Category Archives: Infectious Disease Control

In Sierra Leone, “HIV/AIDS, TB & Malaria Pose Serious Threats to Development in Africa”…President Koroma tells Counterparts


President Dr. Ernest Bai Koroma has said that HIV/AIDS, Tuberculosis and Malaria pose serious threats to the socio-economic development of Africa.He made this statement on the occasion of the Special Summit of the African Union on HIV/AIDS, Tuberculosis & Malaria in the Nigerian capital, Abuja on Monday 15th July, 2013.

The theme of the two-day summit is ‘Ownership, Accountability and Sustainability of HIV/AIDS, Tuberculosis and Malaria Response in Africa: Past, Present and the Future’.

President Koroma informed his colleague Heads of State and Government that Sierra Leone has drastically reduced HIV infections and was now aiming towards a zero tolerance plan against the malaise. Whilst acknowledging the challenges facing the fight, he however maintained, “We have shown leadership as a nation”.

The president also informed the Summit that in the fight against malaria & TB, the Government of Sierra Leone has made tremendous progress and was still making the necessary efforts to minimize the presence of these syndromes in the country.

President Koroma further used the platform to continue to appeal to donors to increase funding to enable performing governments accomplish their struggle against HIV/AIDS, Malaria and Tuberculosis in Africa.He also called on all to renew their vow and fight against these diseases so that the continent will realize sustainable socio-economic development.

He commended his Nigerian counterpart His Excellency Goodluck Jonathan and the African Union for the initiative to organize a Special Summit to implement the Abuja Call for Accelerated Action towards Universal Access to HIV/AIDS, Tuberculosis and Malaria treatment services in Africa.

In his opening remarks, the Nigerian President Goodluck Ebele Jonathan said the presence of his colleagues at the Summit signifies the importance they attach to the development of Africa. He pointed out that these diseases were crucial to the socio-economic development of the continent and still remain major causes of morbidity and mortality. President Jonathan therefore urged his colleagues to give the relevant attention needed to address these syndromes.

Commending Global Fund for being the major funding agency that continues to sustain the fight against malaria, TB and AIDS, which he dubbed a “noble mission”, President Goodluck Jonathan called on his colleagues Heads of States and Government to take ownership of the process. He also implored them to sustain their commitment, noting that the Summit was also to review their total achievements so far and make a renewed commitment towards the challenge.

The President also acknowledged other development partners for their immense support and efforts towards the fight against malaria, TB and HIV/AIDS in Africa.

According to the World Health Organization (WHO), of the World’s thirty four million people living with HIV, 23.5 million are in Sub-Saharan Africa, and 21 of the Global Plan’s 22 focus countries are in Africa. Similarly, the World Health Organization (WHO) estimates that there were about 219 million cases in 2010 and about 90% of the estimated 660,000 deaths from malaria in that year occurred in Africa. Africa also carries a large burden of the TB disease with 30% percent of the approximately 9 million new TB cases each year and 9 of the 22 most affected countries coming from Africa.

Recognizing the devastating impact of HIV/AIDS, TB and Malaria and other related infectious diseases on the socio-economic development of Africa, the Heads of State and Government of Africa adopted the 2000 and 2001 Abuja Declarations and Action Frameworks committing Africa Union Member States to take measures to halt the progression of these diseases in Africa. This high level commitment, reinforced on multiple occasions at the continental level over the past five years, marked a turning point in the continental response to the three diseases stimulating a sharp increase in resources and the scaling-up of programs to fight HIV/AIDS, TB and Malaria.

Although countries have strengthened their interventions in many of the priority targets set by the Abuja Call, they still continue to face constraints due to the lack of financial, material, technical and human resources for addressing health needs. Increase access to Anti-Retroviral Treatment (ART) is imperative. It is against this background that the Heads of State and Government during their Twentieth Ordinary Session of the January 2013 Summit held in Addis Ababa, endorsed the offer made by the Federal Republic of Nigeria, to host the Special Follow-up Summit on the Abuja 2001 Africa Union Summit on HIV/AIDS, Tuberculosis, Malaria and other related communicable diseases in the third quarter of 2013 to address the numerous challenges that will enable Africa realize the Abuja Call objectives and the Millennium Development Goal (MDG) on health.

