MB Civic

By Manto Tshabalala-Msimang  |  May 26, 2006  |  The Boston Globe
GLOBAL LEADERS will converge for a special session of the UN General Assembly next week to review progress and seek agreement on the best path toward universal access to treatment and prevention of HIV and AIDS.

The session focuses on an exceptional challenge. However, it is also part of a complex, interlocking set of problems demanding our attention. Due to the limited resources available to combat HIV and AIDS, the more inclusive that we make the priorities that we set, the better.

In the runup to the special session, African officials have consulted widely to strengthen our consensus on the best way forward.

We agreed that there has to be a renewed focus on prevention as the mainstay of our response to the spread of HIV infection and the impact of AIDS. We also agreed that our common purpose would be better served if the international donor community were to align itself more closely with the plans that Africans are establishing for themselves.

In South Africa, we launched the Comprehensive Plan for Management, Care, and Treatment of HIV and AIDS two years ago, and it is almost entirely funded by the national budget. The plan has three pillars.

First, we try to ensure that the majority of South Africans who are HIV-free remain that way, by making the country hostile terrain to the virus. Our interventions include campaigns to promote safe and healthy sexual behavior and to remove the stigma attached to AIDS. We offer counseling and testing, free distribution of male and female condoms on a massive scale, and programs to prevent mother-to-child transmission of HIV. There also are broader governmental interventions to combat poverty and malnutrition, to improve the socio-economic status of women, and to deal with the challenges of violence.

Also, we have to help those who are infected to stay as healthy as possible. This means improving the nutrition of those affected, redoubling our efforts against tuberculosis, and ensuring that everyone has access to prophylaxis and treatment for other opportunistic infections. Good nutrition cannot rid a person of HIV, but it can improve the immune system and be an important factor in staving off illness.

When faced with ill health, many of our people turn to African traditional medicines, which sustained them through generations of colonialism and apartheid. In response, we are investing in research and development of these medicines to treat various ailments, and we are establishing the efficacy of such medicines in alleviating conditions associated with AIDS.

Lastly, once an HIV-positive person has a high CD4 cell count or exhibits stage 4 AIDS-defining illness as defined by the World Health Organization, the patient is eligible for antiretroviral treatment at government expense. The Health Systems Trust, an independent group that monitors healthcare delivery in South Africa, recently reported that our progress in delivering antiretroviral treatment “has probably been swifter than in any comparable country.”

Building the infrastructure to deliver treatment safely and effectively on a large scale is no easy task in the public health environment that we inherited from apartheid. Caregivers have to be recruited and trained, clinics accredited, and testing, monitoring and reporting systems put in place. There have to be reliable supplies of affordable drugs that meet our regulatory standards.

Above all, the program has to be built up in a manner that strengthens the overall public health system to deal with the broader burden of disease facing us, ranging from infections to trauma and chronic ailments such as diabetes and cardiovascular diseases.

The Washington-based Hudson Institute has said our plan is “the only one that has taken into consideration such important issues as the future recurrent cost obligations that will be required to sustain it, independent of external financial support,” and “is based on the uncompromising dictates of science and medicine.”

It is critically important to recognize that antiretroviral treatment is but one of the components in our response to the scourge of HIV and AIDS. Despite the fact that our program cannot be compared with some others in terms of its scale and comprehensiveness, we believe that the number of patients receiving antiretroviral treatment cannot be the only measure of our success or failure.

If we let that happen, we risk shortchanging the other efforts — especially on the prevention front — that we are making to ensure the health of our people.

Dr. Manto Tshabalala-Msimang is minister of health of South Africa.