After celebrating success what is next at the South African AIDS Conference?
As I sat through the official opening at the 6th South African AIDS Conference I found myself wondering what the focus of the first conference post 2015 will be. Will there be a national conference after the countries are supposed to have achieved the Millennium Development Goals?
“We have fought a good fight. At last the glass is half full,” declared Professor Koleka Mlisana, the conference chair, the first of many plenary speakers to outline the successes achieved in the national AIDS response. The figures certainly are encouraging:
- Life expectancy in South Africa has risen from 56.5 years in 2009 to 60 years in 2011
- 2 million or 54% of people needing treatment are on ARVs in the world’s largest treatment program
- Between 2010 and 2011 13.4 million people were tested for HIV and know their status
- The government provides 1 billion condoms a year
Other factors give cause for high-fives and back-slapping that was implied in most presentations. South Africa has become better at working with data. Dr Yogen Pillay the Deputy Director General, HIV/AIDS, TB, and Maternal and Child and Women’s Health in the National Department of Health outlined various aspects of the epidemic beyond 2013 based on modeling data, with the question “What more can we do to get down to zero?”
In the same vein, Dr Olive Chishana, CEO of the Human Sciences Research Council mapped out the HIV prevalence according to the findings of the 4th National HIV Household survey.
At a leadership level, it was good to see government, researchers, civil society, and the United Nations in broad agreement on the assessment of progress made. Gone are the days when government was branded “uncooperative” and civil society “disruptive.” Michel Sidibe, the UNAIDS Executive Director was quoted as having said that South Africa was a good example of how shared responsibility can reduce dependency on international aid.
As the conference progressed and I listened to more presentations and discussions I concluded that if it was up to me the next conference would focus on HIV Prevention. We know that there is consensus among practitioners that mass media campaigns have not had the desired impact in changing deep-seated behavior—inconsistent condom use particularly among the older age groups, multiple concurrent partnerships, and alcohol abuse. There is agreement that campaigns are effective instead as a first step to introduce HIV issues in people’s conversations and discussions.
What then is to be done for young black women, heavy drinkers, and drug users who are some of the country’s most-at-risk groups?
Dr Chishana certainly caused some controversy when she said research suggests that marriage may have a protective effect, as being unmarried appeared to be a risk factor for HIV.
The health system needs some attention, as Dr Francois Venter of the South African Clinicians Society pointed out, a more nuanced understanding of the health system is needed—to understand “what is broken and what isn’t” and to develop a strong and inclusive health system.
For me one takeaway from the SAAIDS conference is that if we want to get down to zero—now is the time for new ideas to advance HIV Prevention, including ideas from outside the mainstream HIV and public health fields.