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Aids experts to review progress at UNGASS
  In 2001, more than a 180 countries made a promise to accelerate the fight worldwide against HIV/Aids
Aids activists are gathering this week to discuss the pandemic's effects at UNGASS

May 29, 2006, 07:30
Aids activists gathering in New York this week for the United Nations General Assembly Special Session on HIV/Aids (UNGASS) are more confident than ever that the pandemic's effects can be reversed in the next 10 years. Hundreds of delegates will meet at the United Nations headquarters to review the progress made in the fight against HIV and Aids.
In 2001, more than a 180 countries made a promise to accelerate the fight worldwide against HIV and Aids. Five years later, the financing for HIV programmes has increased more than fourfold, while the number of people on ARV's has increased five times.
Last year saw more new infections and Aids deaths than ever before. And South Africa, with more than five million people, is the country with the highest number of people living with the disease. This week, health leaders will go back to the drawing board, debating a more effective response to this epidemic.
Leaders meet NY to turn HIV/Aids epidemic around
May 28, 2006, 16:30
Health leaders will meet this week in New York at the UN GA Special Session on HIV/Aids (UNGASS) to review the progress that has been made since 2001 and look at ways to turn epidemic around by 2010.
In 2001 more than a 180 countries made a promise to accelerate the fight worldwide against HIV and Aids. Five years later the financing for HIV programmes has increased more than fourfold, while the number of people on anti-retrovirals (ARV) has increased five times - but it seems that's not enough.
Last year saw more new infections and Aids deaths than ever before and South Africa, with more than 5 million people, is the country with the highest number of people living with the disease. This coming week in New York health leaders will go back to the drawing board, debating a more effective response to this epidemic. Manto Tshabalala-Msimang, the SA health minister, says: "We're saying as Africa and as a developing world, it must be universal access to prevention, to support and treatment. We will speak along those lines as we go to UNGASS."
HIV/Aids demands more attention - TAC
Sipho Mthathi, a member of the Treatment Action Campaign (TAC), says: "When we say that we have achieved a lot in dealing with HIV, we must also acknowledge the size of the epidemic demands ten times more effort, it demands in fact more than anything else (from) political leadership."
Criselda Kananda regards herself as living proof that HIV is not a death sentence. Eight years after she was diagnosed with the virus, Kananda is still healthy, although she hasn't taken ARVs. Kananda says: "Many people are scared to just finding out, to even know that I have HIV and if I do have HIV, there is so much that I can do about it. If we can get individuals to acknowledge that HIV is a viral infection and that it can be managed."
Kananda believes her HIV diagnosis gave her a new appreciation for life. And when she's in New York this week, Kananda hopes countries will come up with a plan to give the poor especially, a second chance at a healthier life.
South Africa won't cope with HIV/Aids costs
Mon, 29 May 2006
Researchers say they are bracing for a sharp rise in the cost of public health services in South Africa within the next few years, due to HIV/Aids.
And, they warn that the country's health department might not be able to cope with its ever-growing responsibilities if government fails to increase the department's budget substantially.
Large numbers of HIV-positive South Africans are expected to develop Aids-related diseases, as the country's high prevalence rates start manifesting themselves in illness and death, predicts the Health Economics & HIV/Aids Research Division (HEARD) of the University of KwaZulu-Natal, in the coastal city of Durban.
"HIV patients might soon account for 60 percent to 70 percent of hospital expenditure in medical wards," says HEARD researcher Nina Veenstra.
Already, about half of all patients admitted to hospitals in South Africa seek care for HIV-related illnesses, while the numbers of HIV-positive patients in paediatric wards are even higher, she added. According to figures posted on the website of the Joint United Nations Programme on HIV/Aids, adult HIV prevalence in South Africa is 21.5 percent.
As the numbers of Aids patients grow, there will be a greater demand for skilled health workers, medication and hospital facilities.
According to researchers at the Cape Town-based Human Sciences Research Council (HSRC), a non-profit organisation partly funded by government, AIDS patients generally stay in hospital for a greater length of time than other patients because it takes them longer to recover from opportunistic diseases.
"HIV-positive patients stay on average four times longer in hospital than non-HIV patients," explains HSRC President Olive Shisana.
Greater pressure on health facilities will impose a heavier financial burden on the country's public health care sector - even as health workers suffer more stress from an increased workload. This is likely to prompt higher levels of absenteeism, low staff morale, and large numbers of health care workers quitting their jobs.
