From the Front Lines of the Global AIDS Fight
Peter Navario, PhD, MPH and Alan Whiteside, DEcon, MA
The picture of the current state of AIDS in South Africa is ambivalent. There are some notable successes in preventing mother-to-child transmission and access to antiretroviral treatment (ART), but a worrisome lack of progress in preventing new adult infections. Prospects for resourcing and financing over the next five years are equivocal at best.
Earlier this year a group of South Africa's leading HIV experts, the authors among them, gathered to reflect on progress, identify challenges, and recommend strategies and tactics for surmounting obstacles in the fight against HIV and AIDS. The Special Report on the State of HIV/AIDS in South Africa summarizes the analysis and recommendations that emerged from that meeting.
One theme was transcendent - winning the AIDS fight requires a paradigm shift on the part of all South Africans. Two strategic objectives were mooted again and again as essential to galvanize this shift: 1) The South African department of health must change the way it does business; and 2) Reversing the trend of new infections requires a mass social movement. At a glance, these objectives appear as inchoate as they do intractable, though they reflect several fundamental truths about the current state of AIDS. With five infections for every two people started on ART, HIV incidence remains too high. Extant public sector health staff, including doctors, pharmacists and laboratory technicians, cannot cope with the 3 million plus people needing ART by 2015. Finally, there is not enough money in the AIDS budget to treat everyone needing ART.