On arrival in Abuja, Nigeria, President Koroma was received by the Special Adviser to President Goodluck Jonathan on Performance Monitoring and Evaluation, Professor Sylvester Monye, where he was taken to CGOCC Company Limited for a brief presentation on projects undertaken by the company on hydro electricity and water supply.


By State House  Communications

17 July 2013

ARVs for the almost healthy.

Bottles of antiretroviral drug Truvada. File photo. Image by: AFP / AFP

The Health Department wants to use antiretrovirals to treat patients with a CD4 count of 500 or more next year, as recommended by the World Health Organisation’s new guidelines.

Currently pregnant women and patients with a CD4 count (a measure of immunity) of 350 or less qualify for treatment.

Health Minister Aaron Motsoaledi told The Times: “The guidelines we are currently following are from WHO, so I see no reason why we should not adopt the new guidelines. If they come with new guidelines, ours is to follow.”

But activists and doctors say the department needs to sort out its drugs stocks first.

On Sunday, the UN organisation announced the new guidelines. It said because treatment makes HIV-positive people less infectious, giving it to more people would save millions of lives by 2020.

South Africa has 2million people on ARVs, a regime that resulted in life expectancy jumping by six years last year.

Professor Francois Venter, of the HIV Clinicians’ Society, said doctors debated giving ARVs to healthier people extensively last year.

He said that giving ARVs to a million more people would create jobs and keep people in the health system.

“Patients hate being told to come back later [to get treatment].”

But, he said, “It would have been good to sort out supply issues first.”

However, with more people on treatment for longer, there is a greater chance of people developing resistance to the drugs, as happened with TB medications.

This can result in premature deaths.

Venter said the research on starting treatment earlier has not factored in “drug interruptions that we are seeing throughout our region”.

Mluleki Zazini, general secretary of the National Association for People Living with HIV and Aids, said his organisation had raised concerns about ARV stocks.

Zazini said Motsoaledi had promised to implement a centralised hi-tech stock-monitoring system for drugs.


5 July 2013

US Supreme Court strikes down policy requiring AIDS groups to oppose prostitution in order to receive US Government funds.

Clinical Director Chuck Cloniger (R) seeing his patient, Tanesh Watson for medical counseling at St. James Infirmary in San Francisco, a medical and social service organization for current and former sex workers of all genders, on 14 June 2012 in California. Credit: UNAIDS/K.Hoshino

On 20 June 2013, the United States (US) Supreme Court struck down section 7631(f) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (The Leadership Act). This provision which the Court called the “policy requirement” mandates that no funds made available under the Leadership Act may “provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.”

The US Supreme Court ruled in response to a challenge filed on 23 September 2005 by 5 civil society organizations against the provision and its negative impact on their efforts to address HIV.  The organizations include: Alliance for Open Society International; the Open Society Institute; Pathfinder International; the Global Health Council; and InterAction.

The US Supreme Court held that the policy requirement violates the First Amendment of the US Constitution which protects free speech. In particular, the Court held that the “policy requirement compels as a condition of federal funding the affirmation of a belief that by its nature cannot be confined with the scope of the Government program.”  The Court noted that “the First Amendment prohibits the government from telling people what they must say.”

Commenting on the decision of the Court, Purnima Mane of Pathfinder International said, “It has been a long and uphill battle, but we are very happy that the Court has spoken out in defense of our ability to engage with sex workers so we can better put in place programs that protect them and their clients from HIV.”

Respondents had claimed, among other things, that adopting a policy explicitly opposing prostitution may diminish the effectiveness of some of their HIV programs by making it more difficult to work with sex workers—a population at higher risk of HIV infection.

