HIV testing within a reasonable distance from his or her home, along with the counselling that is so necessary both before and after testing.

“A second key goal is the rolling out of ‘PMTCT-plus’ — prevention of mother-to-child transmission — but expanded to include the father. If we find a mother is HIV-positive, we will employ the necessary medicines to halt transmission to the child, but we don’t want to leave it at that. The woman’s male partner must be given assistance.”

A national safe-blood initiative will be expanded, highlighted by the opening of a national blood bank and testing facility at the central commercial hub Manzini. The Italian government, in partnership with Swaziland’s government, is the facility’s principal donor.

Swaziland is at present scrambling to meet its blood-supply needs. A public-awareness campaign to prompt voluntary blood donations will be launched.

The blood centre in Manzini will complement an expansion of medical laboratory services planned this year for the Mbabane government hospital.

“There is a new structure, fully operational, at the hospital. We Swazis say it is not opened until it is officially dedicated by a national leader. But until that time it is undergoing an expansion that will see a national HIV/Aids reference laboratory,” says Kunene.

Another initiative is the aggressive roll-out of life-prolonging anti-retroviral (ARV) drugs, which were belatedly introduced to the Southern African country in 2003.

“Last year, one to two thousand people benefited. [About] 10 000 patients will be on an ARV regimen by the end of this year, and no less than 14 000 by the end of next year,” Kunene says.

More of them will receive ARVs, Kunene believes, as Swaziland participates in the UN’s “3 by 5” initiative, whereby three million HIV-positive people worldwide will receive ARV treatment by 2005.

“Swaziland is one of the first countries in Africa to take up this initiative. Already a country assessment has been done, which is a prerequisite, and we are in the implementation phase,” Kunene says.

In Botswana, the Ministry of Health has obtained funding from the Bill and Melinda Gates Foundation and the Merck Company Foundation for an ARV treatment programme called Masa, the Setswana word meaning “new dawn”. Currently more than 15 000 people are receiving ARVs through the programme.

With Swaziland’s hospitals and clinics unable to cope with the expanding number of Aids patients, home-based care has become crucial. By December, a network of supply centres for Swazis tending to family members who have Aids, or caregivers assigned to neighbours with Aids, will be in place nationwide.

Kenya is another country where a “multisectoral response” to Aids has reaped positive results. The government holds an annual Joint Aids Programme Review for all health and social welfare organisations in the country. The conference helps the government link its national strategic plan on Aids with the activities of NGOs on the ground that are providing services to people living with HIV and Aids.

“There is no question of the skill and dedication of health personnel in Swaziland,” Kunene says. “We need more of them, and more resources. But we are serious, and we have a willing donor community internationally willing to assist.”

The same take-charge attitude is evident throughout Southern Africa against the subcontinent’s shared survival challenge. — IPS

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James Hall
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