Legalising commercial sex work, programmes against alcohol and drug abuse, subsidies for people who adopt orphans and food support for HIV positive moms who breastfeed exclusively are some of the innovative new interventions contained in government’s draft plan to fight HIV/AIDS.

The new HIV/AIDS national strategic plan for 2007-2011 was debated in the most representative HIV/AIDS meeting ever held in the country. Deputy President Phumzile Mlambo-Ngcuka opened the meeting on Wednesday together with health officials, trade union leaders and world health authorities.

Mlambo-Ngcuka, as head of the SA National AIDS Council (SANAC), and deputy health minister Nozizwe Madlala-Routledge have been driving the development of the plan.

The meeting was the final consultation before the plan is adopted as government’s official strategy for the next five years. The primary aims of the plan are to halve the number of new HIV infections and to offer treatment, care and support to 80% of all people with HIV within five years.

The latest draft, dated 12 March, is far more comprehensive – and expensive – than the one released in October last year and rejected as lacking in ambition by the Treatment Action Campaign.

Virtually all obstacles to HIV prevention, treatment and care have been identified and steps to address these have been laid out. Young people between 15 and 24 are identified as the priority target group.

The down side is that the much expanded plan may exceed the entire health budget by 20% – and cost up to R45-billion. By far the biggest cost is antiretroviral drugs (40%) followed by support for orphans and children affected by AIDS (7%).

The plan acknowledges that the health system will be challenged by “the complexity of maintaining more than one million people on antiretroviral therapy at high levels of adherence”.

For this reason, it envisages that by 2011 the majority of those needing ARVs will not get them from doctors in hospitals but rather from nurses in clinics.

In addition, it stresses time and again that prevention is the country’s best hope.

“Identifying and keeping HIV negative people negative is the most effective and sustainable intervention in the AIDS response,” stresses the plan.

It proposes a huge public awareness campaign involving high profile people taking HIV tests every month or the next five years to encourage citizens to follow their example.

The plan also aims to reduce mother-to-child HIV transmission to 5%. HIV is responsible for an increase of 42% in under-five mortality in this country in 2004.

“It’s one of the most far-sighted strategic plans on the globe at the moment,” according to the AIDS Law Project’s Mark Heywood, who has been working flat-out with government to refine proposals and targets.

But it is in response to a very grim situation. The plan acknowledges that there is a “generalised HIV/AIDS epidemic” affecting over one in ten people (11.2%) in the country.

The epidemic is “firmly established in the general population and sexual networking in the population is sufficient to sustain the epidemic independent of sub-populations at higher risk of infection”.

By mid-2006, an estimated 5.4 million people were living with HIV/AIDS, almost 300 000 of whom were children under the age of 14. Some 38 000 babies were born HIV positive, while another 26 000 were infected by breastmilk.

Over one in five women aged 15 to 49 are HIV positive, in comparison to 15.4% of men of the same age. Almost 17% of young women between the ages of 15 and 24 are HIV positive as opposed to a mere 3.7% of young men.

Dr Francois Venter of the Reproductive Health Research Unit at Chris Hani Baragwanath Hospital has also made submissions to the plan: “There are more hard targets in terms of treatment and testing and that’s great. But we need to fast track the restructuring of the health care system if we want to make this piece of paper real. We will need to dramatically change the way we do business and the leadership will need to come from the top. If it’s going to be more of the same, then we won’t get very far,” Venter cautioned.

Unlike the previous five-year plan, implementation of the new plan will be closely monitored every six months by SANAC and there will be a mid-term review in 2009.

Kerry Cullinan & Anso Thom

Health-e News Service

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