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- Volume 15, Issue 1, 2014
Southern African Journal of HIV Medicine - Volume 15, Issue 1, 2014
Volumes & issues
Volume 15, Issue 1, 2014
Author Landon MyerSource: Southern African Journal of HIV Medicine 15, pp 3 –4 (2014)More Less
In considering the HIV epidemic and its impact, many of our anniversaries are sad ones. Personal anniversaries often mark losses - remembrances of the deaths of family, friends or patients. Clinicians or scientists may mark the anniversary of the first documented AIDS case in a country, or the discovery of the virus itself, but these aren't generally moments for celebration per se. So it's not often that we have cause to smile about an anniversary related to the epidemic. However, 1 April 2014 marks one happy anniversary worth remembering - a decade of antiretroviral therapy (ART) in the public sector.
Source: Southern African Journal of HIV Medicine 15, pp 7 –8 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1031More Less
There is much to celebrate at the end of the first decade of South Africa's public sector antiretroviral therapy (ART) programme. An estimated 2 million South Africans had started ART by 2012, making ours the largest ART programme globally. ART coverage in adults, according to current guidelines, was estimated at 81% in 2012. The prevalence of HIV is increasing, because people receiving ART are living longer. In rural KwaZulu-Natal, adult life expectancy increased from 49.2 years in 2003, just before the beginning of the ART programme, to 60.5 years in 2011. Tremendous strides have been made in the prevention of mother-to-child transmission (PMTCT) of the virus. Almost 90% of pregnant, HIV-infected women access antiretrovirals (ARVs) either for their own health or for PMTCT, resulting in a 67% decline in new infections in children from 2009 to 2012. Further declines in new infections in children should be seen with the new PMTCT guidelines, which include prolonged ARVs for infants during breastfeeding, and combination ART for all mothers irrespective of CD4+ counts. ART access in eligible children has increased from 17% in 2009 to 67% in 2012. We have even started a third-line ART programme.
Author M. MoorhouseSource: Southern African Journal of HIV Medicine 15 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1030More Less
To reflect upon ten years of antiretroviral therapy (ART) rollout, one really should set the clock back a little further to see the massive impact of ART on our lives - for clinicians and patients alike. My own journey with HIV began in 1999 when, as a young doctor, I decided to venture into private practice with a local general practitioner (GP) while assessing my career prospects. A week into my new job, the GP went on a trip overseas, leaving me with the following pearls: 'look after the HIV patients and don't let any die before I get back'. I was terrified, as HIV had not formed an extensive part of the medical school curriculum when I trained, and while our exposure to such patients was considerable, we were taught that the only management options were palliative.
Source: Southern African Journal of HIV Medicine 15, pp 10 –11 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1026More Less
South Africa's mass rollout of antiretroviral therapy (ART) a decade ago changed the face of the AIDS epidemic in the country. Various populations have, however, not benefited equally. Treatment programmes have been successful in reaching women, who make up two-thirds of those receiving treatment in state sector clinics, but less so in reaching men. This is even more apparent for South African men who have sex with men (MSM), who have historically been ignored for directed service provision, despite being a key population at high risk of HIV acquisition and transmission.
Author A.K. NelsonSource: Southern African Journal of HIV Medicine 15 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1010More Less
'It's impossible to roll out antiretrovirals in Africa!' I clearly remember hearing this on a daily basis while studying in Canada 13 years ago. And there were strong points made: too expensive, not enough doctors, risk of resistance, how to monitor patients in resource-limited settings, and so forth. Thankfully, not everyone believed this and we advocated and pressured from all around the world, and the price of antiretroviral therapy (ART) did come down, by more than ten times.
Author C. SerenataSource: Southern African Journal of HIV Medicine 15, pp 14 –15 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1028More Less
I became involved in the HIV response in 1999, when I joined the HIV, AIDS, STI and TB (HAST) unit within the National Department of Health. Little did I know in 1999 that HIV would become my life. I had already been working in public health since 1993, and had been on the fringes of HIV, through the interdepartmental HIV and AIDS committee. At that point, the focus was on HIV awareness for public sector workers, and success was measured by the availability of condoms.
Author C. ArmstrongSource: Southern African Journal of HIV Medicine 15, pp 16 –17 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1033More Less
I held her hand; her wasted arm revealing the anatomy of every bone and muscle. Her eyes were closed, weighed down by the burden of disease. She lay upon the bed in my consulting room and there, with no fanfare, she breathed her last breath, passing effortlessly from life into death. Ironically, it was 1 December 2000, World AIDS Day. The patient was a nursing sister and her decline in the face of no antiretroviral therapy (ART) had been harrowing. At times like these, the futility of working in an HIV clinic was overwhelming, and I fought tears as I turned with a heavy heart to deal with the devastated family as best I could.
