HIV and TB: Facing up to the current challenges

HIV and TB: Facing up to the current challenges


Ten years ago on 19th November 2003 the late Dr Manto Tshabalala-Msimang made public South Africa’s first plan to treat people with HIV using anti-retroviral (ARV) medicines. The announcement came in the face of up to 1 000 AIDS-related deaths a day. It was after a persistent campaign led by the Treatment Action Campaign (TAC) and its allies.

Tshabalala-Msimang, former President Thabo Mbeki, former health Director General Thami Mseleku and their cronies never believed in the treatment plan – and did all they could to frustrate its implementation. But the dam wall had been breached and TAC’s campaigns to promote treatment, later fully supported by Health Minister Dr Aaron Motsoaledi, led to a steady growth in numbers of people on ARVs.

Ten years later there are well over two million people taking ARV treatment – the exact numbers are uncertain and that is one of the matters we take issue with in this edition of the NSP Review. Life expectancy has increased, some say by up to ten years. AIDS related mortality has come down dramatically, but at over 150 000 deaths a year is still very high. And mother to child transmission of HIV, the challenge with which TAC launched its first campaign in 1999, is down to 2.7% of HIV+ pregnancies at 6 weeks post birth.

All very good news indeed and we salute our government and our public health workers for such a remarkable turn around.

However TAC and SECTION27 are not part of the clapping classes. From the outset we have fought for quality health care services and sustainable treatment programmes. We have fought for the rights of every person with HIV and will not stop at ‘a lot of people with HIV’.

It is for this reason that this NSP Review aims to cause alarm about aspects of our response to HIV and TB – because alarm is warranted. UNAIDS with its love of slick and sometimes misleading slogans talks of ‘Getting to Zero’ and South Africa has adopted this language. But we are nowhere near Zero on anything and AIDS is far from over.

On p3 you will find an interview we conducted with Minister Motsoaledi about the National Strategic Plan on HIV, TB and STIs (the NSP). Whilst we concur that his leadership deserves high praise, we believe that he is over confident about a range of interventions. In the pages that follow his interview we allow experts and activists to write about why.

We unapologetically focus on the fault lines in the implementation of the NSP and will continue to do so in 2014;

  • Perhaps the biggest challenge facing us are stockouts, which an investigation and report by the Stop Stock-outs Project (SSP) shows have reached extreme danger levels and may be directly affecting up to half a million people living with HIV;
  • Integrally linked to this problem is the almost non-existent qualitative monitoring of the ARV programme – a threat and a travesty after 10 years and now that so many people are on treatment;
  • We argue that South Africa is not making progress against TB;
  • But we also describe growing concerns about the overall state of the health system, as reflected in our report on the crisis in Gert Sibande, an NHI pilot district in Mpumalanga and the district with the highest HIV prevalence in the country;
  • We are concerned that ‘key populations’, sex workers and prisoners in particular get little more than lip services in programming.

Sometimes what we describe are hairline fractures, but sometimes they are cracks, and sometimes they are gaping chasms. They all need action.

Until they get this action we will grade South Africa’s response to HIV as a C. Denial of the existence of HIV may be over; denial of access to ARVs might be a thing of the past; but denial of the scale of the underlying challenges can be just as deadly for many as their predecessors.

We therefore appeal to Minister Motsoaledi, SA National AIDS Council and the government as a whole to take what we say seriously.