The 4th Southern African AIDS Conference was held in early April at Durban’s International Convention Centre. This year’s meeting was themed, ‘Scaling up for success’, and brought together over 4,000 HIV and AIDS researchers, policy-makers and stakeholders from more than 50 countries. According to Conference Chairperson and Deputy Director of the Desmond Tutu HIV Foundation, Professor Linda-Gail Bekker, the theme “recognises that there is an urgency to take stock of best practices in treatment and prevention and to scale these up sufficiently to begin to roll back the onslaught in numbers and impact that the epidemic is currently waging in Southern Africa.”  With this in mind, at the top of the agenda was to explore and provide insights into factors that drive HIV and AIDS responses in Southern Africa, and to identify what is and is not working in the region’s efforts to combat the epidemic. This article briefly describes some of the key highlights of what has been described as the most unified and successful South African AIDS conference to date.

A multi-faceted epidemic necessitates a multi-faceted response

During the opening of the conference, on 31 March, then South African Deputy President Baleka Mbete highlighted that the basis of a strong anti-HIV and AIDS initiative depends on the buy-in of the broader community, especially those infected and affected by the epidemic. According to Mbete, the involvement of civil society, the private sector, community organisations and religious formation collaborations are all necessary in order to expand a universal response to the disease. She also noted that, “Such a multi-sectoral approach brings together all these stakeholders at the South African National AIDS Council (SANAC) to assist in implementing that national response”. This multi-sectoral approach is something that many researchers and activists fighting on the HIV and AIDS battlefield have been calling for, for years. An epidemic of this proportion requires the involvement and support of society as a whole, primarily because the epidemic itself is so multi-faceted.

Similarly, the nature of the HIV and AIDS epidemic requires the continual development and refinement of attempts to address its impact. A recent example of this is the steady growth of research focusing on the integration of HIV treatment and prevention initiatives. HIV and AIDS researchers and delegates at the conference were in agreement that HIV prevention and treatment efforts must merge. Research has recently started to explore ways in which anti-retrovirals (ARVs) can aid in HIV prevention. HIV vaccine trials have had limited success, and so the development of new and innovative prevention strategies is imperative. According to Professor Salim Abdool Karim, Director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), the preventative value of Pre-exposure Prophylaxis (PrEP) is still being studied, but has already shown great potential. He commented that clinical trials on macaque monkeys have revealed that a single dose of Tenofovir provided 100% protection against HIV infection. There are currently three PrEP studies planned by several research institutes world-wide.

Increased funding and improved management required for treatment initiatives

Aside from discussions around the use of HIV treatment as a possible prevention strategy, there was also a significant focus on the improvement of treatment strategies and outcomes themselves. AIDS activists highlighted the shortcomings of the South African Government’s National Strategic Plan (NSP), and the urgent need to improve HIV and AIDS treatment in the country. During a press statement released by the AIDS Law Project (link to their website), the Treatment Action Campaign (TAC), Medecins Sans Frontieres (MSF) and the HIV Clinicians Society, emphasis was placed on the severe lack of financial resources that is currently preventing many South Africans from receiving ARVs.

They explained that additional funds will be needed if the government is to achieve the HIV treatment goals set out in the NSP. Specifically, the TAC revealed that an estimated ZAR 1 billion (US$ 100 million) will be needed to meet the current ARV treatment target and to meet the treatment deadline in 2011. Despite the fact that over 200,000 people started ART in 2008, the director of the AIDS Law Project, Mark Heywood, said that the government has underestimated the funding requirements for the national roll-out of ARVs and has used funds inappropriately. The lobby groups also criticised the National Health Council’s decision to reject the World Health Organisation’s (WHO) ARV guidelines of increasing the initiation of ARV treatment, even though several studies proving that the earlier initiation of treatment can save lives.

Despite the concern around funding for HIV treatment initiatives, especially in the wake of the current global economic situation, a number of health experts at the conference stressed that money to scale up HIV treatment is available, however the implementation of the programmes is often too slow, thus creating a problem. Director of the Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA) at Stellenbosch University, Dr John Hargrove, reiterated that finances to provide ARVs to all persons living with the virus should not be an issue, because it will ultimately be more expensive if the spread of HIV is not halted.

Professor Hoosen Coovadia, the Victor Daitz Professor of HIV & AIDS Research at the University of Kwa-Zulu-Natal (UKZN), emphasised that, “As a country, we do have the funds. It’s about political will, budget allocation and proper use of the money.” Coovadia is of the opinion that the South African government has the financial capacity to provide health services to all HIV-positive persons in the country, especially because “ARV treatment is now cheaper than diabetic drugs and PMTCT is cheaper than managing blood pressure.” Former Deputy President, Baleka Mbete, disagreed with Coovadia’s point of view, but also revealed that government is considering changing the Patent Act and regulating the private sector to make sure that ARV treatment is inexpensive and private patients are no longer pushed to the state. Mbete emphasised, and almost echoed the words of Coovadia, that “political will and financial support are key to any success.”

Directions for the future

Although there was much discussion around things that need to change, and where the region has faltered, there was also a much-needed focus on the positives, and directions for the future. Conference chairperson, Professor Bekker, noted that, “The new National Strategic Plan on HIV & AIDS is a significant movement in the right direction.” She was also quick to point out however, that in order to halt new infections, implementation and scaling up of campaigns needs to be tackled as a matter of urgency. Bekker also highlighted the need to intensify efforts aimed at promoting nurse-driven and community-managed HIV and AIDS programmes.

During the closing of the conference, then Health Minister Barbara Hogan addressed concerns that have been raised about the cost and viability of scaling up South Africa’s HIV and AIDS treatment programme to meet government’s NSP goal of reaching 80% of those in need of ARV treatment by 2011. Hogan called for HIV and AIDS resources to be used more efficiently in order to minimise overspending, and mentioned that during the year, teams of financial experts will be deployed to the country’s nine provinces by her ministry to investigate reasons for overspending. She then appealed to international donors to make longer-term commitments, and to coordinate their assistance with other donors. Time will tell as to whether her calls are answered, and whether the abundant research findings that were presented at the conference will ultimately lead to a more effective response in the region most profoundly affected by the HIV and AIDS epidemic.

Jonathan Mundell is Director: HIV & AIDS Unit at Consultancy Africa Intelligence. The May edition of the HIV & AIDS in Africa Newsletter is republished here with permission from Consultancy Africa Intelligence (CAI), a South African-based research and strategy firm with a focus on social, health, political, and economic happenings in Africa. For more information see http://www.consultancyafrica.com or http://www.ngopulse.org/press-release/consultancy-africa-intelligence. Alternatively, visit http://www.consultancyafrica.com/promo2 to take advantage of CAI’s free, no obligation, 3-month trial to the company’s Standard Report Series.