CABSA Notes and Highlights. 16/04/09
Highlights from the 4th SA AIDS Conference, by Lyn van Rooyen (these are not always direct quotes):
Prof Susan Kippax: Sex at the Heart of the Epidemic: How to make it Safe
- The Prevention Question: Is it that we are promoting non-efficacious HIV prevention technologies/tools? OR Is it that we are ineffectively promoting efficacious HIV prevention technologies/tools?
- The answer is to address the social and cultural conditions in which sex and sexual risk are enacted and to enable social transformation
- The problem is 1. The almost exclusive focus on individuals, with assumptions of individual agency, control and rationality and 2. A separation of ‘behaviours’ of individuals from the social, cultural or political contexts in which the sexual conduct of these same individuals is enacted
- The answer includes a change of focus from 1. Sexual Behaviour to Sexual Practice and 2. Changes in Individual Behaviours to Social Transformation
Johan Hargrove: “The only thing more expensive than stopping the HIV Pandemic is not stopping it.”
Bishop Tutu: God is waiting for people to turn this wilderness into a garden.
Deputy President - Ms Baleka Mbete : Less than 5% of South Africans have been tested and know their status.
Dr Francois Venter:
- We need drugs for children in better formulations and dosages, so that a grandmother does not have to leave the clinic with shopping bags full of medicines for a child.
- The late start of ART means that we face a serious array of opportunistic diseases that could be avoided with early diagnosis and care.
- The NSP target for treatment is 80% - at present we are treating less than 30% of those needing treatment. The delay is causing deaths.
Other sessions and speakers:
- 74% of South African transmission is in concurrent relationships.
Rapporteur Session - Themes of the Conference
Track 1 – Basic Science
- Elite controllers – These individuals who have an inborn immunity against HIV may act as a ‘human model’ that could in future provide information for the development of a vaccine against HIV.
- Acute infections
o Individuals with more immune system damage early in their infection often have a poor disease outcome ( They develop opportunistic infections and AIDS related conditions quicker)
o 73% of people with new infections are infected by only one virus – if they are infected with more than one virus, there is a more rapid disease progression.
Track 2 – Clinical Science
-Paediatric diagnosis and treatment is very important:
o Children are often diagnosed when they are already very ill
o Many children die before they are one year old, and are only brought to hospital when they are very sick.
o If children are treated in time, they have a good response to treatment
o It is difficult for parents and caregivers to access treatment.
o 29,5% of all Baragwanath paediatric admissions are HIV related
-TB and HIV can be seen as ‘evil twins’
-Opportunistic Infections
o Open wound fractures – no difference in healing for HIV+ and HIV –
o Hepatitis B
-Dried blood spot HIV viral load testing – technology improving, easier to transport and can lead to easier diagnosis
Track 3 – Epidemiology, Prevention and Public Health
- Measurement
o Measuring incidence remains difficult
o Monitoring and evaluation is crucial
§ We need to be measuring the impact of NSP programmes more efficiently
§ Patient level data and adherence records are not comprehensive enough
§ There is a need for more efficient feed back data
o Modelling
§ Risk factors and transmission
§ Impact of prevention methods
§ 80% of heterosexual transmission is currently in Non cohabiting relationships
- Implementation & Health System strengthening
o We need to be getting on with what we know
o Prioritisation
§ Do what works
§ Economic – most benefit for input
§ Greatest impact on epidemic
o Strengthen delivery level
§ Human resources is a huge challenge and creative solutions are necessary
§ Adherence Support is crucial
§ Efficiency and quality of care should be measureable
§ Strengthen local level implementation
o Integration
§ TB/HIV. SRH/HIV; STI/PITC; ART/ANC
§ More attention on men, adolescents and children
§ Monitoring and Quality of Care
o Scaling up testing
o Prevention
§ Epidemic drivers
§ MCP
§ Male circumcision
· Acceptable, high uptake
· Link to culture
§ PMTCT
· Dual therapy
· Breastfeeding
Track 4 Social & Economic sciences, human rights and ethics
- Testing
o Uptake low
o Need range of services
o Client initiated VCT
o Self testing needs post test support
- Circumcision
o Scale up
o Consider ethics and consent
- MCP
o Culture is a contested construct
- Key groups
o Children
o Migrant populations
o PLHIV
o Marginalised groups
§ MSM
§ Prisoners
§ Sex workers
§ Research participants
· Avoid tokenism
· Real communication and community participations
- HIV and Human rights in SA
Track 5 Best practices and programmes
- Readjust the focus
o Peer education
§ Not consistent
§ Recognise gender differences
o Adolescent programs
o Testing strategies for kids
o Address intergenerational sex
o Down referral and integration
- New services
o Health services in prisons -Transient nature of offender populations might drive TB and HIV
o Male clinics
o Gay friendly services
o Use cell-phones
o Targeted messages
- Going forward
o Document good practice!!
o Fine tune successful programmes
o If doesn’t work – stop and do something else!
Track 6 - Community Track
- HIV is not in recession!
- ARV is most accessible where disease is least prevalent
- Treatment must be in primary health care
- Task shifting is essential
- ARV treatment
o We need to do more with less: better adherence is critical!
o Access to drugs with lower toxicity is critical Tenovir
- Opportunistic Infections
o TB treatment should be better and more integrated with HIV treatment
o Cervical cancer
- Youth programmes and access to ART for children
o Comprehensive PMTCT programmes essential
o More comprehensive programmes essential
- There is a growing public perception that battle for healthcare is won – THIS IS NOT TRUE!!