South African protocol for ARV treatment.

Our country’s political history has played a significant role in the evolution of its HIV epidemic. In 1982, the first case of HIV was officially diagnosed and announced in South Africa. At the time, treatment was entirely palliative.

As you can imagine, there was great public and scientific confusion around the virus. The first deaths as a result of HIV were recorded in 1985, and HIV was officially announced as a communicable disease by the then-government in 1987. Towards the end of the 1980s, the Department of Health set up an HIV/AIDS advisory board, and began to look into the virus and disease.

By the early 1990s, HIV was already becoming quite common, with approximately 120,000 people having tested positive for HIV.

Infection rates rose exponentially during the 1990s, becoming an epidemic. Demand for accessible treatment grew, particularly for ARV treatment that was well-known outside of South Africa. People heard of HIV-positive individuals being able to live longer, healthier lives, and avoid the progression into AIDS.

Unfortunately, HIV treatment became a highly politicised item of concern. Throughout the 1990s, despite many warnings from scientists and health care workers, the South African government did not offer ARV treatment through the public health system. It’s still unclear as to whether it was a case of not wanting to or not being able to. In 1998, Former President, Thabo Mbeki, was appointed to the Inter-Ministerial Committee on HIV/AIDS.

Claims arose, related to potential side-effects and ingredients of ARV treatment options. This resulted in Dr Manto Tshabalala Msimang advising the Committee to stall the introduction of ARVs into the South African healthcare system. Unfortunately, because of further disinformation and uncertain agendas, the fight for ARV treatment would continue far longer than necessary.

The South African government continued to focus on preventing HIV transmission, above the promotion of treatment. It was at this point that the Treatment Action Campaign (TAC) was launched. TAC lobbied and pushed for government to provide ARVs via the public health system. Various campaigns, court cases and civil disobedience initiatives were used to achieve this goal.

Eventually, ARV treatment became available in South Africa. The government finalised a rollout plan for these life-saving medications during 2003. Gauteng was first in line for implementation and rollout and, shortly thereafter, a nationwide rollout followed. But, by the following year, over 5 million South Africans were HIV-positive, making the country home to the highest HIV infection rate in the world.

Rolling out treatment to HIV-positive South Africans gained momentum thereafter. Former President, Jacob Zuma, led government’s 2009 commitment to conducting HIV tests for all pregnant women, immediately providing ARV treatment if necessary.

The significance of this decision is still relevant today, as the prevention of mother to child transmission (PMTCT) programme has been instrumental in reducing the national infection rate among children and babies. Another key benefit of the treatment has been the drop in the mortality rate of mothers.

At first, ARV treatment was complicated. It remained this way even when initially introduced to South Africa. There were also different criteria compared to today, for beginning treatment.

Previously, only when the CD4 count fell below a specific figure, was an HIV-positive person offered ARV treatment. There were also many tablets that needed to be taken at the exact same time every day. Confusion and anxiety around treatment rose, and many people, through no fault of their own, missed doses.

Today, ARV treatment comes in many options, and new discoveries are constantly being made around the world. Often, research is presented at the United Nations AIDS conference, for experts around the world to scrutinise, support and challenge, before the public can be introduced to more options.

Treatment protocol has also changed in that anyone in South Africa testing positive for HIV is immediately placed onto ARVs – there is no longer a requirement for the CD4 count to fall below a specific figure. HIV is also no longer a hotly contested political issue. Instead, effective and proactive treatment and support programmes are provided. This ensures that every person who tests positive for HIV can live a long, healthy, and happy life.

Research is being funded around the world, and with it, the possibility of an HIV vaccine is becoming a viable development. If governments commit and stay the course, anything is possible.

Closer to home, though, each year seems to offer simpler treatment options to HIV positive people, making it a manageable chronic condition, and re-classifying it from the terminal condition it once was.