Ambitious and inspirational

Government concedes that the aim of halving the rate of HIV infections in the next five years is ambitious, but says it is an inspirational target. The other main target of the new plan is to provide care and treatment to 80% of those who are HIV positive.

Last month government and civil society agreed on the National Strategic Aids plan for the next five years. The head of the health department’s Aids unit, Dr Nomonde Xundu, said HIV infections had gone past peak stage and it was now time to start reversing the steep increase in infections, which happened in the late 1990s.

‘The estimate figures that we see now are encouraging because they suggest that the rates of infection are possibly on the decline. We need to latch on to that and intensify the magnitude of that possible decline — We will all like to see a zero infection rate, especially since there is no cure and scientists have said there will be no vaccine in the next 10 years,” Xundu said.

But the biggest achievement of the new plan has been to get South Africans moving in the same direction. Xundu, who joined the national health department in 2005 after heading a successful Gauteng Aids programme, says the protracted battle­ between the health department and civil society organisations came to an end once they reached consensus on what is feasible to implement given the government’s logistical and financial resources.

She said the bone of contention between government and the civil society organisations was the provision of antiretrovirals to HIV-positive people and while civil society was insisting on universal provision of ARVs, government found the costs of ARVs prohibitive.

At the time, a month’s supply of ARVs for one person cost R4 000, which government could not afford. If government had agreed to provide ARVs to everyone who needed them, it would have entailed dedicating more than 20% of the entire government budget to the provision of ARVs, Xundu pointed out. But when activists and government started collaborating to put pressure on pharmaceutical companies to push for a drop in prices, it prompted a shift in their relations.

‘You know activists, being activists, want things done like yesterday. They want a 100% reach of this or that. But we are now at a point where we agree on what is practical or not and what are the capacities available … They now also realise that government is committed to doing all that needs to be done and they also feel part of the process,” she added.

She insisted government could afford the costs of the plan, despite concerns that costs may balloon way beyond what government has budgeted.

Outside government, activists have cruelly suggested that the temporary incapacitation of Health Minister Manto Tshabalala-Msimang with a liver disease enabled the government to assemble a new team, which was willing to engage civil society constructively.

In her absence an interministerial team led by Deputy President Phumzile Mlambo-Ngcuka was assigned to work on the new strategy­, a process that resulted in the harmonious adoption of the plan last month.

Activists agree that while political will by government has been necessary to start movement, there are serious challenges posed by the stigma of the disease and the willingness of individuals and communities to play their part in fighting the disease. Xundu says that low testing rates remain an area of particular concern.

She said that of the estimated five million HIV-positive South Africans, only one million were known to the health system. The figure of five million is an extrapolation from existing national statistics.

Xundu said that while discussion of HIV/Aids was now more open, there was still a lot of stigma attached to the disease, as people still associated it with promiscuity, homosexuality, sex workers and the experiences of watching people getting sick and dying from the disease.

But she said that where programmes such as Khomanani operated, it was found that there was positive peer influence to talk about the disease, resulting in higher numbers of people testing because they understood the services and options available to them.

She said the fact that many people did not test meant that the number of people participating in the government’s treatment programme remained relatively low.

‘If we rely on the estimated [figure of] five million positive people in the country then 17% of them should be on antiretrovirals, but that is not the case at the moment.”

She said that in January this year 250 000 people were on the government treatment programme while an additional 100 000 were treated at private-care facilities.

‘But we still have the largest number of people on ARVs in the whole world. Realistically, given the costs of laboratories and drugs, if we continue to have more people joining the programme, then we might not afford the treatment,” Xundu added.

Asked if government leaders and prominent members of society should not be encouraging testing by undergoing public tests themselves, Xundu sounded unconvinced.

‘It is important for leaders to speak out on Aids issues including about who is at risk and how communities should be organising themselves to confront Aids. But I am not aware of any evidence that if leaders test, their supporters will follow suit. I have seen political leaders test but I did not see supporters doing the same.”

Last week President Thabo Mbeki questioned why Aids orphans were being treated better than other orphans whose parents did not die of Aids because ‘orphans were orphans”. Xundu said special treatment should not be given to Aids orphans, but went on to explain the special challenges facing Aids orphans.

‘The fact of labelling them as Aids orphans should be treated very sensitively because they could be exposed to stigma by their peers at school and by some members of the community. Information so far has shown that Aids orphans tend to drop out of school, they are forced to look after their siblings, they are sometimes abused by their relatives, they lack access to information and therefore to services and are exposed to the trauma of looking after their sick parents.”

She said young black women between the ages of 25 and 35 living in underdeveloped areas were disproportionately infected because of ‘transactional” relationships where they had no choices in sexual matters because of lack of economic means and therefore power to negotiate safe sex.