Author M. TitoSource: Southern African Journal of HIV Medicine 15 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1034More Less
The introduction of antiretroviral therapy (ART) brought about an exciting, yet somehow scary period in terms of treatment and care in our health facilities. In 2004, when the rollout of ART started, I was fortunate to have been working in one of the first facilities to be accredited as an ART site in the Nelson Mandela Bay Metropolitan district.
Author H.A. MooreSource: Southern African Journal of HIV Medicine 15, pp 22 –23 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1020More Less
As part of my work at a primary care clinic in Khayelitsha, I started the paediatric arm of the antiretroviral therapy (ART) service in our clinic six years ago. When I first started, many children were being cared for by family members or foster carers because their mothers had died.
'They dropped the blanket of their fear' : reflections on HIV medicine in South Africa, 2014 : reflectionsAuthor J. MarshallSource: Southern African Journal of HIV Medicine 15 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1032More Less
Coming from a community health background in KwaZulu-Natal and the informal settlements around the Grasmere toll plaza, I was working in occupational health in the late 1990s and seeing a number of truck drivers with all the clinical features of HIV/AIDS, and feeling frustrated at how little we could do for these patients. Then I sustained a needlestick injury with HIV-positive blood in 1997. Spending a nauseous month on Combivir, I became aware that HIV had come to visit me and my family. What was this experience saying to me? It was calling me to engage.
Author C. FriendSource: Southern African Journal of HIV Medicine 15 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1039More Less
The red HIV ribbon is an almost universal icon for the HIV/AIDS cause. I see the HIV ribbon in four different ways as I reflect on the different periods of work in my medical career thus far. Firstly, I see the red ribbon upside down, just like my head was firmly ostriched in the ground soon after qualifying in the Western Cape. There was one ward right at the top, out of the way of a medical intern's rounds, where all those patients went to die and at least I didn't need to worry about a 'resus' in that ward. But, towards the end of 2003, my interest was piqued when a few of the respected medical officers were heading towards HIV care. That was forgotten though when I started private general practitioner work with not a single HIV-positive patient, until one routine insurance test came back positive - one devastated patient!
Source: Southern African Journal of HIV Medicine 15, pp 28 –29 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1035More Less
In the deeply rural Zithulele community, based in one of the poorest districts in South Africa, the clinical and HIV programme staff believe that despite our resource-poor, rural setting, our patients deserve the same quality of medical care as their compatriots elsewhere. As a result, the HIV service that we have developed over the past seven years has had a strategic emphasis on providing accessible, quality care delivered in an innovative way that addresses local challenges and builds a robust foundation for future growth and sustainability. While our challenges are not unique, rural health facilities are often fragile entities. They have low staff numbers, yet carry a relatively heavy responsibility. In these parts, there is no plan B unless you devise it yourself!
Source: Southern African Journal of HIV Medicine 15, pp 30 –32 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1025More Less
Great progress has been made in the prevention of mother-to-child transmission (PMTCT) of HIV in the past ten years in South Africa, and this is reflected in the achievements of the health services in Khayelitsha. Located 56 km from the centre of Cape Town, Khayelitsha has an estimated population of 500 000, with a 38% unemployment rate. Forty-five per cent of the population live in formal housing. Antenatal (ANC) HIV seroprevalence increased from 19.3% in 2000 to 37% in 2011 and is the highest in the Western Cape.
Author D. HagemeisterSource: Southern African Journal of HIV Medicine 15, pp 33 –34 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1036More Less
It has been more than ten years now that we have been rolling out antiretrovirals (ARVs) to the general population. And we have achieved a lot. We have successfully initiated the world's largest ARV treatment programme in South Africa, and we are starting to see the positive impact of these efforts in indicators such as life expectancy and maternal deaths.
Source: Southern African Journal of HIV Medicine 15, pp 35 –37 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1040More Less
After 12 years, the Hannan Crusaid Treatment Centre (HCTC) in Gugulethu, Cape Town has screened more than 10 000 women, men, adolescents and children for life-saving antiretroviral therapy (ART). While we have seen a slow but steady increase in the starting CD4+ count of new patients, the monthly inflow of new clients goes on unabated. A successful example of public-private partnership, this provincial clinic, supported by a local non-governmental organisation and initially funded by a UK-based charity, may provide a model for similar programmes within the National Health Insurance plan. Here we discuss the history and development of this programme, with a focus on lessons learnt about rolling out ART in South Africa more generally.
Author W.D.F. VenterSource: Southern African Journal of HIV Medicine 15, pp 39 –40 (2014) http://dx.doi.org/http://dx.doi.org/10.7196/SAJHIVMED.1029More Less
The state programme giving free antiretrovirals (ARVs) started on 1 April 2004 in several large centres across South Africa. For many of us, it seemed unimaginable, after years of running HIV battles with President Thabo Mbeki and his odious Minister of Health, 'Manto' Tshabalala-Msimang, on everything from the cause of HIV to the efficacy of ARVs. A decade later, the state programme is the biggest in the world, with millions of lives saved and families returned back to normal life.