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2010 is a significant year for HIV activist and media specialist Pholokgolo Ramothwala.
He has lived with the virus for more than a decade without needing to take antiretroviral drugs.
But his CD4 count has been dropping, viral load rising and Pholokgolo has been developing opportunistic infections, like oral thrush, more often.
His doctor has advised him that now it is time to initiate treatment.
Despite his initial reluctance, Pholo writes: “I have always known that one day my health will deteriorate and I will have to start taking antiretrovirals (ARVs) to manage my HIV.
His online diary will be focused on this journey for the next six months.
He writes: “I must now accept that this virus has progressed and my fighting strategy must also change. I must prepare myself for the challenge.
“I am not afraid of taking ARVs. I just don’t know if I have the discipline to take them every day for the rest of my life.”
HIV drug resistance at about 5% in Sub-Saharan Africa
South Africa has initiated more than 700 000 people with HIV on antiretroviral drugs and – along with scaling up the rollout of treatment – a major challenge for 2010 and beyond will be containing drug resistance.
A presentation at the HIV Clinicians Society of Southern Africa this year outlined the increasing number of patients failing treatment, and the steps required to avert the widespread development of drug resistance.
The human cost of drug failure is vividly illustrated in an Associated Press feature from South Africa published today.
The Associated Press did a six-month investigation into soaring drug resistance to a range of diseases worldwide.
Among the key points this excellent story highlights are:
* HIV drug resistance ranges from 5% to 30% across the world, up from about 1% to 5% 10 years ago;
* HIV drug resistance is increasingly common in South Africa;
* Monitoring for HIV drug resistance is scarce in Sub-Saharan Africa, where the highest number of people have the virus;
* HIV drug resistance “mirrors the rise worldwide of new and more deadly forms of killer infections, such as tuberculosis and malaria. These diseases have mutated in response to the misuse of the (drugs),” the story says;
* “In some high-risk populations worldwide, HIV drug resistance rates soar as high as 80 percent”, according to studies published in the journal AIDS;
* Drug resistant strains could cost $44 billion to treat by 2010;
* Every year more drug resistant strains are detected: in 2008 there were 93, up from 80 different documented strains in 2007, according to Stanford University’s HIV Drug Resistance Database; and
* Adherence among children is difficult “because they depend on someone else to make sure the meds are swallowed”.
Substitute stavudine (d4T) in first line regimens
The end of an era
Former health minister, Dr Manto Tshabalala-Msimang passed away yesterday, on South Africa’s Day of Reconciliation December 16, at the age of 69.
Condolences are due to her family and loved ones as they grieve.
But I don’t think respect and reconciliation require being silent about her disastrous mistakes – estimated to amount to at least 330 000 lives lost to AIDS between 2000 and 2005.
Yes, she was a veteran activist who committed her youth to overcoming injustice and apartheid and she should be honoured for that. But her leadership as as health minister for almost decade (1999 to 2009) was catastrophic.
The book “The Virus, Vitamins & Vegetables, The SA HIV/AIDS mystery” – in which I have a vested interest having written a chapter -documents how she and former President Thabo Mbeki allowed the HIV/AIDS epidemic to spiral out of control and obstructed the rollout of antiretroviral treatment.
“The book chronics the tragedy that unfolds when leaders choose to play with people’s lives”, former deputy health minister, Nozizwe Madlala-Routledge, said at its launch.
“Dr No” didn’t only do untold damage in HIV/AIDS, she also exacerbated the decline of the public health system in many ways, including driving dedicated doctors out of the public service and undermining scientific programmes.
As Professor Francois Venter, president of the HIV Clinicians Society of Southern Africa, said: “The family should be allowed to grieve in privacy.
“Equally, political leaders should keep eulogizing to a bare minimum, to respect the large number of people who died unnecessarily of HIV or who suffered at the hands of a decimated health system.”
Today Anglican Archbishop Thabo Makgoba, extended condolences to those who grieve for her passing and urged South Africans to move forward determined to fight the scourge of HIV/AIDS.
“Let us use the death of Dr Tshabalala-Msimang as a milestone on our journey, a signpost towards a future with an Aids-free South Africa,” he urged. Let’s do that.
It is the first time on World AIDS Day that South Africa’s leaders have announced such good news: from April all babies under one years old will be able to get antiretroviral treatment and adults will be able to access to antiretrovirals with a CD4 count of 350 (up from the low bar of 200) – in line with international guidelines.
The government is also scaling up HIV testing, with Zuma and Motsoaledi indicating they will take HIV tests themselves.
I’m going away for two weeks and this is the perfect way to start my holiday. Will be back on December 16.
A new Ugandan study offers great hope for people with AIDS in rural areas in Africa needing antiretroviral treatment.
The trial tested a model in which lay-trained counsellors, not doctors or nurses, treated people at home – and they were as healthy as the patients being treated in clinics.
The cluster randomised trial took place in 44 areas in Jinja, Uganda.
The results, published in the Lancet journal online this week, suggested: “This home-based HIV-care strategy is as effective as is a clinic-based strategy.
“(This) could enable improved and equitable access to HIV treatment, especially in areas with poor infrastructure and access to clinic care.”
