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Is South Africa’s HIV treatment success breeding complacency?

Staff members of the Themba Lethu Clinic in Johannesburg, the largest antiretroviral treatment site in the country, posing behind candles commemorating World Aids Day,November 28, 2013. (AFP PHOTO / ALEXANDER JOE)

JOHANNESBURG: South Africa has been hailed as a model for HIV treatment, but some now fear that its very success may be breeding complacency and making people less careful about infection.

South Africa’s free drugs program for AIDS has expanded rapidly to 2.4 million people – more than double the number three years ago – and boasts the largest treatment project in the world.

At a clinic at one Johannesburg public hospital, life-saving antiretroviral (ARV) drugs are dispensed at the click of a button.

A doctor sees a patient and sends the prescription electronically to the pharmacy, where it is immediately dispatched to a robot.

The robot then picks up the prescribed drugs and drops them into a pigeon hole in just under 90 seconds for the patient to collect.

“It’s almost like your ‘McDonald’s drive-thru’ principle,” said Ian Sanne, managing director of Right to Care, the nonprofit organization running the Themba Lethu clinic.

“The doctor orders it and by the time you get to the next window your drugs are ready.”

The high-tech dispensary bears testimony to how far Africa’s largest economy has come after a court forced it to give free AIDS medicines – called anti-retrovirals or ARVs – in 2002.

With drugs, life expectancy has shot up to 60 years from just 51.6 in 2005.

Around 6.4 million South Africans – 12.3 percent of the population – live with HIV or AIDS, according to a survey last year.

“We are proud that we are regarded as a model country,” Health Minister Aaron Motsoaledi told AFP.

But anti-AIDS activists say one unforeseen consequence of the country’s success may be that people are less careful about having safe sex.

“I find that people don’t take the virus as seriously as they should be, especially people our age,” said University of Pretoria volunteer AIDS counselor Palesa Motau, 21.

Some become complacent, she thinks and then say “There’s a Plan B, there’s a Plan C – I’ve always got a safety net.”

Even as HIV/AIDS is now a manageable condition, 21-year-old Ayesha Dlamini, who tested positive for HIV at 17, cautioned: “Young people should stop being reckless”.

“You get people saying: ‘It’s fine if I get HIV, then I can get treatment.’ That irritates me.”

Mpho Motiang, another counselor at the university, said young people were “losing that fear” of HIV, while others said pregnancy was a bigger concern.

“We have seen students who go to the clinic not for testing, but for the morning-after pill,” said Johannesburg-based AIDS activist Mongezi Sosibo.

U.N. children’s body UNICEF believes that the stigma of AIDS is still preventing young people from getting tested for it.

“We haven’t seen a lot of ‘Oh! I am not afraid of HIV,’ but we have seen that young people are quite afraid of going for testing because they still have issues with testing services, like lack of confidentiality,” said UNICEF HIV specialist Rick Olson, who is responsible for prevention and adolescents.

Motsoaledi agreed that HIV/AIDS was “no longer regarded as a death sentence” in South Africa, but he pointed to the country’s extensive anti-AIDS education drive.

The program is targeting 12 million school children, though a plan to distribute condoms in schools has sparked anger among some activists and parents.

Last year the country gave out almost 480 million condoms.

But the HIV/AIDS treatment system still has worrying gaps.

As the number of people on treatment expands and authorities mull plans to make the drugs available 24 hours a day from ATM-like machines, a study by Doctors Without Borders (MSF) has shown 1 in 5 health centers suffers ARV shortages.

Medicine availability depends on where you live in the deeply unequal country, and interrupting ARV treatment is very dangerous because the body then develops immunity against the drugs.

“The number of patients impacted is astounding and can’t be ignored,” said Gilles van Cutsem of MSF, which surveyed over half of South Africa’s 3,800 health centers.

But the government had rejected the study’s findings, calling them “extremely exaggerated.”

“Such a huge operation is likely to have challenges but to suggest that we are in ‘crisis’ is extremely dangerous,” said health spokesman Joe Maila.

 
A version of this article appeared in the print edition of The Daily Star on November 30, 2013, on page 9.

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