NOW IS NOT A TIME FOR BACK-SLAPPING ABOUT PROGRESS – Critical Challenges Threaten Successful HIV Prevention and Treatment Programmes if not Addressed Urgently
Yesterday at the opening of the 6th SA AIDS Conference the TAC was the recipient of the Dira Sengwe leadership in AIDS award. Sifiso Nkala, a TAC activist since 2000 and a person living with HIV, received the award. Initially the conference organisers denied him the right to speak on acceptance of the award. In the tradition of TAC, we refused to take no for an answer. Here is the speech he delivered to great support and endorsement from the audience.
The 6th South African AIDS Conference, is a very important event. The first SA AIDS conference took place in 2003 – the year of TAC’s civil disobedience campaign to demand an ARV Treatment Plan. We have come a long long way since then!
The conference is therefore a timely opportunity to critically assess our progress on preventing and treating HIV and TB. It is an opportunity for sharing and learning as it brings together health professionals, policy makers, researchers, activists and people living with HIV.
It also allows us to identify priority areas going forward.
TAC and SECTION27 attend this year’s conference as participants and as speakers, not as pariahs as was the case in the early days. We salute the leadership of SANAC Chairperson, Deputy President Motlanthe, and particularly Health Minister Dr Motsoaledi in bringing energy and real commitment to saving lives and improving health systems.
However, the main message we wish to convey is that whilst we have made great progress since the launch of the first National Strategic Plan on HIV, STIs and TB (NSP) in 2007, now is not the time for back-slapping and self-congratulation. Issues exist which, if not addressed urgently, threaten the continued expansion of treatment, ARV adherence and effective HIV and TB prevention. Remember, AIDS is not over, the battle is not won. There are still another two million people needing access to treatment.
In our view the FIVE KEY ISSUES that must be addressed are:
- Frequent ARV Stocks-outs
The TAC receives regular reports of ARV shortages in public health care facilities. We draw attention to a report that we are issuing this week about the dire situation that exists in the Eastern Cape. See:
While some provinces such as the Western Cape and KwaZulu-Natal appear to be rarely, if ever, affected by stock-outs, reports from other provinces particularly Eastern Cape, Limpopo and Gauteng show that stock-outs are a regular occurrence. We expect to see plans about how to address on-going medicines shortages.
On the 19th June 2013, MSF will be hosting a session on Stock-outs. TAC will participate on the the panel. We need a strong stance from this conference about overcoming stock-outs. All provinces need to implement better medicines supply models that will guarantee a constant medicine supply.
- Lack of commitment and focus with HIV and TB prevention strategies especially in key populations
Progress with reducing HIV vertical prevention through the PMTCT programme is commendable. Tens of thousands of infant lives have been saved and it seems unbelievable that 11 years ago we had to go to the Constitutional Court to get an order for the government to run this programme! So is the commitment of the national Minister of Health to voluntary male medical circumcision (VMMC). However, although the NSP 2012 – 2016 identifies “key populations” for HIV and TB prevention, none of these interventions are taking place at the scale that is required:
- It is six months since the Dudley Lee judgment but there is little evidence of serious TB prevention interventions in prisons.
- Reports of very high rates of teenage pregnancy suggest that we are not making significant enough progress with HIV prevention amongst young people. [See the latest June 2013 TAC/SECTION27 NSP Review www.nspreview.org/ for more on this]
- ‘Projects’ and ‘pilots’ for sex workers are not enough. We need to be reaching every sex worker with HIV and TB prevention strategies and protecting them from the violence and abuse that is associated with continued criminalisation.
- Dysfunctionality of AIDS Councils at every level
TAC members report that in every province exept KwaZulu-Natal, AIDS Councils are dysfunctional. They are good at eating money for meetings, but incapable at leading or implementing programmes. This issue has been raised on numerous occasions with the Chairperson of SANAC, Deputy President Kgalema Motlanthe, but there seems to be very little political commitment to tackling HIV at provincial and district level. We do not understand how this can still be the case.
TAC calls on the government to make a functional AIDS Council, which is implementing programmes, to be made a service delivery indicator for every Premier and Mayor in South Africa.
- Lack of qualitative and consistent monitoring and evaluation
We are almost two years into the 2012-2016 NSP, but there is no effective M&E system. We rely on infrequent and unpublished reports from the NDOH on the numbers of people on treatment, condom distribution etc. But there is no independent verification of these reports and figures that are provided tell us little about the quality of essential interventions. An NSP without a robust M&E system is like driving when drunk: we do not know where to focus. We insist that an M&E system be finalised and resourced within the next two months.
- Drying up of support for civil society activism and overlooking people living with HIV as leaders in the response
Civil society organisations have driven the response to HIV. But today many, such as the Greater Nelspruit Rape Intervention project (GRIP) (which had to fight the then-MEC Manana to get PEP for rape survivors) face closure.
People with HIV have literally sacrificed their lives for where we are today. Yet people with HIV were largely overlooked as partners in this conference. Activism is not a thing of the past. It is vital to the future. So are NGOs that work with communities on HIV and TB prevention and treatment. We are partners not second class citizens.
Finally, we draw attention to the ever continuing challenge of ensuring that we improve treatment regimens. And that they are affordable.
The annual Conference Retroviruses and Opportunistic Infections (CROI) 2013 highlighted a few developments in the care and management of HIV and TB that must be taken into consideration. For example, the most notable development was the proposed TB regimen that could shorten the duration of treatment.
Currently, TB treatment is two months of Isoniazid, Rifampicin, Ethambutol and Pyrazinamide followed by four months of Isoniazid and Rifampicin. These medicines are either taken daily or five times a week. A new regimen (Moxifloxacin, Rifapentine, Ethambutol and Pyrazinamide for two months followed by four months of Moxifloxacin and Rifapentine) has been shown to have similar health outcomes when compared to the standard one. During the continuation phase medicines only have to be taken once-weekly. That's a substantial reduction in burden on patients and health workers.
However the prices of Moxifloxacin and Rifapentine are higher compared to the current regimen. In addition, Rifapentine is not yet available in South Africa. These are issues we must campaign on and this conference should be a platform to discuss ways to reduce the cost of these and other drugs and ensure that they are made available in the South African public health sector.
So in conclusion our message to the 6th SA AIDS Conference is that there are no grounds for complacency. The challenges are many. They have solutions. Millions of lives still depend on us.
For further comments contact:
Vuyiseka Dubula, TAC General Secretary: 082 763 3005
Mark Heywood, SECTION27 Director: 083 634 8806
Simonia Mashangoane: 083 285 3846 / firstname.lastname@example.org