South Africa: Burying the ghost of past AIDS policies

By Tamar Khan - The government is finally laying the ghosts of the previous administration’s HIV policies to rest. Figures released by the Medical Research Council (MRC) earlier this month show a surge in life expectancy largely attributable to the provision of antiretroviral drugs through the public health system, a programme that was official policy for years but only gained real impetus when Thabo Mbeki was ousted as South Africa’s president in 2008.

More than 365,000 lives could have been saved between 2000 and 2005 if the government had provided treatment sooner and administered drugs to prevent mothers infecting their babies, according to a Harvard University study.

The MRC’s Rapid Mortality Surveillance report shows that life expectancy rose 6% between 2009 and last year, from 56.5 to 60 years, reversing the downward trend that began in the 1990s as the HIV epidemic grew rapidly. Between 2009 and last year the infant mortality rate fell 25%, from 40 deaths per 1,000 live births to 30 per 1,000, and the mortality rate for those under five dropped at the same rate, from 56 per 1,000 to 42 per 1,000 over the same period.

These statistics were seized upon by African National Congress secretary-general Gwede Mantashe last week to attack Mr Mbeki after the former president delivered a speech at Fort Hare University criticising South Africa’s political leadership. Mr Mantashe was notably silent about the fact that many senior ANC figures who remain in government today did little or nothing to challenge Mr Mbeki’s HIV/AIDS policies when he was president.

Politics aside, the improvement in life expectancy is a real achievement for government.

"This is good news, which we attribute to our HIV programmes," Health Minister Aaron Motsoaledi said in an interview this week.

He described how a series of initiatives announced by President Jacob Zuma in December 2009 enabled patients to start treatment sooner and ensured more HIV-infected women delivered babies free of the virus.

Not long after that, the president announced a huge HIV testing programme in which more than 20-million South Africans have taken a test since April 2010.

"All these things are starting to bear fruit … (but) we were pleasantly surprised that the impact on mortality was so quick," said Dr Motsoaledi.

Today South Africa has the world’s largest public sector treatment programme, with about 1.7-million patients on antiretrovirals, and its mother-to-child transmission rate of HIV has fallen from 8% in 2008 to 2.7% last year, according to the MRC.

The rapid gains in life expectancy in the past two years mean the government has already met some of the health targets it set itself for 2014, in a service delivery agreement signed by the president, the health minister and MECs.

The 2014 target for life expectancy was 58.5. The target for infant mortality was 36 per 1,000 live births and the target for child mortality was 50 per 1,000 live births.

The initial targets were revised in 2010 after a high-level discussion with the statistician-general, with adjustments made to both the 2009 baseline and the 2014 targets.

The development was not an attempt to move the goalposts, but was a pragmatic revision based on a better understanding of the available statistics, according to Dr Motsoaledi.

This kind of revision of a service delivery agreement is not unusual, according to Presidency spokesman Harold Maloka. The government reviews all these agreements annually and will set fresh targets if existing ones have been met.

However, the MRC report is not all good news: there is no sign of an improvement in the death rates of babies under 28 days, and maternal mortality rates appear to be getting worse.

"Our biggest problem now is making the public healthcare system effective," said the minister, noting that the most recent confidential inquiry into maternal mortality found 49% of the deaths were attributable to HIV and the rest were due to conditions such as high blood pressure and post-partum bleeding — the kinds of health problems that need swift attention from skilled health professionals in a public hospital or clinic.

The government recently introduced specialist teams in each health district in the hope of improving child and maternal health. It is clearly a move in the right direction, but it is too soon to tell what effect these extra personnel will make.