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South Africa's HIV/Aids battle plan

A bold plan to scale-up South Africa's fight against HIV/Aids, integrating tuberculosis into its efforts against the epidemic for the first time, was announced by President Jacob Zuma on World Aids Day, 1 December 2011.

Prevention is at the heart of the new National Strategic Plan for HIV, sexually transmitted diseases (STIs) and TB 2012-2016, which aims to reduce new infections by 50% by taking a holistic approach.

The plan also promises to do much more in tackling related issues of violence against women.

The NSP, which represents the country's multisectoral response to the challenges of HIV, draws on the lessons of the previous NSP of 2007-2011, guides the development of provincial and sector implementation plans.

Five goals, four objectives

The plan brings together five goals and four strategic objectives, which combine to effectively prevent or treat HIV and TB infections.

The five goals are:

• To reduce new infections by at least 50% by using a combination of prevention approaches.
• To ensure that at least 80% of people who are eligible for treatment for HIV are receiving it, with at least 70% being alive and still on treatment after five years.
• To reduce new TB infections and deaths from TB by 50%.
• To ensure an enabling and accessible legal framework that protects and promotes human rights to support implementation of the plan.
• To reduce the self-reported stigma related to HIV and TB by at least 50%.

The NSP has identified four strategic objectives that will help South Africa reach these goals:

• Address the social and structural factors across all sectors that drive these epidemics, influence their impact, and affect the way we care for affected people.
• Prevent new HIV, STIs and TB infections through a combination of biomedical, behavioural, social and structural interventions.
• Sustain health and wellness, primarily by access to quality treatment, care and support services, and to develop programmes that focus on wellness.
• Protect the human rights of people living with HIV, primarily through ending stigma, discrimination, human rights violations and gender inequality.

• Download: National Strategic Plan on HIV, STIs and TB – Summary [PDF]
• Download: National Strategic Plan on HIV, STIs and TB 2012-2016 [PDF]

Vision – four zeroes

The NSP is based on a 20-year vision for reversing the burden of disease from HIV, STIs and TB in South Africa.

Adopting the United Nations' "three zeroes" agreed to at the UN high level meeting on Aids in New York in June 2011, South Africa has added a fourth, which aims to eliminate HIV transmission from mother to child.

South Africa's four zeroes are: zero new HIV and TB infection; zero new infections due to mother-to-child transmission; zero preventable deaths associated with HIV and TB; and zero discrimination associated with HIV and TB.

• See the Joint United Nations Programme on HIV/Aids' Getting to Zero: 2011- 2015 Strategy [PDF]

Health profile

South Africa has a generalised epidemic of HIV, driven largely by sexual transmission. There are large differences in HIV prevalence across age groups, gender, geographical area and socioeconomic status.

According to Statistics South Africa, in 2011 16,6% of the adult population (aged 15– 49) years was living with HIV. There are an estimated 5,38-million people living with HIV, including about one-fifth of South African women in their reproductive ages.

South Africa has the third highest level of TB in the world, after India and China. New infections have increased by 400% over the past 15 years, reaching 970 new infections per 100 000 people in 2009.

About 1% of the South African population develops TB every year. In addition, more than 70% of patients are co-infected with both HIV and TB.

The highest prevalence of TB infection is among people aged 30–39 years and living in townships and informal settlements.

• See Health care in South Africa

Violence against women

Research shows that South Africa could often prevent HIV infections in young women if they were not subjected to violence and intimidation by their partners.

"Government is prioritising the fight against the abuse of women and children through law enforcement as well as education and awareness," Zuma said at the launch. "We must also enhance our socioeconomic interventions to deal with poverty, unemployment, food insecurity, and inequality … These either contribute to the spread of HIV or worsen the impact of the epidemic."

HIV Counselling and Testing campaign

In April 2010, the government launched its HIV Counselling and Testing campaign, which offers free testing to all patients at public hospitals and clinics across the country.

The campaign seeks to promote voluntary HIV counselling and testing, encouraging all South Africans to know their HIV status and to be screened for TB at the same time.

While providing people with the information and interventions they need to manage their health and to prevent further HIV transmission, the campaign aims to ensure that people in need are fast-tracked onto the treatment programme.

It also seeks to raise awareness of the issues around HIV/Aids, foster a culture of collective responsibility among South Africans, and remove the social stigma attached to HIV/Aids.

By mid-2012, Health Minister Aaron Motsoaledi announced that almost 20-million South Africans had been tested knew their status. Millions were also screened for TB.

Treatment

The re-engineering of South Africa's primary health care places a special emphasis on community-based services. These have a critical role to play in expanding the quality and reach of health and wellness services, including early diagnosis, follow- up, support to adherence and retention in care.

The HIV/Aids prevention and treatment plan aims to reduce the rate of infection in the country by 50 percent, while providing free antiretroviral (ARV) treatment to 80 percent of those who need it by 2016, a major extension to an ARV programme that is already the biggest of its kind in the world.

In 2004, 47 000 people were on antiretroviral (ARV) treatment; by mid-2011 this had increased to 1,79-million people.

An increase in ARV treatment has seen a reduction in the number of people dying as a result of HIV infection. By 2010, deaths in Gauteng, where life expectancy is 57 years, had dropped by 20% in 2010.

The new NSP recommends that all HIV-positive TB patients should irrespective of their CD4 count, and that all infants under 24 months who test positive for HIV should be placed on ARVs. Infant children of HIV-positive mothers are treated regardless of their CD4 count.

Other HIV/Aids treatment protocols, which have been in place since April 2010, include:

• HIV-positive pregnant women, and people co-infected with TB and HIV, receive free antiretroviral (ARV) treatment at CD4 counts of 350 or less.
• Antitretroviral treatment for prevention of mother-to-child transmission of HIV starts at 14 weeks into pregnancy, instead of only during the last term of pregnancy.

All public TB treatment sites in South Africa also have to test and treat for HIV, and vice-versa – recognition of the fact the high rate of TB in South Africa, as well as the 70% co-infection rate between TB and HIV.

There is am emphasis on reducing the rate of mother-to-child transmission of HIV/Aids. The government now integrates all aspects of its HIV programme with its maternal and child health programmes, and campaigns vigorously for women to report for ante- natal visits as soon as they suspect that they are pregnant in order to do the necessary tests on time.

Male medical circumcision

According to the World Health Organisation, there is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by up to 60 percent.

South Africa first launched its ongoing campaign to promote and conduct medical circumcision in April 2010. Since then, about 250 000 men have been circumcised. The target for 2016 is to have more than 4,3-million men circumcised.

The Health Department will continue to promote the use of condoms, especially among older age groups, where HIV infections are increasing.

Health Minister Aaron Motsoaledi has said that the campaign has many added benefits: "A lot of counselling of the young men takes place there, with traditional advice imparted to the young people, together with the technical aspect of HIV/Aids on male and female sexuality."

One the points strongly emphasised is that condoms should be used regardless of circumcision, with the Health Department continually increasing access to free condoms at public health facilities and other public centres.

• See the KZN Health Department's male circumcision factsheet [PDF]

Multisectoral solution

The NSP was developed by the South African National Aids Council, which represents all national and provincial government departments, civil-society organisations, trade unions, private-sector bodies and faith-based organisations that are working to reverse these epidemics. SANAC structures also include the country’s top researchers and experts on HIV, STIs and TB, as well as international development partners.

• See the South African National Aids Council for more

SAinfo reporter

Reviewed: 17 June 2012