In its 2012 report, the Global Commission on HIV and the Law already noted that, “The pledge puts grantees in an impossible bind. If they don’t sign, they are denied the funds they need to control and combat HIV. If they sign, recipient organisations are barred from supporting sex workers in taking control of their own lives.”

Female sex workers are 13.5 times more likely to be living with HIV than other women of reproductive age in low-income and middle-income countries. In sub-Saharan Africa, the region with the highest HIV prevalence, the pooled HIV prevalence among sex workers is 36.9%.

The involvement and empowerment of sex workers with regard to HIV prevention, treatment and care services has shown to have great impact in reducing HIV infections among both female sex workers and the overall adult population. “The end of this requirement is a significant victory for sex workers and their advocates globally. Our contributions to effective HIV responses have now been recognised,” said Ruth Morgan-Thomas of the Global Network of Sex Work Project.

Given the importance of the case for the global AIDS response, the UNAIDS Secretariat participated as an amicus curiae (friend of the court). In that role, UNAIDS provided public health evidence and human rights arguments to support greater access to funding and resources for organisations engaged in HIV prevention, treatment, care and support services with and for sex workers. UNAIDS main points to the Supreme Court included:  1) Sex workers are among the populations most affected by HIV; 2) engagement with sex workers is essential to an effective response to HIV; and 3) any effective response requires adequate funding for programmes designed to ensure HIV prevention, treatment, care and support for sex workers.

UNAIDS Executive Director, Michel Sidibé praised the groups that were courageous enough to challenge the provision. “This shows civil society at its best – advocating for global health for all.  No group, including sex workers, should be left behind in our efforts to bring the AIDS epidemic to an end.”

US funding critical to HIV response

US leadership and generosity has been instrumental in the progress made in the global AIDS response over the last decade. Since the adoption of the Leadership Act, some 45.7 billion dollars have been made available to address HIV worldwide. The President’s Emergency Plan for AIDS Relief (PEPFAR), authorized by the Leadership Act, has been the largest health initiative ever undertaken by one country to address a global health epidemic. Thanks to US funding, access to HIV treatment has been expanded in low- and middle-income countries, and millions of lives are being saved. The decision of the US Supreme Court to strike down the policy requirement will greatly contribute to expand and improve the global AIDS response even further.


21 June 2013


More people living longer with HIV in SA.

South Africa has more people living longer with HIV, which is attributed to the country’s anti-retroviral (ARV) treatment programme. The National HIV Household Survey for 2012 shows about 6.4 million people in South Africa are living with HIV, or about 12.3% of the population.

These figures are up from 5.6 million or 10.3% of the population, in 2008. Over 2 million people are on ARV treatment.

Dr Khangelani Zuma of the Human Sciences Research Council presented some of the survey’s findings at the 6th South African Aids Conference in Durban.

“When we looked deeper into the results is that the prevalence of HIV has increased among people who are 25 years and above, but among those that are 15 years to 24 years HIV prevalence has gone down, which means actually fewer youth is HIV positive. But more people who are 25 and above are HIV positive which has a steady increase that could be attributed to the success of ARV therapy,” says Zuma.

A more worrying finding is that condom use among the youth between 15 to 24 years, and among adults aged 25 to 49 has significantly declined.

The Health Department’s Dr Yogan Pillay says they’re extending condom distribution.

“The department is currently working on condom distribution plans at district level which is far more targeted for both male and female condoms because we recognise that while we need combination prevention, condoms work,” says Pillay.

Pillay adds: ” We buy a lot of condoms, 500 male condoms are not enough but 12 million female condoms. The question is who is using it and for those that are not using it why aren’t they using it and what can we do about it. Those are critical questions that we need to answer.”

20 June 2013



Male circumcision could save Zimbabwe US$3 billion.

Zimbabwe could save up to US$3 billion in treatment of HIV and Aids and downstream costs if the country can scale up its Voluntary Medical Male Circumcision (VMMC), a health official has said.

