The 5th SA AIDS conference started in Durban today with a call to prioritise young people in the next HIV/AIDS National Strategic Plan.
Young people have a high rate of HIV infection, too many of them confront violence every day and many of the youth urgently need access to education Mark Heywood, deputy chairman of the SA National AIDS Council, said at the opening session.
“The bottom line is that the lives of young people have not improved,” he said.
Heywood shared the platform with a courageous young woman Mandisa Dlamini, whose mother Gugu was killed in 1998 for publicly disclosing she had HIV.
“I saw my mother dying but I nearly became infected with HIV. Two years later I was pregnant,” said Dlamini, talking about how young women can make wrong decisions and get into destructive cycles simply to survive.
The vulnerability and exploitation of young women is visible in any South African city. Leaving the International Conference Centre at 10pm tonight, I saw young female sex workers hanging out on street corners only a few blocks away looking for business.
One measure of the success of this conference and the next five-year National Strategic Plan (NSP) will the difference it makes the lives of women like them.
Conference chairman Professor Francois Venter reported on what great progress has been made on tackling HIV/AIDS in South Africa since the first conferences were held in Durban in 2000 and 2003.
But Venter, also president of the HIV Clinicians Society of Southern Africa, warned against being complacent, particularly in gains made around access to antiretroviral treatment.
“Antiretrovirals are magic muti. You go from zero to 100,” said Venter, commenting on how he has seen skeletal children and adults recover from near death to lead healthy lives again.
He warned that if funding for treatment runs out doctors could be telling patients, as they were back in the ‘80s in the US: “We have what it takes to keep you alive but we won’t pay for it”.
About 1.4 million South Africans — 100 000 of them children — are now on ARV medicines but still roughly 50% of people who need the life-saving drugs do not have them.
HIV prevention needs to be prioritised, Venter said, but not at the expense of cutting back on treatment.
An important new study on AIDS treatment in the private sector in Southern Africa examines what drives up costs in HIV management – and many of these findings also apply to the public sector.
The researchers analysed the direct costs in treating more than 10 000 “HIV-infected adults are enrolled in managed care programmes” from three years before ARV initiation up to five years afterwards and the results are published in the current issue of PLos Medicine.
They found: “There was a peak in costs in the period around ART initiation (from 4 months before until 4 months after starting ART) driven largely by hospitalisation, following which costs plateaued for 5 years.”
Rory Leisegang, from UCT’s Clinical Pharmacology division in the Department of Medicine, and his co-authors concluded: “Starting ART at higher CD4 counts or longer pre-ART care should reduce early costs.
“Monitoring ART adherence and interventions to improve it should reduce later costs.”
President of the HIV Clinicians Society of Southern Africa, Dr Francois Venter, commented: “$2400 annually in direct costs, once accounting for the early hospital; costs, is a bit over double that in the state sector.
“The hospitalization rates were similar, but that probably is because of a higher bar to hospitalization for state patients (which also again drives cost). As expected, poor adherence impact on costs.”