South Africa already suffers a shortage of health workers, due in large part to unattractive working conditions. Many posts for health workers remain vacant, notes a study by a national research organisation, the Durban-based Health Systems Trust (HST).
According to the HSRC, these pressures will compromise the quality of HIV/Aids care on offer.
The HST has already found that a number of sites where anti-retroviral drugs (ARVs) are dispensed have reached saturation level due to staff shortages.
HST researchers estimate that only 12 to 13 percent of all patients in need of ARV therapy are receiving it at present. "Limited human resources capacity is the biggest constraining factor on further rollout of the ARV programme and must be addressed as soon as possible," state researchers Rob Stewart and Marian Loveday in the organisation's annual health review for 2005.
In addition, the already-limited number of health care workers will be further reduced through HIV-infection. According to an HSRC study, 13 percent of health workers who passed away between 1997 and 2001 died of Aids-related diseases.
These findings are likely to receive attention this coming week, during the latest of the United Nations General Assembly Special Sessions (UNGASS) on HIV/Aids.
In 2001, the assembly held its first special session on HIV/Aids, in acknowledgement of the fact that while some progress in increasing access to HIV-prevention and treatment initiatives had been made, the programmes were still failing to reach those most vulnerable to HIV.
During the first UNGASS meeting, participants agreed on goals set out in a ''Declaration of Commitment on HIV/Aids'' which was adopted by leaders from 189 countries.
The declaration sets targets to halt and reverse the spread of the pandemic by 2010 through action by government and civil society.
Together with other countries, South Africa vowed to improve conditions for health care workers, and upgrade supply systems and financing plans concerning access to ARVs, testing facilities and care by 2005.
Delegations from South Africa will have to report back on progress in achieving these goals at the UNGASS+5 meeting, which will take place from 31 May to 2 June in New York, five years after the General Assembly held its first special session on HIV/Aids.
Taking action to improve South Africa's response to the pandemic will, in part, require hospitals to give health workers greater job satisfaction through better salaries and working conditions, says Elsje Hall, a researcher at the Pretoria-based Independent Research Services.
HST figures show that by 2009, an additional 3 200 doctors, 2 400 nurses and 765 social workers will be required to run the country's ARV programmes. This will translate into a substantial increase in personnel costs.
The supply of ARVs and drugs to treat opportunistic infections will also need to be increased, Hall adds.
The cost of full-scale ARV treatment is expected to come with a price tag of about $996-million by 2008/2009, up from $179-million in 2005/2006, according to the HST.
Government Plan to Fight HIV/Aids Is Working, Deserves Donor Support
South African Government (Pretoria)

May 26, 2006
Posted to the web May 26, 2006
By Manto Tshabalala-Msimang
Leaders in the global struggle against HIV and Aids come together for a special session of United Nations General Assembly this week to take stock of what has been accomplished and, we hope, find consensus on how we can do better. The goal is universal access to prevention, treatment, care and support.
Delegations gathering from around the world, including my own from South Africa, comprise elected representatives and government officials, members of civil society and faith-based groups, activists, community workers and medical professionals, and, most importantly, people living with HIV and Aids.
United as we are against a common and deadly foe, it is only natural that we should have differences of opinion on strategy and tactics. Sadly, these differences have sometimes led to the caricaturing of positions.
To cite an example, the fact that my government has chosen to talk about "HIV and Aids" rather than HIV/Aids is taken by some to suggests that we are heretics on the causation on Aids. Actually, we prefer the phrase "HIV and Aids" because it helps clarify the specific challenges we confront.
These are, one, to prevent the transmission of HIV; two, to slow progression to Aids-defining illness once transmission has occurred; and three, to treat and support HIV-infected patients to the best of our ability when they contract Aids-defining illnesses and/or their immune systems become compromised.
In an ideal world, we would have limitless resources to devote to every phase of managing this major challenge from changing behaviour and checking the spread of the virus, eliminating discrimination and stigma to mitigating the tragic social impact of Aids and finding a cure. But in this imperfect world, priorities have to be set because HIV, exceptional threat though it is, is only one of a complex, interlocking set of problems demanding our attention.
The more inclusively priorities can be set the better. In the run up to the special session, we in Africa have been consulting widely within and between our countries to strengthen our own consensus on the way forward.
