Finally, the right HIV tactic
About 2 000 doctors, nurses and pharmacists have come out of retirement to provide voluntary help in a massive national drive to HIV-test 15-million South Africans.
Medical schools have also agreed to release final-year students to assist with testing, while the NGO sector has mobilised 9 000 lay counsellors as part of the programme. In an interview this week Health Minister Aaron Motsoaledi said that South Africa has little choice but to push ahead with the National HIV Counselling and Testing (HCT) campaign—despite the country’s crumbling health system.
‘The country is going through a very serious pandemic, the biggest in the world, and we have to deal with it,” Motsoaledi said this week. He said the health department has been preparing for the campaign, which kicks off this Sunday, since last year.
‘For the moment we have got enough condoms and testing kits to start. To sustain it we’re staggering the programme over 15 months and over two budgetary years,” he said.
During the campaign, which is coordinated by the South African National Aids Council (Sanac), the health department seeks to test 15-million people—one-third of the population—by June next year.
The rollout will begin in nine high-priority districts, one in each province, before moving to the others. Under the theme of ‘taking responsibility for oneself”, the drive will encourage people to adopt a healthier lifestyle. In addition to testing for HIV medics at the country’s testing stations will offer to test for hypertension, diabetes, anaemia and TB.
Motsoaledi said this was a deliberate attempt to bring the country back to a preventative healthcare approach. ‘In the past 10 years South Africa has gravitated towards a curative healthcare system, which is much more expensive,” he said. Salim Abdool Karim, director of the Centre for the Aids Programme of Research in South Africa, said the HCT campaign is ‘absolutely” the right approach for the country.
‘Of all the things that we could be doing, in my opinion, this programme is probably the most appropriate at this point,” he said. South Africa already has the largest Aids treatment campaign in the world, but its impact has been limited because most people start treatment at a very late stage.
‘With a million people on treatment, we should be saving lives. And we’re not doing that,” said Abdool Karim. He said getting people on to treatment early is a key factor in the fight against Aids and the testing drive could help to address this.
But Abdool Karim said he has doubts about whether the 15-million target is realistic. ‘It’s an aspirational goal, but we should try for it,” he said. Treatment Action Campaign general secretary Vuyiseka Dubula also questioned the state’s ability to follow through with the appropriate care once tests had been administered.
‘If we test 15-million people, there’s a possibility that 1.5-million of those will be HIV positive. How many of those will need treatment immediately and will we be able to provide that?” asked Dubula.
Sanac chief executive Dr Nono Simelela said the health department has planned for the increased demand for HIV/Aids drugs.
‘The [health] budget pronouncement by the minister of finance earlier this year was based on projections that include the number of people that will go on ARVs following this programme,” she said, adding that the health department has sought assistance from aid organisations such as USAid, the US President’s Emergency Plan for Aids Relief and the Global Fund to fight HIV, Aids and Malaria.
There are fears that because of the human resource crisis in healthcare, people may not receive the level of counselling and post-testing support they require.
Kevin Kelly, director of the Centre for Aids Development, Research and Evaluation (Cadre), warned that there is a danger that the campaign may create a ‘treadmill of processing people”.
‘My concern is that we might not be able to reach the numbers required without compromising on quality,” he said. Many people who are tested in South Africa have no more than 10 or 15 minutes of counselling after discovering their status. This, Kelly said, can be very risky.
A Cadre study of 900 people has found that HIV-positive people who have recently discovered their status are likely to suffer from mental health illnesses and increased depression.
‘While testing remains a central part of our HIV response — the principle feature is the quality of the counselling,” he said. ‘Discovering your HIV status is no small thing. It’s not the kind of thing that can be done in casual circumstances.” Sanac’s deputy chairperson, Mark Heywood, agreed that ensuring quality counselling will be a key challenge, conceding that ‘if there is no capacity for counselling, there shouldn’t be testing”.
But, he said: ‘We can’t say that because we’re not 100% ready, we can’t do this. We know for a fact that almost 1 000 people die of Aids on a daily basis because they’re avoiding testing for HIV and they don’t understand how treatment works. There is a big price to pay for doing nothing or doing too little.”
Heywood said the campaign will expose weaknesses in the health system. He called on civil society to help monitor facilities to ensure that people receive counselling and treatment, and to ensure that they are not discriminated against or victimised.
Heywood said the Sanac Nerve Centre will be on hand to coordinate the effort, provide support and act as a troubleshooter in cases of understaffing or shortages of drug and test kits.