Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

06 June 2011

South Africa and HIV: Insights

Mark Chataway is co-chairman of Baird’s CMC, a Mapping Pathways partner organisation. Here, he talks about his visit to South Africa and his thoughts on the region in the context of HIV treatment and prevention strategies.

I was in South Africa last week, working with our Mapping Pathways colleagues to finalise the ExpertLens survey questionnaire. It’s a very exciting time – we’re going use this survey for in-depth discussions with high-level policymakers, key opinion leaders and pivotal civil society figures. The information we get will help us crystallise the project’s outputs. The idea is to make sure we provide data and analyses that are relevant and helpful for all the key stakeholders.

My visit to the country once again brought into sharp focus for me just how significant South Africa and the rest of the southern African region are in the context of HIV treatment and prevention strategies.

Sub-Saharan Africa is the most heavily affected region in the world with regard to HIV. Swaziland has an adult HIV prevalence of 26% (the highest in the world) – the epidemic reduced the country’s life expectancy rate to 31 years as of 2007. South Africa has the highest number of people living with HIV in the world – 5.7 million as of 2007. The incidence rate in South Africa is declining, but not nearly as fast as it needs to.

The pressure on South African decision-makers is even greater because of the manner in which the HIV situation was handled by former president, Thabo Mbeki, and his government. The links were often parodied: Mbeki did question the very link between HIV and AIDS as well as the value of antiretroviral drugs for treatment, but he was never as hostile as many suggested he was.  The Health Minister, Dr Manto Tshabalala-Msimang, suggested the use of garlic, lemon juice and beetroot but, probably, not as substitutes for antiretrovirals (although she was widely reported as having done so), rather as a way of managing opportunistic infections. There is no evidence that beetroot ever helped anyone but some traditional African medicines do seem to hold promise in managing fatigue and diarrhoea (in well-controlled trials, no less). There have been non-political controversies too; for instance, the evaluation of a US-funded behaviour change programme called LoveLife.

Keeping in mind the scale of the HIV epidemic, South African policymakers’ decisions about prevention and treatment are going to be crucial not just for their own country but for the entire region. They’ll have to take a call on where to spend money in the future, and the range of options is growing: circumcision, behaviour change, treatment, microbicides and vaccine research, just to name a few. South Africa has, in the past, funded a big AIDS vaccine research programme – in fact, I was on the government panel that reviewed it. The government is now making great efforts to get the funding required for larger trials for microbicides – it has put in a lot of its own money in and is hoping international donors will also provide funds.

The HIV budget is a massive part of South African government spending, and it will have to be justified in years to come. With all the other demands on government funding (education, housing, other health demands), decision-makers need to see whether their efforts are paying off and will continue to do so. The all-important question will remain: will continued action help force this epidemic into faster reverse?

I have worked in Southern Africa since the late 1980s and I think that governments in much of the region – and in South Africa, in particular – have more capacity now to act on good research than they have ever had before. Many South African government officials are very impressive and are hungry for objective findings with which to provide advice for their ministers. That’s why I think that Mapping Pathways is so important.

On a related note, the Mapping Pathways project is also in the process of trying to gather perspectives on these questions from folks in our current focus areas – the US, South Africa, and India. If you’re interested in new ways to prevent transmission of HIV – and want to help shape our project goals and deliverables – we encourage you to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

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