At last government reviews its Aids strategy with treatment being part of an integrated health plan, writes Ido Lekota

Today millions of people throughout the world observe World Aids Day with its theme "Keep the Promise - Accountability".

Today millions of people throughout the world observe World Aids Day with its theme "Keep the Promise - Accountability".

According to the World Aids Campaign, the organisation running the World Aids Day project, the theme is designed to inspire citizens across the globe to hold their political leaders accountable for the promises they made about Aids. The promises include the Millennium Development Goal to halt and reverse the spread of Aids by 2015.

It is estimated there are 39,5 million HIV-positive people in the world today, and that this year 4,3 million people became infected with the virus.

Of these, 95percent are believed to be living in developing countries, including South Africa. For South Africa the theme couldn't be more apt because the country is reviewing its Aids strategy.

The country has an unfortunate history when it comes to tackling the Aids pandemic. Its unsavoury history in this regard has been linked to the position taken by President Thabo Mbeki, who questioned the link between the HI virus and Aids.

His comments have invariably been linked to the fact that South Africa lags behind even less developed neighbours when it comes to providing antiretroviral drugs.

Mbeki subsequently withdrew from the HIV-Aids debate, but Health Minister Manto Tshabalala- Msimang then labelled antiretrovirals as "poisonous". She also ran a campaign promoting beetroot and garlic in stalling the progression of HIV-Aids.

In 2004 the government eventually rolled out antiretrovirals, but on a far lesser scale than its much smaller neighbour, Botswana. The roll-out has grown steadily in the past two- and-a-half years and now reaches 200000 people living with Aids. An estimated 5,4 million South Africans are HIV-positive.

In August Tshabalala-Msimang drew international ire during an international Aids conference in Toronto, Canada, where she sponsored the display of beetroot and garlic, and excluded antiretrovirals.

Many believe that the Toronto debacle was a turning point for the government.

In an interview the chief director for HIV-Aids, tuberculosis and sexually transmitted infections in the national Department of Health, Nomonde Xundu, confirmed that the government was reviewing its Aids strategy.

Xundu, however, pointed out that the review was part of "a normal process of providing strategic direction for the country's fight against Aids".

She said the review was meant to deal with whatever shortcomings had impeded implementing the government's broader Aids plan.

Xundu said one of the shortcomings identified was the ineffectiveness of the National Aids Council, a multi-sectoral body headed by Deputy President Phumzile Mlambo-Ngcuka.

"From the government's side the council is headed by the deputy president and also has ministers participating. But when it comes to business or sport you don't have high-ranking officials participating. This inhibits the level of discussion and the decision-making process," said Xundu.

What is needed, she said, is for chief executives from business and the sport sector to participate in the council.

At government level Xundu said there would be an "upscaling of all the aspects of the comprehensive plan be it treatment, prevention or monitoring".

Xundu said treatment wasn't done as an integrated part of the broader health provision plan. What should ideally happen is that when a pregnant woman goes to a clinic for a pre-natal check-up, she should have access to all services including testing, the provision of antiretrovirals or drugs preventing the transmission of HIV from mother to child.

"The HIV-Aids treatment should be part of the clinic's health plan so that when the nurse orders Panado, she also orders antiretrovirals,'' Xundu said.

Regarding the issue of prevention, Xundu said there was a need to make the ABC - abstain, be faithful and condomise message - more target-specific.

For example, for people younger than 15 there should be a stronger message that encourages them to delay sexual activity.

Research has shown that the highest number of new infections is among young people between 15 and 24. Research also shows that they don't use condoms consistently. The message should therefore be one that encourages consistent use of condoms.

At another level, she said, the focus should be on the community in the fight against the pandemic.

"Communities know the extent to which they are affected. The plan is to get the various sectors of the community to come up with plans on how to tackle it, taking into consideration their circumstances," said Xundu.

There should be specific focus on the role the elderly play in giving support to those afflicted and affected by HIV-Aids.

Xundu said the government accepted the proposal by Aids organisations such as the Treatment Action Campaign (TAC) that new targets must be set.

The TAC has suggested that the target should be providing antiretrovirals to one million South Africans.

"But we must sit down and discuss these targets after we have agreed on issues such as our estimates when it comes to infections.

"It is important that the plan should not only be ambitious but practical."