Monday
Aug 12
2013
August 12, 2013

Turning the Tide on HIV and AIDS in South Africa

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Ten years ago I was working in the National Department of Health (NDOH) HIV and AIDS program, when then-President Mbeki met with President Clinton and asked for the assistance of the Clinton Foundation in combatting the country's HIV and AIDS crisis. The Foundation immediately mobilized resources to help South Africa write its treatment plan, working side-by-side with the South African government as well as local academics and clinics and coordinating closely with South Africa's nine provinces on their implementation plans.

It was at this time that I started working with the Foundation team, which was mostly volunteers, to develop the plan. This is also where I first encountered the values that form the core of how the Clinton Health Access Initiative (CHAI) approaches its work – being humble and modest, ensuring the government leads, always striving for excellence, and always doing more with less. I remember months of 16-to-20-hour days, and draft after draft of the plan – and always knowing that we were on the verge of something revolutionary. And then finally, on November 19, 2003, my 34th birthday, the plan, called the Comprehensive Care, Management and Treatment Plan for HIV and AIDS, was approved by the South African Cabinet – easily one of the happiest days of my professional life.

Implementation began in April 2004, and I took great pride in working towards something that was finally providing life-saving antiretroviral treatment to the people of South Africa. We started so small – only one facility per district – but when the first data came in, the excitement was indescribable.

Through the help of so many stakeholders, mainly funded by PEPFAR, South Africa kept expanding the treatment program. We all worked as hard as we could, but even so, by the end of 2009 we still had only 495 facilities, mostly hospitals, providing treatment to fewer than 900,000 people.

In late 2009, then-Minister of Health Barbara Hogan asked CHAI to return to South Africa to assist with increasing the response. In December 2009 President Zuma announced a major scale-up of HIV prevention and treatment services. Specifically the South African government aimed to provide 15 million HIV tests in 15 months, provide HIV treatment access in all health facilities, and ensure that every person tested for HIV was also screened for TB. As in 2003, CHAI immediately got to work – mobilizing resources from across its various teams – and once again I worked with CHAI to help the government plan for the massive scale-up in services.

Antiretroviral therapy (ART) is now provided is more than 3,500 facilities, the majority of which are primary healthcare clinics, and more than 2 million people are on treatment. 

And here we are in August 2013. Antiretroviral therapy (ART) is now provided is more than 3,500 facilities, the majority of which are primary healthcare clinics, and more than 2 million people are on treatment. Since the scale-up started, more than 500,000 new people have been initiated on treatment each year. And that 15 million tests target? Achieved in 16 months! It is now routine for people accessing HIV services to also be screened for TB. And thanks to new technologies such as GeneXpert (also implemented with CHAI support), drug-resistant TB can be diagnosed in hours, not weeks. 

...transmission rates between mothers and children have dropped from 8 percent in 2009 to less than 2.5 percent in 2012.

South Africa has made great progress in other aspects of care as well. Because of successful prevention of mother-to-child transmission (PMTCT) programs, transmission rates between mothers and children have dropped from 8 percent in 2009 to less than 2.5 percent in 2012. Lastly, because of CHAI support for antiretroviral (ARV) procurement, we have been able to secure massive savings in tender prices, and in 2012 secured the lowest price in the world for a fixed–dose combination.

Because of the support of so many stakeholders, including CHAI, South Africa has the largest HIV treatment program in the world. But then again, our epidemic is also the largest in the world. The fight is far from over, but for the first time since the mid-1980s, it feels as if we are winning. Our achievements in HIV counseling and testing (HCT), antiretroviral treatment, and PMTCT have filled me with joy and pride. There are so many challenges ahead – HIV prevention is not nearly addressing behavioral change sufficiently, supply chain failures still occur, and retention in care is something we have to continuously focus on – but there is hope. And there is the knowledge that by working together, we can collectively make a difference. 

Nelson Mandela said "It always seems impossible until it's done." And President Clinton said "We cannot build our own future without helping others to build theirs.”

Nelson Mandela said "It always seems impossible until it's done." And President Clinton said "We cannot build our own future without helping others to build theirs.” I think both of these quotes inspire us to work more, focus on helping others, and always keep the goal in mind – saving lives.