For every person given antiretrovirals (ARVs) for HIV in South Africa, seven more become infected. If that continues, the health system will be completely overwhelmed.
The advances of treatment in South Africa currently are groundbreaking. This must continue, expand and reach every person who needs drugs. Every HIV-infected person should know his or her status and be monitored so that treatment starts when he or she needs it.
A good starting point would be a seven-point prevention plan, to counter the seven people that become infected for every ARV treatment.
Promote HIV literacy: Received wisdom is that everyone knows about HIV and its transmission. The truth and the facts are muddled for many. That is partly the government’s responsibility and partly because widespread information and messaging campaigns are imperceptible.
Goal 1: By 2010, 75% of adults score 100% on Aids literacy tests.
Promote HIV counselling and testing: People cannot plan their futures, take treatment or prevent transmission (including to babies) unless they know whether they have HIV. The biggest barriers to HIV testing are logistics and cost. We have found that bringing HIV testing to people — either through mobile or door-to-door testing — massively increases uptake. Mobile testing draws youth and especially young men.
Goal 2: By 2010, 75% of people have been tested for HIV at least once.
Protect young people: They are the future of South Africa. Access to accurate information, services and condoms are fundamental human rights. Young people vitally need them.
Goal 3: Prevalence of HIV among youth is reduced by 50% by 2010.
Prevent and treat substance use and abuse: Alcohol is probably a major driver of HIV transmission in South Africa, but other drugs such as tik and cat are spreading rapidly and could further fuel the pandemic.
Goal 4: What if every alcoholic beverage sold were accompanied by a condom? It would get the message across and demonstrate commitment to HIV prevention.
Get ready to circumcise: The results from Orange Farm’s male circumcision study are the most hopeful we have had in HIV prevention since we found that ARVs can prevent mother-to-child transmission.
Goal 5: Circumcise 50% of men by 2010, advise 100% of parents of baby boys about circumcision and 75% opt for it.
Integrate prevention into treatment for HIV-positives: HIV can only spread from those who have it to those who don’t. Treatment for HIV is wonderful, not only because it extends people’s lives and brings hope, but also because it gives us the chance to interact with HIVÂpositive people regularly.
Goal 6: By 2008, every HIV-infected patient is advised about safer sex at every clinic visit, every patient is offered a bag of condoms along with ARVs. An annual sexually transmitted infections check is offered to all HIV-infected patients.
Tackle stigma head-on: The popular paradigm is sad: if someone has HIV, they’ve been sleeping around and they bring shame on themselves and their families.
Goal 7: By 2010, 75% of South Africans regard HIV like any other disease, and that 75% of people with HIV disclose their status.
Dr Thomas J Coates is the Michael and Sue Steinberg professor of global Aids research and professor of medicine in the division of infectious diseases at the UCLA David Geffen school of medicine. He is also the director of the UCLA programme in global health with offices and extensive research activities in South Africa