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South Africa: Where is Our HIV Prevention Campaign?
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Health-e (Cape Town)
15 May 2008
Posted to the web 16 May 2008
Kerry Cullinan
While science battles to find an HIV vaccine, there have been real advances in the field of HIV prevention. So why isn't South Africa taking advantage of these?
Over the past year, there have been a number of scientific disappointments in the HIV/AIDS field including two failed vaccine trials.
With the failed trials comes the acknowledgement that the world is almost as far from finding a vaccine as 25 years ago when the research first started, and that scientists are short of ideas about how to circumvent the tricky virus.
"You are quite within bounds to ask, if [the vaccine has] been 10 years away for 20 years, does that mean it's really never going to happen? " Professor David Baltimore, head of the American Association for the Advancement of Science, told his organisation earlier this year.
Others have questioned whether the billions of dollars spent on the vaccine could not be better spent on AIDS treatment.
Back in South Africa, despite the fact that we are in the dying phase of AIDS, HIV/AIDS seems to have fallen off the public agenda.
There is a widespread assumption from many South Africans that the epidemic is being dealt with simply because we have a national HIV/AIDS treatment programme based on free antiretroviral drugs. But in many parts of the country, there are serious problems with this programme. Long waiting lists and a chronic shortage of health workers to administer it are two of the most serious problems.
A poorly administered ARV programme with a high patient drop-out rate means we are courting multi-drug resistant HIV, something we have with TB after years of a third rate treatment programme.
This is bad news for those five million plus people already living with HIV. But what about the over 40 million people who are not?
We have an almost non-existent HIV prevention campaign yet this is where there have been interesting advancements.
Based on studies that show that circumcision offers men significant protection against HIV infection, countries such as Kenya and Swaziland are running vigorous campaigns to get men circumcised. But our health department says there is insufficient scientific evidence.
The developed world, and even the Western Cape, has reduced the rate of HIV positive mothers infecting their babies with HIV to less than 5% by treating both mothers and babies with at least two ARVs. South Africa (with the exception of the Western Cape which has been doing this for five years) is only just adding a second drug to our prevention-of-mother-to-child HIV treatment.
But little is being done to address the fact that only about 60% of pregnant, HIV positive women ever get ARV treatment - either because it's not available at their clinics or they are too scared to test for HIV.
The third interesting development in the field of HIV prevention lies in new knowledge about what researchers call "concurrent partners".
There is growing consensus that the HIV epidemic is particularly bad in southern Africa because it is pretty common for many people to have two or more concurrent partners over a long time.
This makes us vulnerable to HIV because of the nature of the virus. Scientists will tell you that it's not the quickest or most effective virus around. It can often take a while to get passed from one person to the next. In fact, some mathematical models say a person with HIV will only transmit it every 100 times they have sex.
So having a one-night stand with a person with HIV is far less risky than having regular sex with someone with HIV.
"Concurrent or simultaneous sexual partnerships are far more dangerous than serial monogamy because they link people up in a giant web of sexual relationships that creates ideal conditions for the rapid spread of HIV," explains Helen Epstein in her brilliant recent book, "The invisible cure: Africa, the West and the fight against AIDS".
Far from being "promiscuous germ-carriers", to borrow a phrase from President Mbeki, a number of surveys have shown that Africans generally have fewer sexual partners than Westerners do and that Brazilian men have more casual partners than Africans.
Our vulnerability comes from this "interlocking sexual network that [serves] as a 'superhighway' for HIV", Epstein argues.
Importantly, concurrent partnerships are not unofficial polygamy, involving one man and a number of women. For the sexual networks to link up, some of the women also have to have more than one partner.
Epstein believes that Uganda was effective in radically reducing the rate of new HIV infections because of its "Zero Grazing" campaign aimed at encouraging people to be faithful to their partners.
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While in South Africa, we supposedly have an HIV prevention programme built on "Abstain, Be faithful, Condomise", in reality no one has ever run a national campaign aimed at getting people to be faithful to their partners.
It's almost as if we accept that concurrency is normal and we'll never be able to change it.
But in times of deep crisis, people have to adapt to survive new conditions. The "bridges" that facilitate HIV's superhighway need to come down - and we don't need a vaccine or a microbicide to do that.
Dear Sir, First of all, kindly allow me to introduce myself. My name is Gatot Soedarto, from Surabaya, East Java, Indonesia. The diseases caused by HIV Virus has already existed for more than 25 years and its drug has not yet been found ever since it broke out for the first time in 1981. In line with this matter, I am in the same opinion with Professor David Baltimore, that the scientists are demanded to think more deeply and out the usual habit in order to gain a new innovation... [Read Full Text]
The best way to prevent is abstinence and second are good condoms like Trojan Condoms. The Catholic Church is now considering a change in their position due to all of the cases in Africa. They may support condoms for disease prevention only and not to inhibit pregnancy.
The best way to prevent is abstinence and second are good condoms like http://www.trojancondoms.org, Trojan Condoms. The Catholic Church is now considering a change in their position due to all of the cases in Africa. They may support condoms for disease prevention only and not to inhibit pregnancy.
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