2016 HIV goal of 75% less infections remains elusive

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ARVs have changed the face of the disease, with those who start on it, and stick to it, often living healthy lives.

Although South Africa has made significant inroads in reducing HIV-related deaths and new infections, the country is far from reaching the 2016 goal of a 75% reduction in infections by 2020.

The concession was made on Monday by President Cyril Ramaphosa in his latest weekly newsletter.

He made the remarks as the country prepares to join people across the globe today in marking World Aids Day.

“If we keep working, we are likely to end Aids as a public health threat by 2030,” wrote the president.

As the chair of the South African National Aids Council, Deputy President David Mabuza will lead the national commemoration with an address on progress in the country’s response.

With this year’s event taking place amidst the Covid-19 outbreak lockdown, Ramaphosa reflected how the pandemic has exerted pressure on health facilities.

“Many HIV, Aids and tuberculosis [TB] services have suffered. This has posed a challenge for people testing and starting antiretroviral treatment. Many people found it difficult to collect their medicines and fewer people accessed other services, such as voluntary male medical circumcision,” he said.

However, public health’s response to the coronavirus pandemic can strengthen the country’s fight against HIV and TB, said the president.

Despite the huge success South Africa has had in fighting HIV/Aids, many people are still infected with HIV every year.

Hospices provide care for about 100 000 patients each year, of which up to 44% are HIV-positive, and often many suffer from more than one diagnosis, such as co-infection with TB, cancer and other chronic conditions.

Hospices have a long history of providing care to HIV patients and were one of the first organisations to start to respond to the HIV pandemic – long before antiretrovirals (ARVs) were available, according to Bishop Kevin Dowling, who worked with the Tapahoho Hospice.

“Back then, the HIV epidemic was calling for a holistic end of life care in the most challenging of conditions, shocking conditions, and this holistic care had to embrace every facet of the life of the person and their psyche, including the spiritual dimension of dying people who had no hope at all because they were succumbing to Aids-defining diseases for which there was no remedy yet,” Dowling said.

“This holistic end of life care in those conditions was, in fact, palliative care.”

ARVs have changed the face of the disease, with those who start on it, and stick to it, often living healthy lives. Yet there is still a stigma around the disease that prevents many people from getting tested.

Today, the focus is on keeping patients in care, bringing back patients who stopped treatment and supporting them though their journey.

“While we know that ARVs change the dynamic of the disease, we believe ARV therapy alone is not enough,” said Ewa Skowronska, chief executive of the Hospice Palliative Care Association.

“Holistic care that includes psychosocial, spiritual support and bereavement are all needed to offer people a better quality of life and to help them comply with the medication schedule. It’s a complicated disease as it carries with it the psychological challenge of a lifetime on medication and combating stigma. A support system that assists people to mentally and emotionally work with the diagnosis is important.”

Zodwa Sithole, head of advocacy at the Cancer Association of SA, said: “HIV infection can lead to a weakened immune system and a lower number of CD4 cells that help fight viruses, such as human papillomavirus and Kaposi sarcoma herpesvirus.

“A stronger immune system provides very important protection against many types of cancer.

“It’s important that people take all of their medications on schedule and not skip doses.

“If you do have both HIV and cancer, palliative care can help by managing your symptoms and treatment side-effects. These include pain, fatigue, shortness of breath, depression, anxiety, nausea, vomiting and diarrhoea.”


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