Achieving South Africa's National Strategic Plan for HIV/AIDS

Abstract

Clare Kapp (Jan 24 p 285) reminds us that under the National Strategic Plan for South Africa the target is to reduce the rate of new HIV infections by 50% by the year 2011. After a suggestion that giving antiretroviral therapy to all HIVpositive people could eff ectively eliminate the epidemic a modelling exercise4 showed that if everyone in South Africa were tested once per year on average and started on antiretroviral therapy as soon as they were HIV positive if other behavioural and social interventions contributed a 40% reduction in transmission and if full coverage was reached by 2016 it would be possible to eliminate HIV transmission by 2016 and HIV infection by 2050. Such a scenario would reduce the rate of new infections by 48% by 2011 thus reaching the National Strategic Plan target. However the current policy is to start antiretroviral therapy when the CD4 count is below 200/microL or in WHO stage 4 or 3 and when it is below 350/microL. Even if all HIV-positive people started antiretroviral therapy at a CD4 count of 350/microL the reduction in the rate of new infections would be only 22% in 2011 and would not reach 50% until 2020. To meet the National Strategic Plan target South Africa will need a strategy of universal testing and immediate antiretroviral therapy. This programme would entail a substantial investment of money and people and would have to be part of a broader strategy of health-system strengthening social mobilisation community development and rural reconstruction. It will need strong and dedicated leadership but it could also be the beginning of a New Deal for South Africa. (full-text)