SA Weighs Aids Guidelines after Conference. 18/08/08
South Africa's official Aids treatment guidelines are being re-assessed following the international Aids conference.
By Louise Flanagan
Health Department chief director of HIV/Aids Dr Nomonde Xundu said: "There is a draft recommendation that is being discussed."
Xundu, who attended the XVII International Aids Conference in Mexico City earlier this month, told The Star that issues under discussion include whether antiretroviral (ARV) drugs such as tenofovir should be added, whether patients should start ARV treatment earlier, treatment guidelines for pregnant women, and issues around dealing with co-infection with hepatitis B.
The conference discussed problems with using the ARV drug nevirapine for those on TB treatment, but Xundu said there were difficulties with simply replacing this with a drug such as efivarenz as this was linked to foetal abnormalities when used by pregnant women.
Xundu said conference speakers had emphasised the complexities of HIV/Aids and the need to take this into account in treatment and prevention.
The draft recommendation will be passed on to the South African National Aids Council (Sanac) for comment, then taken to the National Health Council, which should take about a month. Sanac is a multi-sector organisation led by Deputy President Phumzile Mlambo-Ngcuka, and the NHC is the Health Department's policy-making body.
Xundu has attended four of the international Aids conferences and described the Mexico conference as one of the best.
She said South African inputs were well received and the country was beginning to be regarded as a leader in the field.
Previous conferences were marked by antagonism between the South African government and non-governmental organisations, but Xundu said this year there was a stronger team feeling.
"I didn't at any point feel antagonism. I think people realise the collective responsibility."
She said Mlambo-Ngcuka's leadership through Sanac helped bring the sector together.
Conference speakers emphasised the need for packages of solutions and for partnerships to implement those solutions, for the need to recognise the social aspects of HIV/Aids and for respect for the human rights of affected people.
"This conference witnessed a marriage between prevention and treatment and we hope this marriage will last forever," Xundu said.
Funding remains a key problem.
While there will always be a need for more money, Xundu felt that existing funding should be better managed.
"It's a spaghetti that you need to manage," she said, acknowledging that her department needed to do more work in that area, and emphasising that partnerships with all players were central to efficiency.
New research from Kenya on the use of male circumcision to help reduce the chances of infection is being looked at with interest by South Africa and Xundu said Sanac planned to look further at this.
During the conference, a woman in Lusikisiki in the Eastern Cape killed her four children and herself because her neighbours claimed she was HIV-positive and were stigmatising her.
Xundu was distressed over the deaths and said dealing with stigma was difficult.
"It's going to be like that for a while … it's the nature of this disease," she said and called for more research into combating the stigma still associated with the pandemic.
"We haven't done a thorough analysis of stigma in South Africa, which should then guide stigma-reduction programmes."
She said these sort of problems emphasised the need for communities to be involved in solutions. The conference was told that if communities were not strengthened to work against HIV/Aids together, then "you can educate as many people as you want, you won't beat it".