‘Goals of HIV plan attainable’ – Dr. Connie Kganakga
This article was originally published on the City Press newspaper (11 June 2017).
The National Strategic Plan for HIV, TB and sexually transmitted infections (STIs), launched by Deputy President Cyril Ramaphosa in March, will be in the spotlight again at a satellite session of the SA Aids Conference in Durban this week.
While we have made exceptional progress in tackling these infections, HIV, TB and STIs remain national health, social and development priorities. About 270 000 people were newly infected with HIV last year – 100 000 of whom were adolescent girls and young women – and more than 3 million more people need to receive lifelong HIV treatment. Tuberculosis is our country’s leading cause of death and large numbers of people have untreated, asymptomatic STIs. Is the National Strategic Plan a credible response and what does it offer?
The plan is certainly ambitious because it seeks to reduce new HIV infections by 63% by 2022 (from 270 000 in 2016 to less than 100 000 by 2022) compared with a 25% reduction in the past five years; double the number of people receiving anti-retroviral treatment (ART); and significantly reduce TB infections and STIs.
“Focus for impact” approach
While continuing to be grounded in human rights principles, the plan has a strengthened focus on equal treatment and social justice. It heralds a “focus for impact” approach, which will see an intensified focus on locations with high burdens of HIV, STIs and/or TB; adolescent girls and young women; and tailoring interventions for key and vulnerable populations disproportionally affected, so that nobody is left behind. HIV prevention will be prioritised, this time through intensification of the combination prevention approach.
Implementation of the recently launched universal “test-and-treat” approach for HIV will be accelerated. This means that people with HIV will start ART as soon as possible after their diagnosis. The aim is for 90% of those living with HIV to know their status, 90% of them to be on sustained antiretroviral medication and 90% of them to have suppressed viral loads and live healthily. Test-and-treat will now be accompanied by differentiated care to provide a client-centred approach that takes into account the treatment needs of people living with HIV across the treatment cascade and stages of HIV. The master patient index that is currently being used will enable early identification of those missing appointments and allow for continuity of care if people change clinics.
There will be a new focus on prioritising service quality and on the critical health and social system enablers that are needed to translate the plan into reality. This includes trained and caring health and social service workers; effective supply chains so that there are no shortages of drugs or condoms; the use of innovative social behaviour change communication strategies for effective messaging and building strong social systems, including families and communities, needed to address the root causes of infection. There will be a focus on the specific social and structural drivers of HIV, TB and STIs, such as sexual and gender-based violence, harmful alcohol consumption, drug use and overcrowding and poor ventilation. While the public health cases for the decriminalisation of sex work and of people who use drugs are clear, their absence remains a gap in the National Strategic Plan, which needs to be advocated.
The plan seeks to capacitate civil society to be resourced to play its full role, to embrace the potential of the private sector and for every government department to contribute.
We all need to work together
The ingredients for success are there, but the ambitions of the plan will not be realised without exceptional leadership, effective implementation and adequate financing. An action framework for leadership and accountability has been committed to and the SA National Aids Council (Sanac) will be strengthened. Implementation will be cascaded to local communities and driven at provincial level through multistakeholder implementation plans currently under development, and by matching plans in civil society sectors with the private sector.
Detailed economic modelling has shown that South Africa spent R28.8bn on HIV, TB and STIs in 2016/17 and this is projected to reach R38.5bn in 2021/22. However, if we want to realise the goals of this National Strategic Plan and the National Development Plan vision of a generation free from the burden of HIV, TB and STIs, then the projected funding gap, reaching R7.2bn in 2021/22, will need to be breached in tandem with greater efficiency in the use of available resources. Sanac will continue to mobilise for the necessary funding so that the country can realise the social, economic and health benefits the strategic plan offers and be on track to eliminate HIV, TB and STIs as public health threats by 2030.
The goals of the National Strategic Plan are attainable, but only if the plan is followed in its totality to achieve compounding benefits; if systems are actually strengthened; if all heed its call to action; and if additional resources are mobilised to bridge the funding gap. Delivering on these is the heart of the challenge. We all need to work together to make our actions count.
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