Motsoaledi happy with HIV response

When Dr Aaron Motsoaledi was appointed health minister in May 2009, the country was slowly emerging from a dark and sad time in the government’s response to HIV.  NSP Review had 30 minutes with the Minister to pose a number of burning questions on the HIV programme.

The South African government has the HIV epidemic under control, according to the Minister of Health, Dr Aaron Motsoaledi. Recent statistics, he says, support his claim: 2.1 million people are on antiretroviral treatment (up from 923,000 in 2009), 3,540 HIV treatment sites have been established (up from 490 in 2009), and 23,000 nurses are able to initiate patients on treatment, compared to 250 four years ago.

Speaking exclusively to the NSP Review, Motsoaledi acknowledges that there are challenges. “We do experience logistical problems when it comes to drug distribution, but it is important to note that these stock-outs are sometimes caused by industry,” he claims.

Gauteng has managed, he says, to double the number of people on treatment from 250,000 to half a million, despite serious obstacles.

Quizzed about levels of retention in care, Motosoaledi responds that South Africa’s monitoring systems are successful and indicate positive trends. “If you want to know whether people are accessing treatment and managing to stay on this treatment, you can look at our life expectancy figures that are increasing. I think [the figures] answer that question,” he says.

“If people were still dying in large numbers we would be seeing it … Our monitoring systems are not picking up such trends. In fact, the number of people dying has decreased markedly.” Motosoaledi believes the rollout of fixed dose combination antiretroviral treatment will raise adherence levels further.

He predicts that forthcoming data from the prevention of mother-to-child transmission (PMTCT) programme are likely to show that HIV transmission rates have declined further from the current level of 2.7%.

“All the indications are there that we are making progress. [This shows] that our HIV programmes have turned the corner,” he says. Motsoaledi acknowledges, however, that getting people to take an annual HIV test is difficult.

When asked to comment on the success of the South African National AIDS Council (SANAC), he says that the organisation has played an important role in mobilising civil society, but declines to be drawn further on whether he believes SANAC is fulfilling its mandate. Properly-functioning AIDS Councils are critical to the success of the National Strategic Plan and KwaZulu-Natal’s achievements [in managing/treating HIV?] need to be replicated, he says.

Motsoaledi acknowledges that he is deeply worried about the high incidence of TB in the country. BRICS nations such as South Africa carry a high burden of TB and account for 60% of drug-resistant TB cases. He believes though that we are making progress. “We have increased the TB cure rate tremendously and I think the GeneXpert [testing system] has played a role in that. We have 80% coverage and [aim to achieve] … 100% coverage by the end of this financial year.”

The Minister reveals that teams of health workers are screening family members their homes, where TB has been diagnosed and 150,000 families have been visited. This has led to 3,000 new diagnoses.

Progress is also being made in treating TB in prisons. Since the launch of the [new TB in prisons] guidelines on World TB Day in March, six regions have started using GeneXpert testing to screen inmates upon arrival and twice a year while incarcerated, says Motsoaledi.

In Pollsmoor Prison in Cape Town, 12,000 inmates have been screened, with 175 testing positive and placed on treatment. The families of prisoners have also been followed up.

Motsoaledi says that South Africa now needs to focus on TB in the mining sector. Money from The Global Fund to Fight AIDS, Tuberculosis and Malaria will fund the screening of 100,000 workers at smaller mines, while government money will help to screen 500,000 people at larger mining sites. Motsoaledi says this [new] drive is part of an effort to monitor compliance by the mining companies when it comes to their workers. The results of the programme will be announced at an international mining conference in February next year.