Friday, October 24, 2014
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South Africa’s Winnable AIDS Battle

ERFURT – In the battle against HIV/AIDS, South Africa was for many years the perfect example of what not to do. Until recently, the government’s response to the epidemic, which threatened the country’s very lifeblood, was lackluster and foolish. But rising pressure over the past two decades – from civil-society groups, the media, and more enlightened politicians – is finally showing results. A disease that has inflicted profound social and economic pain, and dramatically reduced life expectancy, appears to be in retreat.

But a new UN report suggests that South Africa’s battle against the virus is far from over. The country has the world’s most severe HIV problem, with some 5.6 million citizens – more than 10% of the population – currently living with the virus. Every year, around 300,000 new infections, and 270,000 AIDS-related deaths, are recorded. HIV/AIDS patients are also prone to other infections: an estimated 70% of South Africans with AIDS also contract tuberculosis, while half of those carrying the HIV virus are expected to do so during their lifetime. Worse, a third of pregnant women – a highly AIDS-prone demographic – have been diagnosed with the virus, which can be passed on to their babies during childbirth.

The ferociousness of the disease, and the speed at which it spread, took many South Africans by surprise. As in developed countries, HIV infections initially were concentrated among hemophiliacs, sexually active gay men, and intravenous drug users. But, during the 1990’s, and for reasons that are still not fully understood, the virus exploded into the general population. The number of infected South Africans (equivalent to the population of Denmark) outstrips that of neighboring Mozambique, Lesotho, Botswana, Namibia, Swaziland, and Zimbabwe combined.

Yet, incredibly, the rapid spread of HIV and the rising toll of AIDS-related deaths failed to galvanize the country’s post-apartheid leaders, especially former President Thabo Mbeki, into meaningful action. For years, the top ranks of the governing Africa National Congress seemed to be in denial over the pervasiveness of HIV/AIDS and how best to combat it.

Civil-society organizations were not so complacent, using the courts, the media, and civil disobedience to lobby for change. Although contradictory views about how to treat HIV persisted, at least antiretroviral therapy has been available in some public facilities over the past decade. But a more coherent and consistent approach evolved following the appointment of Aaron Motsoaledi as Minister of Health in 2009.

The South African National Department of Health and private health-care providers now report that conditions are no longer so desperate. Three approaches have helped to contain the spread: the provision of antiretroviral therapy by the government and donor agencies; better treatment of tuberculosis patients, who tend to contract HIV/AIDS as well; and a greatly expanded program to prevent mother-to-child transmission.

These remedies have reduced the rate of new infections (though the total number of people living with HIV, especially aged 15-49, continues to rise). With almost two million patients now on antiretroviral treatment, annual AIDS-related deaths have fallen by around 100,000 since 2005. Contagion among newborn babies, once running at around 70,000 per year, have been cut by some 63%, and the lives of millions of HIV/AIDS sufferers have been prolonged.

Another important factor has been better integration of treatment plans. The government has aligned its early antiretroviral treatment programs for existing sufferers, initiated in 2008, with early monitoring programs for pregnant women. New, more effective treatment to prevent tuberculosis, especially the multidrug-resistant strains, has also helped.

More can and must be done. Newborn infections, for example, could be further reduced by encouraging more pregnant mothers to visit health clinics for early monitoring and for checkups after delivery.

But progress to date should be acknowledged, if not celebrated. The recent successes demonstrate that with political will and sufficient resources, even the greatest of scourges can be beaten – a lesson not only for South Africa but also for countries elsewhere in Africa and the developing world.

Read more from our "Visionary Voices" series

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