Report by Christopher Mahove

Ministry of Health and Child Welfare, HIV and Aids and TB Specialist, Owen Mugurungi, said if the VMMC was to make an impact in the country, there was need for a rapid scaling up of the programme among the 15 to 49 age groups to above the 80% mark, which translated to 1,9 million men.

“If we do that, we will be able to reduce the rate of HIV infection from the current 130 000 new infections to less than 50 000 per year by 2020,” said Mugurungi.

“What it means is we would have also prevented close to 750 000 new HIV infections throughout the country and we would have invested around between US$100-US$120 million, but in terms of treatment and downstream costs, we will probably save US$2,9 billion.

“So you can see from an investment perspective, of saying where should we put our money, this is one of the high return areas in which we should be able to put our money.”

He said at community level, there were also even more benefits for partners of circumcised men and others, as it contributed to more than 75% prevention of HIV and Aids transmission to spouses.

Circumcision, Mugurungi said was also crucial in the elimination of the human papiloma virus, which affected the male organ and was the major cause of cervical cancer in women.

“This is because we know that if we circumcise all men, 60% of them are more likely to have reduced risk and if they have reduced risk, they are also less likely to transmit the disease, so that cascades to situations where even at community level, there is higher or better prevention,” he said.

Mugurungi said although the male circumcision programme had started on a slow note in 2009 in terms of uptake, the trend was slowly improving, with high hopes that the country would be able to reach its target.

“….but we are happy that in 2010, we circumcised the whole year, about 15 000, and already this year, 2013, during this previous campaign, which just happened during the holiday, we have circumcised more than 15 000.

“We are happy that we have achieved in less than six weeks what we achieved in 12 months. If that is anything to go by, we are happy to say that at least people are beginning to take it up and we will be able to circumcise more,” Mugurungi noted.

He said there was need for extensive educational campaigns to take the correct message to the people.

There are also other benefits that have for a long time been associated with circumcision, among them the prevention of genital ulcerations and general personal hygiene.

Mugurungi said studies done in South Africa, Kenya and Uganda had shown evidence that HIV infection rate among circumcised males was 60% lower than in those who were not.

Before the introduction of the male circumcision programme only a handful of private health institutions were offering the service and mostly for reasons other than as an HIV intervention measure.

In Africa, the vulnerability of women and girls to HIV remains high, with women constituting 59% of people living with HIV.

19 May 2013


AIDS council adopts National Strategic Plan for HIV, TB

Deputy President Kgalema Motlanthe at a plenary meeting of the South African National Aids Council in Secunda, Mpumalanga. Picture: GCIS

By Samuel Mungadze

A NATIONAL Strategic Plan for HIV, tuberculous (TB) and sexually transmitted infections has been adopted on Friday, during South African National Aids Council (Sanac) meeting in Secunda, Mpumalanga, which was chaired by Deputy President Kgalema Motlanthe.

The National Strategic Plan has a target to have 3-million people on antiretroviral (ARV) treatment by 2015. South Africa currently has 1.9-million people on treatment.

The plan also aims to eliminate the transmission of HIV infection from mother to child by 2015 and to reduce AIDS-related maternal deaths. The country has in the recent past seen significant changes in the rate of mother-to-child HIV transmission.

Between 2008 and 2012, the rate of mother-to-child HIV transmission dropped from 8% to 2.7%. There was a leap in the percentage of HIV-infected women receiving ARV therapy between 2011 and 2012, from 87.3 % to 99%.

Similarly, 99 % of all infants born to HIV-infected women receive prophylactic ARV medication to reduce the risk of early mother-to-child HIV transmission in the first six weeks.

In this plan “Sanac aims to reduce TB incidence and mortality caused by TB in people living with HIV by 50 % in 2015″, read the statement from the council.

Sanac also approved plans to launch an HIV prevention programme aimed at sex workers. Details of the project were, however, not released with the council saying it would do so closer to the launch.

