Médecins Sans Frontières/Doctors Without Borders (MSF) and partner organisations [Treatment Action Campaign (TAC), World AIDS Campaign (WAC), the AIDS and Rights Alliance for Southern Africa (ARASA), and SECTION27] last week issued a joint letter to the South African government, including President Jacob Zuma, calling on the country provide critical leadership in ensuring increased access to HIV services ahead of a crucial United Nations High Level meeting on HIV/AIDS.
Next month’s UN meeting in New York (June 8-10) will pave the way for the next decade of the international HIV/AIDS response. The meeting comes at a time when the world has seen both unprecedented scientific gains proving the benefits of anti-retroviral therapy (ART) and mounting threats to HIV programmes through persistent funding cuts.
UN Member States are already shying away from committing to treatment targets despite the fact that UN Secretary General Ban Ki-moon has called for at least 13 million people to be placed on treatment by 2015 – a target that amounts to less than universal access, which the world committed to in 2006. In their May 20 letter, MSF and partners call on South Africa to lobby for this target to be set at 15 million.
South Africa is central to this UN meeting because of its leadership role within Africa and the extent of the epidemic within the country. As of 2009, 5.6 million South Africans were HIV positive, more than any other country in the world. While South Africa has made significant strides in scaling up access to services, currently only 37% of people eligible for ART under World Health Organisation (WHO) guidelines receive it.
MSF and its partners call on South Africa to set ambitious and measurable domestic targets that will increase access to services motivate fellow UN Member States to set global targets that can ultimately reverse the course of the HIV epidemic. The requests to the South African government include:
- Place at least 3 million people on ART by 2015;
- Because tuberculosis (TB) is the number one killer of people living with HIV, ensure that at least 80% of public sector facilities provide integrated TB and HIV services. These services must include ART.
- Immediately and fully implement WHO treatment guidelines for earlier ART initiation at CD4 350. Currently South Africa’s treatment protocol allows for initiation at CD4 200 except for pregnant women and people co-infected with TB, who can be initiated at CD4 350. South Africa has not instituted new WHO protocol despite being a recent recipient of the Global Fund to Fight HIV/AIDS, TB and Malaria, and the fact that treating people earlier has been shown to save lives and reduce illness in people living with HIV. Importantly, an increasing amount of scientific data shows that ART also makes people less infectious. A recent study (HPTN 052) showed that ART use in heterosexual couples where one partner was HIV positive and the other HIV negative reduced infection rates by a staggering 96%. Other Southern Africa countries with less resources have already implemented or are in the process of implementing new WHO treatment guidelines;
- Implement innovative treatment and care strategies such as out-of-facility community distribution of pre-packaged ART to stable patients in order to optimise limited health resources and promote better patient outcomes;
- Put in place the policy framework to fully take advantage of flexibilities as allowed under international law to increase access to affordable, effective medicines; and
Actively support innovative financing mechanisms on both a national and international scale that provide long-term, predictable and robust funding for HIV and other health programmes.