South Africa on Sunday embarked on the biggest HIV testing programme the world has seen to date, with the ambitious target of persuading 15-million people to find out their status in the next 14 months — a six-fold increase on the 2,5-million tested in 2009. The launch, at Natalspruit hospital in Ekurhuleni, Gauteng province in the presence of President Jacob Zuma, could mark a significant moment in the epidemic.
When I spoke to Michel Sidibé, executive director of UNAids, who has flown out to take part, he called it “the biggest national mobilisation in South Africa around any one cause since apartheid”.
It’s not just about getting people tested and treated, he said, although that in itself will save millions more lives (and not only the lives of those with HIV, because people on antiretroviral drugs are less infectious). It is about openness and a frank national discussion about HIV.
It is a real opportunity for social dialogue,” said Sidibé. “Not only for making people aware of their status.”
He believes the campaign, which will move in the form of a traveling health fair from district to district across the country, will facilitate and encourage talk of dark and deep-rooted social issues, such as sexual violence against women, older men who bribe or force young girls to have sex with them and the inability of women to negotiate safe sex with men.
South Africa has been historically slow to address its massive Aids burden. Thabo Mbeki and his health minister Manto Tshabalala-Msimang, who died following a liver transplant failure last year, dragged their feet, disputing the causes of Aids. Tshabalala-Msimang advocated lemon, garlic and beetroot as treatment in preference to antiretroviral drugs.
Zuma hardly helped move South Africa on, asserting when he was caught up in scandal around his alleged rape of a woman who was HIV-positive that he would not have been infected because he showered after what, he said, was consensual sex. And in January he married a third wife.
But his government is now launching the testing programme, which will run to the end of the current national plan on HIV/Aids in June next year, and Sidibé thinks we cannot under-estimate its importance. “It is a new model,” he said, “making sure we have dialogue around these difficult issues but also making sure we give people treatment early. It is cost-effective.”
‘When you want to kill a snake you don’t eat the tail’
On cost, he has something else to say to the South African government. “I call on President Zuma to review the policy on drug purchasing in South Africa,” he said. “The government pays 25 to 30% more for ARVs than the average international price. That is due to the fact that the present government gives preferential treatment to South African drug companies. Changing the purchasing will make significant savings. This will mean more people will be able to access treatment.” The best first-line treatment in South Africa costs $539 per patient per year. The Clinton Foundation has brought the price down elsewhere to $296, which is 45% cheaper.
What happens in South Africa matters to the entire continent. Where South Africa leads, other countries will follow. And South Africa has the highest numbers of people becoming infected with HIV and dying of HIV in Africa. “We will break the trajectory by winning in South Africa,” said Sidibé. “In my village, I used to say when you want to kill a snake you don’t eat the tail.” – guardian.co.uk