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HIV treatment – South Africa, TAC, Manto

HIV treatment  with specialised antiretroviral drugs became available in South Africa soon after the 1996 Vancouver AIDS conference. For those that could afford the HIV drugs AIDS could now be a chronic manageable disease.  For those that couldn’t afford the treatment, HIV was still a death sentence.

National Strategic Plan on HIV and AIDS & STDs (2000 – 2005)

The South African government’s first National Strategic Plan on HIV and AIDS (NSP) was  launched by Dr Manto Tshabalala-Msimang in 2000. The general aim of the plan was to guide the country’s response to the HIV epidemic in South Africa. The plan included improving the care and treatment of HIV positive people, and people living with AIDS in order to promote a better quality of life and limit the need for hospital care. However the HIV treatment to be provided consisted of the treatment of opportunistic infections such as TB, and there was no mention of HIV antiretroviral treatment.

Mandela & HIV treatment

Mandela joins the campaign for HIV treatment in South Africa

Mandela joins the campaign for HIV treatment in South Africa

In 2002 a turning point with the provision of HIV treatment came when Nelson Mandela visited a clinic in the Khayelitsha township that was providing antiretrovirals treatment. Offered an HIV positive T shirt Mandela put it on. The T shirts were provided by TAC.

“The t-shirt promotes openness and breaks stigma. You’ll be challenged ‘Are you HIV-positive? Then you can start engaging with people Thembeka Majali

“The t-shirt symbolises the lives that have been lost and the sacrifices that have been made. It marks us as people with a common purpose.

Operational Plan on the Comprehensive Management, Care and Treatment of HIV and AIDS

In November 2003 the South African government finally decided to introduce a national HIV treatment programme. However, within the first year of the plan it became clear that there was no formal implementation timetable. Implementation of the HIV treatment programme properly started in the middle of 2004, with the Minister of Health using a variety of reasons to delay the start of the program. But finally a slow but incremental expansion of access to HIV treatment in the public health sector started from about mid 2004.

Dr Manto Tshabalala-Msimang continued to stress her mistrust of antiretroviral treatment saying that too little was known about the drugs’ side effects.

“All I am bombarded about is antiretrovirals, antiretrovirals” she said in 2005. “There are other things we can be assisted in doing to respond to HIV/AIDS in this country.1http://www.theguardian.com/world/2009/dec/16/dr-beetroot-dies-south-africa

2006 International AIDS Conference – Beetroot and garlic

The South African conference stand had beetroot and garlic but no antiretrovirals.

The South African conference stand had beetroot and garlic but no antiretroviral drugs.

In August 2006 the bi-annual International AIDS Conference took place in Toronto Canada. The South African government delegation was led by Dr Manto Tshabalala-Msimang. The official South African stand in the conference exhibition hall caused considerable embarrassment to South Africa as it featured the minister’s beetroot, garlic, lemon juice and olive oil remedies for HIV, rather than antiretrovirals.

Shortly after the conference a cabinet statement was issued stating that it was time to end the conflict over HIV, establish consensus and focus on the real challenges presented by the AIDS epidemic.

Presidency Changes

In late 2007 Mbeki was defeated in the election for the presidency of the ANC and he was replaced by Jacob Zuma. President Zuma had been widely criticised for comments about HIV that he made during his trial for rape. He had said that he had had unprotected sexual intercourse with a woman who he knew to be HIV positive, but that it was alright because he had had a shower afterwards. In the months following Mbeki’s defeat, AIDS denialism was to come to an end, with the position of the ANC changing to one where they supported the use of antiretrovirals. In January 2008 the ANC’s 96th anniversary statement included:

The ANC and government must renew efforts and take the lead in mobilising communities and all sectors of society to promote responsible sexual behavior, encourage regular voluntary testing and counseling, improve the access of all to appropriate care and treatment and to support healthy lifestyles.

National Strategic Plan on HIV, AIDS and Sexually Transmitted Infections (2006 – 2011)

In 2007 the South African government had unveiled its National Strategic Plan on HIV, AIDS and Sexually Transmitted Infections (NSP). The NSP had as its primary objectives a 50% reduction in new HIV infections and the expansion of HIV treatment to 80% of those who needed it, both by 2011.

Preventing children being born with HIV

Zackie Achmat who led the Treatment Action Campaign (TAC) in fighting for the provision of HIV treatment

Zackie Achmat who led the Treatment Action Campaign (TAC) in fighting for the provision of HIV treatment

In 2008 TAC was once again involved in the fight to prevent children being born with HIV. After much pressure the Department of Health announced new guidelines for PMTCT (Prevention of mother to child transmission of HIV). These guidelines stipulated that dual HIV therapy (HIV antiretroviral treatment with two drugs) should be used in the public health system. But a month later the KwaZulu-Natal MEC for Health Peggy Nknyeni said that:

“antiretrovirals are toxic and doctors who provide them are working for pharmaceutical companies”

Included in the vicious crackdown that followed was disciplinary action being taken against Colin Pfaff, a doctor working at Mangui Hospital in KwaZulu-Natal. All he had done was to provide pregnant women with dual therapy for PMTCT. The AZT had not been paid for out of public funds, but was paid for by the UK based AIDS charity AVERT. After national and international pressure disciplinary action was withdrawn but subsequently Dr Pfaff left South Africa.

President Zuma & HIV treatment

In October 2009 President Zuma gave a major speech to the National Council of the Provinces during which he spelt out clearly the facts about HIV.

Some studies suggest that 57% of the deaths of children under the age of five during 2007 were as a result of HIV. The Independent Electoral Commission had to remove 396,336 deceased voters from the voters roll between September last year and August this year.

He also drew attention to the connection between TB and HIV and unlike any previous ANC politician he stated that “we are not yet winning this battle”. He called on all South Africans to “know their HIV status” and be informed of the HIV treatment options available to them.

South African Political leadership and Policy in relation to HIV

President Zuma announces policy & treatment changes for HIV anitretroviral treatment

President Zuma announces policy & treatment changes for HIV treatment

On World AIDS Day 2009 President Zuma announced significant policy changes on the prevention and treatment of HIV.

The South African Antiretroviral Therapy (ART) programme which was launched in 2003 had “achieved much success” but it was considered that significant changes were required to the programme. Improving access to antiretroviral treatment formed an important component of South Africa’s revitalized response to the HIV and AIDS epidemic. In particular President Zuma launched:

The South African HIV Antiretroviral Treatment Guidelines 2010.

The South African HIV Treatment Guidelines 2010 had specific objectives which included prioritising HIV treatment for:

  • Patients with CD4 counts < 200cells/mm3 or with severe HIV disease irrespective of CD4
  • Patients co-infected with TB/HIV
  • Pregnant women with CD4 < 350cells/mm3 for lifelong ART and CD4>350cells/mm3 for prophylaxis

In addition all HIV exposed children under one year old were to be tested and treated if infected with HIV and all first and second line therapy was to be standardised. The use of stavudine was to be reduced.

This speech was seen as a milestone in respect of South Africa’s response to the HIV/AIDS epidemic.

We welcome the president’s call for an end to the politicisation of this issue. Without saying it in so many words, he drew a line under the Mbeki approach and crossed it out. It’s a new era. The challenge now is implementation and for the government to put its money where its mouth is. Mark Heywood, director AIDS Law Project

Read more

You can read more about the situation regarding HIV in South Africa now and also about the History of HIV in South Africa.

References

 

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1. http://www.theguardian.com/world/2009/dec/16/dr-beetroot-dies-south-africa