On 1 December, World AIDS Day 2011, TAC and SECTION27 joined the rest of South Africa and the world in welcoming the launch of a new five-year National Strategic Plan on HIV, STIs and TB (2012–2016). The plan’s target is that by 2016 80% of people are on ARV treatment, that deaths from TB have been halved, and that new HIV infections are cut by 50%. This plan is unique, because millions of people’s lives depend on its successful implementation. Already there are over a million people on treatment. By the time the plan is complete that number must be three million.

We therefore congratulate the Minister of Health and the South African National AIDS Council (SANAC) on ensuring that the NSP has been completed on time and making a political commitment to its implementation.

The NSP 2012–2016 succeeds the 2007-2011 plan. It is the beginning of a new era in the response to HIV, TB and the social drivers of these epidemics. Since the last five-year plan, we have seen a revolution in the response to AIDS. South Africa started the last plan with Manto Tshabalala-Msimang as the Minister of Health and Thabo Mbeki as President. Although the plan was adopted by the government, it was resisted by the Minister. Some of the key interventions it proposed, such as a programme to provide voluntary medical male circumcision (VMMC) on a large scale, were delayed; for several years the roll-out of ARVs was kept as slow as possible. Preventable infections and deaths continued.

Five years later all that has changed. We have almost all the tools and policies to fight HIV and TB. What we need now is accountability for implementation.

We have mass programmes on HIV Counselling and Testing (HCT), VMMC, prevention of mother-to-child transmission (PMTCT) and access to HIV and TB drugs. What we need now is to be sure of the quality and sustainability of these interventions.

The NSP 2012–2016 has been developed through an unprecedented degree of collaboration between civil society and the Department of Health, under the auspices of SANAC. It is a bold plan. South Africa is showing leadership at a time when many other parts of the world are retreating from their commitments on HIV. In parts of Africa large numbers of people are dying again and they are losing hope.

But, despite this, TAC and SECTION27 are aware of the challenges that lie ahead. Some of these are summarised below:

• The NSP must be properly budgeted for! Although the plan makes a commitment to being fully costed and budgeted for, we will remain vigilant to see that this actually happens. By the 2013/14 financial year we expect to see clear budgets for the implementation of the NSP in the national budget, provincial budgets and the budgets of government departments.
• Operational plans must be agreed at provincial and local level by April 2012! The NSP is a national guideline. But its first test will be in its implementation by provinces and municipalities. Provincial and local operational plans must reveal real programmes at community level around HIV prevention in places like schools, workplaces, taverns and churches. There must be measurable programmes for voluntary HIV testing in schools and amongst people with higher risk of HIV. We must see plans to stop violence against women. We must see clinics with systems for infection control.
•  Human rights need to be protected and not just talked about! The NSP makes some bold commitments that will need leadership from the government, including the long-delayed issue of the decriminalisation of sex work (promised in the last NSP).
• SANAC must be made a statutory body that is efficient, transparent and effective! In the last five years SANAC has played a growing leadership role and has improved its visibility. But it has also wasted money and become an institution where some of its members lack accountability and scrutiny. This must change. More than many other institutions, SANAC is entrusted with people’s health and lives. It cannot become another feeding trough.
•  TAC and SECTION27 will continue to assist the government at every level. We will help to build effective local and district AIDS councils and communities where people know about their rights. But we will also remain independent, monitoring to make sure that the plan is felt in villages and factories, not just in conference rooms and hotels.

by Mark Heywood