The National Strategic Plan is one of the many plans the government is implementing. Early, this month, Health Minister Aaron Motsoaledi announced the introduction of fixed-drug combination ARV therapy.

Patients living with both HIV and TB, have started being treated on the new therapy.

Fixed-drug combination therapy is a combination of three crucial antiretroviral medications in one tablet, taken only once a day.

This eliminates the need for patients to take three or more pills at various intervals per day.


19 April 2013

From the Business Day Live


The Inextricable Link between Non-communicable Diseases (NCDs) and Maternal Mortality.

(Photo courtesy of MamaYe)

By Daniel Wasonga


Non-communicable diseases (NCDs) are not passed from person to person, and include those such as cancer, diabetes and hypertension. They may be of long duration and slow in progression, or in some instances, result in rapid death. NCDs are categorized mostly by their non-infectious causes and not their duration. Like all diseases that develop slowly and worsen over a long period of time, NCDs require chronic care management.

Expectant mothers, especially those beyond the first 42 days, are uniquely vulnerable to NCDs and require proper maternal care at home or in healthcare facilities. Exposure of these women to any disease is detrimental to their health and that of their unborn babies. Chronic diseases increase the health risks of expectant mothers and without adequate care, maternal mortality will rise beyond the current undesirable levels, especially in the developing economies.

NCDs disproportionately affect the low and middle income countries, where 80% (29 million) of deaths related to these diseases occur. Women in general already bear the burdens of NCDs, which are compounded by myths and misconceptions. Social and cultural taboos often prohibit women from opening up about issues such as family planning and unwanted pregnancies, which impairs the few efforts being made at improving these conditions. Furthermore, the constant “blame game” has not really helped in bringing stakeholders together in finding solutions for the specific issue of maternal mortality related to NCDs.

The cost of treatment is high. For expectant mothers who are the sole breadwinners in their households, getting proper care for NCDs may be difficult. This is especially the case in Africa, where cancer, cardiovascular disease, chronic respiratory disease and diabetes are leading causes of death in women. Worldwide, these diseases kill 18 million women yearly.

The impact of these diseases on society as a whole is enormous – maternal mortality goes beyond its consequences on individuals. The loss of women who are at their prime would leave an economic and social gap in society. Ignoring this aspect of the link between maternal mortality and NCDs is a mistake our decision makers and policy formulators should not make.

The overwhelming emphasis on reproductive and maternal health has pushed the special focus on NCDs to the periphery, an approach that is not effective. Maternal mortality remains the least achieved of the Millennium Development Goals (MDGs) and multi-faceted solutions promise better returns. A comprehensive approach to women’s health that goes beyond the maternal focus is essential and much more sensible. The current interventions are too rigid and limited to the MDGs with little or no focus on post-MDG initiatives.

Although some achievements have been made in Africa on reversing maternal mortality, the progress has been limited and unequally distributed within and among countries. The upcoming Conference of African Ministers of Health should focus on compounding the gains made within countries and ensuring there is no disconnect between government and initiatives taken at the grassroots level. In the push towards achieving the MDGs, Africa needs renewed commitments from the governments and feasible, effective monitoring and evaluation mechanisms. Best interventions should also be shared between countries to underline the collective efforts in eradicating maternal mortality.

23 April 2013

South Africa: Health Minister Aaron Motsoaledi to Launch the Fixed Dose Combination Pill.

Health Minister Aaron Motsoaledi has described the launch of the new triple combination antiretrovirals as a revolution.

Johannesburg — The Minister of Health, Dr Aaron Motsoaledi says the roll-out of the Fixed Dose Combination (ARV) during the 2013/14 financial year as announced last year is on track.

The Minister will formally launch the programme on the 8th of April 2013 at Phedisong 4 Clinic – Ga-Rankuwa, north of Pretoria.

“We will be starting with newly diagnosed HIV positive persons eligible for treatment, HIV positive pregnant women and breast-feeding mothers” said Motsoaledi.

