South African protocol for ARV treatment.
How ARV treatment works.
A quick history of HIV in South Africa
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.
The fight for HIV treatment
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.
Rolling out ARVs
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.
Changes in HIV treatment
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.
Brighter days are ahead
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.
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We all have questions.
Below are some of the answers to the most common questions around HIV.
What is usually the first sign of HIV?
After becoming infected with HIV, most patients only experience moderate flu-like symptoms. Typically, the illness is sudden in onset and is characterised by fever, swelling of the lymph glands, a measles-like rash all over the body, ulcers in the mouth and sometimes on the genitalia.
What are the 4 stages of HIV?
- Stage 1: Infection – Exposure to infected bodily fluids.
- Stage 2: Asymptomatic – HIV quickly spreads and the patient becomes seropositive for HIV antibodies.
- Stage 3: Symptomatic – The immune system is now engaged in a constant battle with the rapidly replicating virus.
- Stage 4: AIDS – At this stage, the patient’s CD4+ count is 200 cells per mm3 or less.
How soon can HIV be detected by a blood test?
No test can detect HIV immediately after infection. The time between initial infection and a detectable viral load is called the window period. It can take anywhere from 2-12 weeks to after exposure, to detect whether you are HIV-positive or not, depending on which testing method is used.
How long does it take to show symptoms of HIV?
Following initial infection, there is a period of intense, unchecked viral replication that occurs. It usually takes 2 to 4 weeks after infection and can last about 1 to 2 weeks, after which there tends to be a slight recovery, and the infected individual is considered to be seropositive for HIV antibodies.
How is HIV transmitted?
HIV is transmitted from one person to another through the exchange of body fluids. The main method of transmission in South Africa is through unprotected sexual activity.
Does HIV test affect life insurance?
Being HIV-positive can affect standard life insurance policies, particularly if your status changes from HIV-negative to HIV-positive within a particular age range. That’s why AllLife covers all lives. Your HIV status doesn’t prevent you from getting cover with us.
Can HIV-positive women have children?
Yes, HIV-positive women can enjoy healthy pregnancies and give birth to healthy HIV-negative babies, through the Prevention of Mother to Child Transmission (PMTCT) programme. PMTCT has been highly effective in reducing the HIV transmission risk to under 1%.
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