CPC Qualicare / DocWeb | Doctor's Online resource for South African Doctors

August 2016 Newsletter

Reasons for the initial successes of the HIV campaign….

A dire warning to the Family Practitioners

Reasons for the initial successes of the HIV campaign…. A dire warning to the FP’s that Non Communicable Diseases and their management can learn from the now successful HIV prevention          campaign. In this first of 2 articles I shall illustrate the HIV successes in prevention campaigns, and in the next, compare this to the rather sad failure of the NCD campaigns to date.  All is however not rosy in “HIV land” and a potential new crisis could be around the corner. 
Off to a flying start……………. Albeit 15 years and 300,000 deaths too late.

The end of demented AIDS denialism and it’s replacement by massive State sponsored and State championed “know your status” campaign marked the start of the largest State sponsored HIV program in the world, currently with 3.5 million people on ARVs. RSA runs one of the best early detection programs in the world, and the largest treatment program in the world

The ever more obvious link between PTB and HIV further spurred on the SA Govt to prioritise this issue.

Ultimately Private funders began to align with Govt and companies appointed AIDS and HIV specialists like Aid for Aids under Medscheme’s Dr Regensberg at the time, and the MHRM program under Mr Siraaj Adams.
 Large corporates organised massive wellness days, with celebrations of HIV sufferers, at Braais, on radio stations and radio commercials, and telethons. Strange but true….

Mother to Child transmission was prioritised, and widely advertised. Milk banks were started and mother to child transmissions have dropped from 70,000 cases  in 2008 to 2000 cases in 2015.
International donors came forward in significant numbers and Pharmacos came to the party with reduced costings.

AIDS and HIV were romanticised in lay publications and on soapies, as breakthroughs as ARVs came on line, and today the disease has taken on the mantle of yet another chronic disease, with fairly good life expectancy.

The system for enrolling into HIV prevention programs was far more advanced and user friendly than NCDs and more uniform in it’s approach.

Granted HIV is thus at a different stage of maturity to NCDs

But storm clouds are rapidly gathering again………….

The latest trends are however worrisome with younger ladies contracting HIV at a rate of  2000 per week between the ages of 15 and 24, more and more unprotected sex, and Pre Exposure Prophylaxis, making it  something “trivial”, and “easily treated” in the eyes of the youth.

You see, neither the State, nor private medicine has ever attempted to change behaviour, and advise on limitation of sexual promiscuity, but rather the opposite. With a circumcision and a condom, you can again have free love! And lots of it!!!
Pre Exposure Prophylaxis (PEP) has now been endorsed by the State , so another mixed message goes out to the youth….. take your PEP, have a circumcision, then sleep with whosoever you  like , as often as you like, in whichever method catches your fancy.

But warning bells are tolling……………

Circumcision, initially seen the panacea to protection and for which RSA enjoys an injection of approx. $140 million from the US and Germany, is now no longer as successful in prevention as it was.  The age of onset of HIV is dropping to 17 years average across the sexes, and condom use is declining, whilst the phenomenon of multiplicity of partners is  again rising.

New Viral mutations have recently been detected and we are unclear as to whether the new mutations will respond as faithfully as did the initial viral groups.

Are we on the edge of another AIDS pandemic? Only time will tell, however the FP is in the best possible position to educate, counsel and test your patients…..

Tony Behrman and the QC team

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