We agree that there has to be a renewed focus on prevention. We are in accord that international bodies of which we are members should seek our input before setting goals and timetables like the World Health Organization's Three by Five initiative which aimed to provide antiretroviral treatment to 3 million people by 2005. We believe our common purpose would be more effectively served if the international donor community were to align itself more closely with the plans and priorities we, as Africans, are establishing for ourselves at national and regional level.
We are not alone in urging this. Based on global consultations in preparation for the special session, UNAIDS recommended in March that by the end of this year, countries should have in place "prioritized, costed and evidence-informed Aids plans" as an integral part of their development strategies.
Once such plans were in place, UNAIDS said, donors should fund them with conditions strictly limited to "generally agreed areas such as governance, financial accountability and sustainability". This "would quicken the utilization of funding and support greater alignment with national priorities."
In South Africa, we are already implementing such a plan. The Comprehensive Plan for Management, Care and Treatment of HIV and Aids, as we call it, was launched in November 2003 as a logical progression from the Strategic Plan for HIV and Aids put in place in 2000. It is largely funded out of our own national budget.
The Washington-based Hudson Institute has said of the Operational Plan that it is "to our knowledge the only one that has taken into consideration such important issues as the future recurrent cost obligations that will be required to sustain it, independent of external financial support" and "is based on the uncompromising dictates of science and medicine".
The plan has three essential pillars.
Firstly, we must to do everything in our power to ensure that the majority of South Africans who are not HIV-positive remain that way. This includes education and other programmes promoting safe and healthy behaviour and removing the stigma attached to Aids; freely available counseling and testing; free provision of male and female condoms on a massive scale; prevention of mother to child transmission of HIV and, more broadly, scaled up efforts to combat poverty and malnutrition. We deal with these social determinants of ill-health because, as Louis Pasteur observed, the terrain is as important as the germ in fighting diseases. We have to make South Africa a hostile environment for the HI virus.
Secondly, we have to help those who are infected to stay as healthy as possible for as long as possible. This means redoubling our efforts against TB and ensuring that all have access to prophylaxis and treatment for other opportunistic infections. Good nutrition cannot rid a person of HIV and we have never said it is a cure. But it can improve the immune system and be an important factor in staving off Aids-defining illness.
Many of our people turn to African traditional medicine, which has sustained their health throughout the period of colonialism and apartheid. Government is therefore investing in research and development of these medicines for alleviation of various illnesses including conditions associated with Aids. Beyond that, traditional health practitioners can help in implementing the operational plan by mobilizing communities, convincing patients to be tested, promoting adherence to treatment options chosen by patients and monitoring side effects.
Thirdly, once an HIV-positive person has a CD4 cell count of 200 cells/mm3 or exhibits stage 4 Aids-defining illness as defined by the WHO, he or she is eligible for antiretroviral treatment (ART) at public expense. Patient compliance and monitoring is essential.
Establishing the infrastructure to deliver treatment safely and effectively on the scale required is a massively complicated undertaking in the public health environment we inherited from apartheid. Caregivers have to be recruited and trained. Clinics have to be accredited. Testing, monitoring and reporting systems, including laboratories and pharmacovigilance centres, have to be put in place. There have to be reliable supplies of affordable drugs that meet our regulatory standards.
Above all, the programme has to be built up in manner that strengthens the overall public health system to deal with the complex burden of disease facing us, including trauma and chronic diseases of lifestyle such as diabetes and cardiovascular diseases.
It is critically important to recognize that antiretroviral treatment cannot be the sole pillar of our strategy, nor can the number of patients receiving such treatment be the only measure of our success or failure. If we let that happen, we risk shortchanging all the other interventions -- especially on the prevention front -- we have to make to secure the health of our people.
Health Systems Trust, an independent group that monitors health care delivery in South Africa, found while our progress in delivering ART "has probably been swifter than in any comparable country". However, it observed that "the general public health care systems" needed to be strengthened beyond a narrow focus on ART.
This is a pressing concern not just for South Africa but throughout our continent and it underlies the call we, as Africans, are making for the international donor community to respect and support national plans rather than pursue their own special priorities. If we are going to meet the challenge of HIV and Aids, we all need to be pulling in the same direction.
Dr Manto Tshabalala-Msimang is Minister of Health of South Africa.
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