Welcome to the first edition of Spotlight. Spotlight is the new identity of the NSP Review. You can follow Spotlight on twitter at @SpotlightNSP, Facebook at Spotlight NSP or sign up for our electronic newsletter at www.SpotlightNSP.co.za.
Like the NSP Review, Spotlight is published by SECTION27 and the Treatment Action Campaign. Spotlight will continue the tradition of asking the tough questions about the HIV and TB response in South Africa, but also look more widely to the health system and other related issues. As you’ll see in this issue, we will include views from a wide variety of people. Ultimately though, the focus will remain on the lived realities of users of the public healthcare system, measurements of key HIV and TB indicators (see pages 120-125), and on scientific evidence.
Reading through this first issue of Spotlight it is hard to avoid the conclusion that neither the South African nor the international AIDS response is ambitious enough nor is it backed up by sufficient human and financial resources. How to respond to this lull in the AIDS response is likely the most important question facing attendees of the 2016 International AIDS Conference in Durban (see Peter Piot’s article on the challenges ahead on page 35).
While rhetoric about the ‘end of AIDS’ has become pervasive – such rhetoric is premature. Indeed, this point is made in an article by foremost AIDS scientists Chris Beyrer, Linda-Gail Bekker and Françoise Barré-Sinoussi (page 39) and also in an article by Francois Venter (page 11). As pointed out by Leigh Johnson (see page 105), the currently available modelling suggests that HIV elimination is unlikely and that only the first of the three 90s will be reached in South Africa. Lots of food for thought amid the hot air coming from some quarters!
The key facts are clear. 17-million people are on treatment, but another 20-million should also be offered treatment. Around a million people still die of HIV-related causes every year. If you read our KwaZulu-Natal (page 51) and Free State special reports (page 72), you will see that the healthcare systems where these battles are being fought are often severely dysfunctional.
These are the realities that Spotlight will engage with. Yes, we will listen to plans to “end AIDS” – but we will interrogate those plans. Yes, we agree with the consensus that everyone living with HIV should be offered treatment – but we will ask to see the plans for making treatment for all a reality. Yes, we will acknowledge what political leaders say about employing community healthcare workers or supporting independent civil society – but we will also check to see whether these leaders put their money where their mouths are. And even though we are linked to activist movements, we will not hesitate to ask the tough questions from civil society.
As argued by Anele Yawa (page 6), we need to get serious about the AIDS response. Of course, most of the healthcare workers, patients, activists, researchers and government officials are already serious about HIV – but somehow this seriousness gets lost in the corridors at UNAIDS, at the G20, or at the various treasuries around the world. We shouldn’t allow this.
This then is our objective – through collecting and summarising evidence, through serious analysis and reflection, through quality journalism, and by investigating and reporting on what is happening at the coalface of healthcare delivery – we intend to provide the information that will help fuel a more active and ambitious political response to HIV and TB.
These are lofty goals. Our very small team here at Spotlight will not achieve them alone. We need the help of people who are also serious and committed to our struggle against HIV. We thank everyone who has so generously contributed articles to this issue.
We want to hear from you. If you want to write for Spotlight or send a letter to the editor, you can mail us on SpotlightNSP@gmail.com. Let’s get to work!
Top 10 Asks from Durban
HIV and TB in South Africa
Despite huge progress since the end of AIDS denialism, only about half of the people who should be on antiretroviral treatment in South Africa are receiving treatment in 2016. HIV incidence remains stubbornly high (over 300 000 new infections per year) and TB continues to kill tens of thousands per year (estimates vary quite widely). HIV and TB is clearly still a crisis.
Based on the articles in this edition of Spotlight and on the recent work of the Treatment Action Campaign and SECTION27 we have compiled a list of the top ten priorities for the HIV and TB response in South Africa. While not everyone will agree with everything, we have tried to make a list most people would agree with.
- All provincial MECs (ministers) for Health, heads of provincial health departments, and others holding key posts in the public healthcare system, who are implicated in corruption, lack relevant qualifications, or lack commitment to public service must be dismissed immediately.
- Before World AIDS Day 2016 government must publish a comprehensive and fully budgeted-for plan to provide all people living with HIV in South Africa with a reliable supply of quality antiretroviral treatment.
- The Department of Health must launch an ambitious new HIV Counselling and Testing campaign before the end of 2016 to ensure that everyone knows their HIV status. Steps must be taken to prevent coerced testing.
- The Department of Health must ensure that every person living with HIV receives at least one viral load test per year. Viral load coverage and viral suppression rates must be reported regularly – broken down by province, by district, and by healthcare facility.
- Government must ensure that all schools provide comprehensive HIV and sex education and easy access to condoms from the beginning of the 2017 school year. Whether or not government delivers on this will be a key test of its commitment to reducing the rate of HIV infections in young women.
- South Africa must triple its investment in TB R&D and pressure other high TB burden countries to do the same – especially other BRICS countries. South Africa must also take the lead in advocating for an R&D treaty or agreement at the World Health Organisation and must play a leading role in UN processes reassessing the way in which society pays for medical R&D.
- South Africa must urgently amend its patent laws so that we can utilize public health safeguards available to us under international law.
- Government (not just the Department of Health) must conduct a survey of TB infection control in all public facilities – including clinics, home affairs offices, police stations, and correctional facilities. This must be followed by an ambitious national TB infection control campaign.
- The Department of Health must ensure that a single patient identifier is fully implemented in the healthcare system in all provinces before the end of 2017.
- Donors must ring-fence at least 2% of all funds flowing into South Africa for supporting independent civil society. Without civil society to hold government to account and to build treatment literacy in communities South Africa’s AIDS response will falter.