Sudan: Lack of HIV Prevention Methods a Major Concern - Living With Aids # 440

Khopotso Bodibe

22 July 2010

The good news from the International AIDS Conference in Vienna that a microbicide gel tested in South Africa for the prevention of HIV infection is an ironically painful reminder that there is an urgent need for effective preventative measures to reduce new HIV infections.

Test results of the microbicide gel demonstrate that it can cut HIV infection in women by 39%. This is a break-through for the scientific community which has been searching for a female-controlled HIV prevention method for years. It's also a break-through for research using antiretroviral therapy as prophylaxis, instead of as treatment. The gel was based on an antiretroviral drug called Tenofovir. The Health Department had long been awaiting the results of the study.

"For too long we have been doing research. We really need something very urgently. It's a very interesting study. It will help us turn the corner because it's not treatment. We are using an antiretroviral to prevent, rather than to treat. That is completely different. It's a new world altogether. That's what will be exciting", enthused Health Minister, Dr Aaron Motsoaledi.

The gel, however, will not be immediately available for public use as an HIV prevention tool. Subsequent trials to confirm the results will be conducted before it can enter the market. Results of the tenofovir gel come at a time when the AIDS community is concerned that there are very limited options for HIV prevention.

"We are still in big, big, big trouble. Make no mistake about it. And I want South Africans to wake up to that. If there is a war we need to wage much stronger than we've ever done, it is the war against HIV/AIDS. It's affecting every aspect of South African life", the Minister warned grimly.

HIV prevention technologies have been hard to find. Save for the male and female condom, and recently, medical male circumcision, no new mechanisms have been successful. A vaccine for HIV is still a long way to come. On a personal level, behaviour change is difficult to adopt and adhere to. Some pockets of society, such as women for instance, are not able to negotiate safe sex with their partners. Sexual abuse is also rife.

On the other hand, finding treatment for AIDS has also taken a while. However, more drugs are now available since the days when AZT was the only medication around. In South Africa, the Medicines Control Council registered over 60 antiretrovirals this week. About one million people are accessing antiretroviral therapy through the public health sector. While it's laudable that government can provide treatment for its people, it is a big concern that the health system cannot prevent new HIV infections.

"When the president announced our new approach to HIV/AIDS on World AIDS Day last year on December 1, people picked up one part, which is the treatment part. The most important part which people never mentioned is the prevention part. Let me tell you: Even before I went to medical school we used to sing Let me put it in my language: 'Thibela malwetse e phala kalafo', meaning prevention is better than cure. Now it's quite unfortunate that in South Africa - it's not only for HIV/AIDS, by the way - we are running a very destructive, very expensive unsustainable health care system which is based on curative rather than preventative and promotion of health care. That's exactly one of the things that we need to change. Only when we change that will our HIV/AIDS, TB burden and all the burden of disease we are carrying, actually start coming down", the Health Minister pointed out.

South Africa has the highest number of people living with HIV and AIDS in the entire world. It is believed that in 2008, over a quarter of a million South Africans died of AIDS. National prevalence is around 11%, with some age groups being particularly affected. Almost one in three women aged between 25 and 29, and over a quarter of men aged 30 - 34, are living with HIV. Among children aged two and older, HIV prevalence differs by province.

Earlier this year South Africa launched a major HIV Counselling and Testing Campaign to have 15 million South Africans tested. By raising awareness of HIV, the campaign aims to reduce by half the number of new HIV infections by 2011.

"We want South Africans to be behind this massive war against HIV/AIDS using the slogan 'I'm responsible. We are responsible and South Africa is taking responsibility'." , Motsoaledi said.

The campaign will sharply increase the number of people needing treatment. Equally, in the absence of new effective methodologies to prevent HIV infection, the government hopes that the campaign will encourage more HIV-negative South Africans to adopt and adhere to existing prevention methods. These are abstaining from sex, using condoms correctly and consistently and being faithful to one partner, and for men to consider medical male circumcision as an added tool to minimise the risk of HIV infection. Until new methods are found, these are the only options available to save ourselves.