The SANAC Programme Review Committee (PRC) meeting was held on 8 April 2014. Matters under discussion included an update on the SANAC’s Prevention Technical Task Team (TTT)’s key focus areas and the approval of the Stigma Index.
Prioritising prevention
Professor Quarraisha Abdool Karim, chairperson of SANAC’s Prevention TTT, highlighted the key focus areas that the Prevention TTT is currently working on, including examining South Africa’s HIV incidence rates and modelling the impact of intensified combination interventions in key geographical areas and key populations; unpacking the implications of new HIV prevention advances for South Africa’s HIV policy and programming; reducing HIV infection in adolescent girls and addressing behaviour change in the South African population.
South Africa makes up 0.7 % of the world’s population, but 16% of the global HIV burden lies in this country, according to a 2012 UNAIDS report.
HIV epidemic and HIV prevention technologies are evolving rapidly. In 2014, there are a number of biomedical and behavioural prevention methods that are available. These include male and female condoms, HIV counselling and testing, behavioural intervention, STI treatment, Voluntary Medical Male Circumcision (VMMC), oral pre-exposure prophylaxis (PreP) and post-exposure prophylaxis (PEP). More recently, the increasing body of evidence that shows that providing ARV treatment to people living with HIV substantially decreases the likelihood of HIV being transmitted, known as Treatment as Prevention or TasP. The HTPN 052 randomised control trial showed that the sexual transmission of HIV can be decreased by 96%.
However, challenges in implementing Treatment as Prevention remain. Implementation requires high uptake of testing (including overcoming stigma and discrimination), significant clinical infrastructure and good adherence to treatment. Prof. Abool Karim also raised some ethical questions regarding Treatment as Prevention by asking if we can really treat our way out of the HIV epidemic when by the end of 2012 an estimated 45% of people were still in need of ARVs under current guidelines?
Improving HIV prevention measures and the 2014 Stigma Survey were some of the key issues addressed at the latest SANAC Programme Review
Committee meeting.
Advances in prevention science are also only a first step – to be successfully implemented we need awareness, acceptability and the uptake and access to services. There is also still the
important gap of female-initiated HIV prevention technologies, which is critical for vulnerable women.
“South Africa bears a disproportionate burden of HIV infection and while we [have] accomplished much on treatment and reducing vertical transmission, preventing sexual transmission of HIV remains a challenge. We can do what we have always done – we can wait for normative guidance from elsewhere, but we can also as a country be more pro-active and come up with novel and innovative approaches to meet our prevention challenges,” said Prof. Abdool Karim at the meeting.
Understanding and addressing stigma in South Africa
A proposal to work on the People Living with HIV (PLHIV) Stigma Index was presented for the approval of the PRC. The PLHIV Stigma Index will measure and detect changing trends of stigma and discrimination experienced by people living with HIV. It aims to address HIV-related stigma while also advocating on the key barriers and issues which perpetuate stigma.
The SANAC Trust contracted the Human Sciences Research Council (HSRC) to conduct the study in 18 National Health Insurance (NHI) districts with a sample size of approximately 10 000 people living with HIV. The survey focuses on stigma as experienced by people living with HIV. The results will be known prior to World AIDS Day on 1 December 2014. This
survey will be conducted every two years.
The PLHIV Stigma Index survey will be conducted by the members of PLHIV organisations such as the Treatment Action
Campaign, NAPWA, SANARELA and the Positive Women’s Network. This will empower PLHIV to better understand the stigma issues and to think about how to tackle them. In this
way, the Stigma Index supports the Greater Involvement of PLHIV (GIPA) principle.
The results that are gathered through the survey will allow South Africa to document and compare the various experiences and situation of people living with HIV provide an evidence base for policy change and programmatic interventions regarding HIV stigma. The Stigma Index will also measure changes over a period of time so that we can answer questions such as, “Has the situation with respect to stigma, discrimination and rights of people living with HIV worsened or improved over the last couple of years in this community?”
“Can we really treat our way out of the HIV epidemic when by the end of 2012 an estimated 45% of people were still in need of ARVs under current guidelines?”
The Stigma Index is not only about gathering data about stigma in South Africa. The results will also be used to formulate interventions to mitigate stigma at grassroots level in the 18 districts of the survey, using the National Strategic Plan objectives and the stigma mitigation framework of the Department of Health and international guidance from institutions such as UNAIDS. SANAC has approved the
undertaking of the Stigma Index and work on it is already underway.