The Lancet: a new South Africa takes responsibility

The Lancet has hailed the new approach evident in South Africa in which the government has decisively turned away from the AIDS denialism associated with former President Thabo Mbeki. 

The Lancet, Volume 374, Issue 9705, Page 1867, 5 December 2009

HIV/AIDS: a new South Africa takes responsibility

On Dec 1 the usual activities surrounding World AIDS Day will take on a special significance for South Africans. In a high-profile event in Pretoria, the South African National AIDS Council (SANAC) is bringing together people who work in HIV/AIDS, those who have been affected by HIV, and government officials, including President Jacob Zuma, Deputy President and SANAC Chair Kgalema Motlanthe, and the Minister of Health Aaron Motsoaledi. Zuma will give a televised address on HIV/AIDS to the nation. Under the motto “I am responsible, we are responsible, South Africa is taking responsibility”, a new era in the country's response to HIV/AIDS is being publicly heralded. In a key-messages booklet, SANAC calls on everyone to know their HIV status by frequent testing; on communities to stop stigma and discrimination against people living with HIV; and on itself to ensure that the government is taking responsibility for people to receive counselling, provide condoms, and give access to treatment for tuberculosis and HIV.

Already on Oct 29, in what has been widely praised as a landmark speech, Zuma left no doubt about the decisive departure from the previous government's stance of denialism and indifference: “South Africa must work harder to implement the national strategy to tackle HIV/AIDS…all South Africans need to know their HIV status and be informed of the treatment options available to them…there should be no shame, no discriminations, and no recriminations”. The non-governmental organisation Treatment Action Campaign called Zuma's speech, which came almost 10 years after Thabo Mbeki made his HIV/AIDS denial clear before the same National Council of Provinces, as “one of the most important speeches in the history of AIDS in South Africa”.

This extremely welcome and long-awaited change in attitude, and its appropriate urgency, is accompanied by a burst of behind-the-scene activities at the Department of Health and SANAC. In a press conference last month, Motsoaledi explained that there are moves ahead to integrate health facilities for tuberculosis and HIV/AIDS, that antiretroviral treatment (ART) guidelines are being revised to initiate treatment for those with a CD4-cell count below 350 cells per μL, and that there are plans for comprehensive integrated antenatal care, which include prevention of mother-to-child transmission—all actions that were called for in The Lancet's recent South Africa Series. The revised ART treatment discussions even came ahead of new WHO recommendations, published on Nov 30. South Africa's National Strategic Plan for HIV/AIDS and sexually transmitted diseases aims to reduce the rate of infections by 50% and cover 80% of the people who need ART by 2011. In October, Cabinet committed to accelerate the response to meet these targets by 2011.

Additionally, Motsoaledi and others in his department are busy identifying and rectifying managerial and attitudinal deficiencies in district-level health-care facilities and have created an expert group to advance the National Health Insurance agenda.

This integrated multilevel approach to tackle the long-neglected burden of HIV/AIDS—based on, and emboldened by, scientific assessment—is a refreshing and brave shake up by a politician. It raises hope and excitement, especially among scientists, academics, and clinicians, who have been ignored and alienated for far too long. However, the task is enormous. South Africa remains the country with the largest HIV-positive population, 5·7 million, according to 2008 UNAIDS figures. Average antenatal prevalence is 29·3% but four districts record a prevalence above 40%, and 79% of maternal deaths tested for HIV were HIV-positive. What is needed to make these ambitious plans a reality is adequate resources, both financial and human, and buy-in by all involved. The South African World AIDS Day motto rightly asks for everyone to take responsibility and play his or her part.

When we asked for serious discussions and decisive actions in a Comment accompanying the launch of The Lancet Series, we could not have hoped for a swifter indication of serious engagement. And although the ultimate test will be in the actual delivery of preventive efforts and treatment for all, and evidence of an effect on new infections and mortality, a first very important and encouraging step towards these goals has been made. South Africa has shown how science and policy working together make the best advocates for change—change for a healthier future.

Article reproduced by permission of Elsevier.

doi:10.1016/S0140-6736(09)62065-1