SA’s spectacular reversal in fight against Aids

South Africa has witnessed an "unparalleled" five-year increase in life expectancy since 2005 thanks to the world's biggest programme of HIV/Aids drug treatment, researchers say.

The trend marks a spectacular reversal from the days when former president Thabo Mbeki was branded an "Aids denialist" whose dogma was blamed for 330 000 deaths. In a few short years, South Africa has gone from global disgrace to shining example.

It is also a rare shaft of light for President Jacob Zuma and his government, recently besieged by violent industrial unrest, corruption scandals, frustration over failing schools and a dearth of jobs.

Professor Salim Abdool Karim, president of the South African Medical Research Council, said the rise in life expectancy – from 54 years in 2005 to 60 in 2011 – was of the order usually only seen after a major societal shift, such as the abolition of slavery. In this case, the catalyst was the industrial-scale distribution of antiretroviral (ARV) drugs by the public health sector, greatly reducing deaths among people in their 30s.

In 2005, under Mbeki and former health minister Manto Tshabalala-Msimang, who promoted a "treatment" of beetroot and garlic, only 133 000 patients were on ARVs. Now the total stands at 1.9-million, the biggest programme on the planet.

Aids-related deaths decreased from 257 000 in 2005 to 194 000 in 2010, according to the Actuarial Society of South Africa. The rate at which HIV-positive mothers transmitted the virus to their babies decreased from 8.5% in 2008 to 2.7% in 2011.

Domestic expenditure
The HIV counselling and testing campaign that was launched two years ago has notched up 20-million tests in 20 months. South Africa has increased its domestic expenditure on Aids to about R14-billion, the highest by any low- and middle-income country.

The advances were hailed by medical journal The Lancet in a paper co-authored by Karim. "The rapid transition from the failed stewardship of ex-president Mbeki and the disastrous policies of his health minister, Tshabalala-Msimang, to the leadership shown by Health Minister Aaron Motsoaledi and his team could not have been more striking," it noted. The mood was very different from when Karim and colleagues began their research, he said yesterday. "Three years ago, there were doom stories about how bad things were and how we were going in the wrong direction. Now, it's so refreshing to write a positive story.

"There has been a dramatic turnaround in mortality. The increase in life expectancy is unparalleled: to get to 10% is unheard of. You have to have a huge change in society."

At last, Karim said, he could meet international counterparts with his head held high. "I'm proud to be a South African, I'm proud of this administration. I used to go to meetings and people would say sorry about all the problems and the denialist president. Now, I can talk to them about our achievements. That's what we want to be known for as a country."

South Africa's first democratically elected president, Nelson Mandela, was slow to address the Aids crisis during the 1990s. But he later took a courageous stand against his own party, visiting a township and donning an "HIV positive" T-shirt ahead of an ANC conference. In 2005, his public acknowledgment that his son had died from Aids boosted efforts to fight it.

The scourge is far from beaten, however. HIV prevalence has remained static – it is about 30% among pregnant women. Unsafe sex is still widely practised and in 2009 there were on average 935 new HIV infections every day. – © Guardian News & Media 2012

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