Other Patients currently on ARV’s will be switched to the Fixed Dose Combination after clinical assessment by their health care providers.

There are about 1.9 million patients on ARV treatment in South Africa.

5 April 2013

By South African Departmment of  Health


Africa: Historic Opportunity to Tackle Drug-Resistant TB Demands Fast Response.

The Lizo Nobanda TB Care Centre is run by Medecins Sans Frontieres. It is a short-stay facility with just 10 beds in the heart of Khayelitsha.

Press Release

People living with MDR-TB and their healthcare providers call for urgent action

Download the manifesto: TB manifesto (PDF)

Read the ‘Test me, treat me’ manifesto and see who signed it at:

“We have been waiting for half a century for new drugs that are effective against tuberculosis. Must we wait another fifty years to seize this historic opportunity to improve and roll out treatment for drug-resistant TB?” said Dr Erkin Chinasylova, TB doctor for MSF in Swaziland. “Getting better treatment is beyond urgent, but we are not seeing anything like the level of prioritisation required to make this a reality.”

MSF projects are seeing unprecedented numbers of people with MDR-TB around the world, with drug resistance found not only among patients who have previously failed TB treatment but also in patients newly diagnosed with TB – a clear sign that MDR-TB is being transmitted in its own right in the communities in which we work.

Left untreated, the infectious disease is lethal, but treatment today puts people through two years of excruciating side effects, including psychosis, deafness and constant nausea, with painful daily injections for up to eight months. Barely half of people get cured.

After close to five decades of insufficient research and development into TB, two new drugs – bedaquiline and delamanid – have recently been or are about to be approved.

Research is urgently needed to determine the best way to use these new drugs so that treatment can be made shorter and more effective, and rolled out to treat the growing number of people with MDR-TB. People on MDR-TB treatment and their caregivers from around the world outline these and other demands in the Test me, treat me manifesto, and urge others to join their call for urgent action.

“It’s 2013 and I’m beginning a fourth year of living with TB, when I should be in my fourth year at university,” said Phumeza Tisile, a 22-year-old woman who receives treatment for extensively drug-resistant TB from MSF in Khayelitsha, South Africa, and is one of the signatories of the manifesto. “I’ve swallowed around 20,000 pills and received over 200 daily painful injections since I started treatment in June 2010, and the drugs have left me deaf. I wish I could take just two tablets a day for a month or so and be cured.”

The number of people receiving MDR-TB treatment globally remains shockingly low, at less than one in five. Greater political and financial support from the international community is needed to address this gap.

“Right when TB should be the global priority, the trend we’re seeing is that it is being deprioritised. This is unacceptable,” said Dr Manica Balasegaram, executive director of MSF’s Access Campaign.

The Global Fund provides about 90 per cent of international support for TB, but it has recently reduced the share going to the disease. Ahead of a key replenishment meeting later this year, donors must ensure the Fund is adequately financed so that countries have the support they need to strengthen the MDR-TB response.

With better treatment on the way, affected countries should scale up efforts to diagnose and treat MDR-TB today, so that robust programmes are in place once the new drugs are introduced.

See MSF infographics on TB – length of treatment, side effects, access to treatment etc – at

Drug-resistant forms of TB are a neglected global health crisis: the World Health Organization estimates there were 630,000 cases of MDR-TB in 2011. MSF started providing treatment to people with MDR-TB in 2001. In 2011, MSF provided treatment to 1,300 people with MDR-TB in 21 countries.

By Doctors Without Borders
19 March 2013

Has HIV funding revived lagging health systems?

JOHANNESBURG, 6 March 2013 (IRIN) – The HIV/AIDS epidemic arrived in sub-Saharan Africa after decades of neglect had left healthcare systems dangerously weak, barely able to cope with the onslaught of patients. Then the money started pouring in – funding for HIV programmes rose from 5.5 percent of health aid in 1998 to nearly half of it almost 10 years later.