The researchers found after two and a half years that:
*Home-based ART by trained lay workers achieved equal health gains;
*Reduced mortality, hospital admission and viral supression were used to measure health gains;
*Patient costs were cut by half or more in the home-based care;
*Home-based care cost the health service slightly less.
Supporting the model, an editorial in Lancet stated: “This result provides compelling evidence for rolling out home-based ART to complement facility-based delivery and facilitate access.
“(This is true) especially in rural settings with weak health systems, shortage of clinical staff , and poor patients for whom transport cost and lost work-time provide obstacles to treatment initiation and adherence.”
The results are exciting but Uganda has one huge advantage over South Africa. Stigma around HIV/AID is far less prevalent and people are much more open about having the virus.
New HIV infections have come down 17% over the last eight years, UNAIDS and WHO reported today.
This finding, reported in the 2009 AIDS epidemic update, is good news.
New infections were down by about 400 000 in sub-Saharan Africa last year, about 15% lower than in 2001 when the UN Declaration of Commitment on HIV/AIDS was signed.
But HIV is rising again in some countries, according to the report.
More people are living with HIV than ever before, an estimated 33.4 million worldwide – with about 5.5 million in South Africa.
“To better connect the 33.4 million people living with HIV and the millions of people who are part of the AIDS response”, UNAIDS has launched a free social networking site, called AIDSspace.org.
UNAIDS executive director Michel Sidibé said today: “The good news is that we have evidence that the declines we are seeing are due, at least in part, to HIV prevention.
“However, the findings also show that prevention programming is often off the mark.”
Over the past five years the number of AIDS-related deaths has declined by over 10%, with antiretrovirals saving some 2.9 million lives, the report indicated.
Dr Margaret Chan, Director- General of WHO said: “International and national investment in HIV treatment scale-up has yielded concrete and measurable results. We cannot let this momentum wane.
“Now is the time to redouble our efforts, and save many more lives.”
Sidibe said: “AIDS isolation must end. Half of all maternal deaths in Botswana and South Africa are due to HIV.
“This tells us that we must work for a unified health approach bringing maternal and child health and HIV programmes as well as tuberculosis programmes together to work to achieve their common goal.”
'Putting pen to paper' to help children with HIV
“Sick kids need medicine. Please share with them,” Zoia Kallimanis Foster, from New York, read from her letter to pharmaceutical executives and government leaders.
Children from 14 countries have written letters to drug companies and governments, urging them to help children living with HIV/AIDS – through the ‘Prescription for Life’ campaign, launched today on Universal Children’s Day.
They are asking them “to improve testing and treatment for infants and children living with HIV”, estimated to number more than two million in 2007.
Only about 15% of those children get the antiretroviral drugs they need to stay alive.
“Without treatment, nearly a third of HIV-positive infants die by their first birthday, and half of all children born with HIV die before they are two years old,” the Ecumenical Advocacy Alliance says.
The alliance and UN partners held a panel today at the UN headquarters in New York on children with HIV, as well as launching an exhibition of the letters last night at the UN.
“These letters remind us that if children can figure it out, why can’t we?” Canadian Karen Plater, co-chairperson of the Ecumenical Advocacy Alliance’s HIV and AIDS Strategy Group, asked at the exhibit.
I know this is the second “campaign” post this week but, like the Lords of Bling campaign, I think it’s an outstanding initiative.
African heads of state are squandering money instead of spending it on HIV/AIDS and TB programmes, activists in Cape Town said today launching a campaign called: Show Us the Money for Health.
“HIV is not over-funded: Health is Under-Funded!” they declared in a statement signed by nearly 100 organisations around the world for the campaign, spearheaded by ARASA (AIDS and Rights Alliance for Southern Africa).
They released a short report – Sick and Tired – highlighting the major challenges on the continent and music videos on the extravagant spending of African heads of state.
“We will call for African governments to meet their commitments to health, to ensure accountability in the use of health funding.
“We will also call on Western governments not let African lives be caught in political crossfire, by backtracking on their commitments to HIV and health funding,” they said.
Demonstrators are using their giant eyeball – a reminder they are watching leaders and will hold them accountable – to mobilise people today in Nyanga, Khayelitsha and the city centre if you want to join the protest.
They will put up large screens with the ‘King of Bling’ music videos and distribute the Mswait dollar bills.
To sign the petition and support the campaign visit the ARASA website.
Lesotho is successfully doing nurse-initiated AIDS treatment at a primary health care level, a study in the current issue of the Journal of the International AIDS Society shows.
And Lesotho is doing better than South Africa despite having fewer resources.
Patients in Lesotho are starting treatment earlier than in South Africa – at CD4 counts of below 350 instead of below 200.
Their programme is using tenofovir in its first line regimen, which is better for patients.
Once again MSF – which initiated a programme in Lusikisiki in the Eastern Cape – is a major player in this rural care and treatment programme.
MSF, the Lesotho Health Ministry and the Christian Health Association of Lesotho rolled out the decentralized HIV/AIDS care programme in a rural area with 14 clinics and one district hospital.
“More than 13 243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level,” according to the study – and the results are encouraging.
“The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008.
“Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%).
“At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care.”
