Equity and HIV/AIDS

This review of the HIV and AIDS national strategic plan (NSP) since the NSP's inception in 2007, reports that condom use has almost doubled, treatment coverage among adults living with HIV has almost tripled, and prevention of mother-to-child HIV transmission (PMTCT) services among HIV-positive pregnant women has reached 76%. In contrast, the uptake of dual ARV therapy PMTCT has been problematic, and there are major shortcomings in monitoring and evaluation (M&E) that could leave decision-makers operating in a vacuum, the report warns. It notes that while provinces had adopted the dual therapy regimen and were training health workers to administer it, some districts were still using the outdated single dose of Nevirapine because funding to buy the ARVs for dual therapy was problematic. It also highlights a dearth of data on babies born HIV-positive, but quotes department of health estimates showing that almost 40% of infants exposed to HIV were put at risk of contracting the virus by incomplete provision of PMTCT services. Problems with monitoring and evaluation were also highlighted, with inadequate data on mothers, babies and HIV-positive patients awaiting treatment. The report suggests that measuring South Africa's success against numerous goals and objectives set by the NSP may be logistically and bureaucratically challenging. Despite a wealth of information on HIV and AIDS that is collected to fulfill government reporting requirements, the uneven quality, scope and availability of the data has presented considerable challenges to those trying to implement evidence-based HIV interventions.

This paper explored the extent to which public sector roll-out has met the estimated need for paediatric treatment in a rural South African setting. Local facility and population-based data were used to compare the number of HIV infected children accessing HAART before 2008, with estimates of those in need of treatment from a deterministic modeling approach. The impact of programmatic improvements on estimated numbers of children in need of treatment was assessed in sensitivity analyses. It found that, if PMTCT uptake were extended to reach 100% coverage, the annual number of infected infants could be reduced by 49.2%. Despite progress in delivering decentralised HIV services to a rural sub-district in South Africa, substantial unmet need for treatment remains. In a local setting, very few children were initiated on treatment under one year of age and steps have now been taken to successfully improve early diagnosis and referral of infected infants.

Aids in Africa is a symptom of an unjust global order, argues the author of this article. Mass poverty leaves people with no option other than labour migration and transactional sex, which he identifies as the key drivers of HIV transmission in southern Africa. Old approaches to rolling back AIDS don’t work any longer – what is needed is a new, more systematic approach in which poor African countries are released from structural adjustment programmes so they can rebuild their economies using tariffs, subsidies, state spending and low interest rates – the very policies that rich countries use. The author also calls for the cancellation of odious debts so African countries can spend money on health services instead of interest payments. Furthermore, governments need to amend TRIPS to decommoditise life-saving drugs and amend the World Trade Organisation’s (WTO) Agreement on Agriculture to ban the dumping of subsidised farm products in Africa and elsewhere. This means reforming the World Bank, the International Monetary Fund and the WTO, where voting power is monopolised by rich nations and special interests. The World Bank and the Gates Foundation – the biggest funders of AIDS prevention – cannot be entrusted with these tasks, as they have clear interests in the very policies (debt service, structural adjustment and patent laws) that have created the problem in the first place.

A campaign launched recently seeks to mobilise political will and financial resources to overcome the bottle-necks that hinder services for children who have HIV and to prevent HIV infection in children. The Campaign to End Paediatric HIV/AIDS (CEPA) will initially launch in six African countries: Kenya, Uganda, Tanzania, Nigeria, Zambia and Mozambique. Its chairperson, Graca Machel, said CEPA seeks to address the bottlenecks encountered in delivering diagnostic, treatment and care services in these countries. ‘In South Africa alone, 280,000 children are said to be having HIV. It is estimated that 1.8 million of the world’s HIV-positive children are in Africa,’ she said. One of CEPA’s goals is to prevent HIV infection from parent to child. Openly HIV-positive TV host and head of Nigeria’s Positive Action for Treatment Access Movement (PATAM), Rolake Odetoyinbo, knows that that can be achieved. The campaign, formed by the United States’s Global AIDS Alliance, has set itself a bold target to increase prevention of mother-to-child HIV transmission and paediatric treatment services from the current average of 30–40% to 80% in three years in the countries it’s working in. A total budget of US$6 million has been set aside to benefit the six countries that are currently being targeted.