But the jury is still out on whether the large sums of AIDS funding have made healthcare systems more resilient, whether ” the capacity gains conferred over the past decade will be durable as donors pull out [and whether] previous, pre-aid boom fragilities in service delivery and volatility in public spending would be reduced in the post-donor period,” noted Amanda Glassman, director of global health policy and research at the Washington-based Center for Global Development.

Some have argued that the AIDS epidemic has helped generate an overall increase in health funding and mobilized an international push for more equitable healthcare access. But others maintain that the billions of donor dollars spent fighting HIV/AIDS in the last decade have done little to strengthen fragile national health systems.

In the initial, emergency phase of the epidemic, donors bypassed weak areas of national health systems to set up structures that would yield faster results. On the ground, this meant modern HIV/AIDS clinics, fully staffed and equipped, offering free services in one corner of a public hospital, while the rest of the hospital limped along with inadequate infrastructure, high user fees and staff shortages.

“It was appropriate and inevitable at the time. We had to react the way we did. Now, we need to be responsive to the current situation and what we learned,” said Alan Whiteside, executive director of the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal.

Lessons learned

It is difficult to assess whether donor funding has increased resilience, but gains in health status and HIV/AIDS service coverage – such as the number of eligible people receiving antiretrovirals (ARV) and the number of pregnant women receiving services to prevent mother-to-child transmission of the virus – suggest that health-system capacity has been strengthened, Glassman told IRIN.

Even with its health sector crippled by tuberculosis (TB) and HIV epidemics, South Africa’s antiretroviral programme is now the biggest in the world – over 1.7 million HIV-positive people are treated by the government. And in this year’s budget speech, Finance Minister Pravin Gordhan announced plans to put an additional 500,000 people on treatment each year.

“The [treatment programme] has added staff and resources to the base of the health system, brought in a whole lot of technical assistance from the outside, and, in an intangible way, it has raised hope amongst [healthcare] providers,” said Helen Schneider of the School of the Public Health at the University of the Western Cape.

“The [treatment programme] has added staff and resources to the base of the health system … and, in an intangible way, it has raised hope amongst [healthcare] providers” HIV treatment programmes have created new regiments of healthcare workers, including lay counsellors and patients with good ARV adherence who assist with adherence counselling through clinics and community outreach. The community outreach approach has been extended to home-based care for patients with extensively drug-resistant TB. In addition, to deal with the scarcity of doctors, nurses have been certified to initiate HIV treatment and to expand access to HIV treatment.

Community health has been positively affected. A recent study conducted in South Africa’s KwaZulu-Natal Province – one of the regions hardest hit by the HIV epidemic – found that increased access to ARV therapy has raised adult life expectancy by more than 11 years since 2004. The observed increase in life expectancy was one of the most rapid in the history of public health, noted the authors of the study, released in the February edition of the journal Science.

But major challenges remain – particularly for countries that are over-reliant on international funding and that still don’t spend enough of their domestic budgets on health.

The real test

As AIDS becomes a chronic and manageable condition, donors are turning their attention to strengthening health systems. The Global Fund to Fight AIDS, TB and Malaria has acknowledged that weak health systems have limited the performance potential of its projects. The US President’s Emergency Plan for AIDS Relief (PEPFAR) is looking at a “deeper integration of HIV services into existing national programs and systems”.

And the real test to measure the resilience of health systems is yet to come. “We won’t really know if that strengthening can be sustained until donors phase out,” Glassman told IRIN.

Savvy recipient countries that have used donor funds earmarked for specific diseases to build their health systems will fare better. Rwanda, for example, used its Global Fund and PEPFAR monies to fund insurance coverage for the poor, including benefits related to HIV, TB and malaria.

“Governments that allowed all the donor spending off-budget on AIDS will have a major problem building resilience, and the transition arrangements [for when donors pull out] in those settings are still vague,” Glassman warned.

By Kanya Ndaki
6 March 2013