JOHANNESBURG, South Africa — As South Africa ramps up a high-profile campaign to test 15 million people for HIV in the next year, experts are questioning whether the country’s struggling health care system can support this massive new undertaking.
The world’s most ambitious HIV testing campaign is appropriate for South Africa as it has more people with the AIDS virus than any other country. But until recently South Africa's fight against the disease was held back by the denialist policies of the government of former president Thabo Mbeki.
To help staff the new campaign, some 2,500 retired health care workers, including doctors, nurses, pharmacists and counselors, have been recruited to return to work. In addition to widespread testing and counseling, the government aims to provide antiretroviral treatment to 80 percent of the more than 5 million HIV-positive South Africans.
Mark Heywood, deputy chairperson of the South African National Aids Council, which is leading the effort, admits that “the capacity of the system to manage the numbers” is one of the main challenges ahead. “We’re already breaking the bank,” he said.
While South Africa’s government currently might not have all the resources to meet the demands of the campaign, Heywood is confident that “we will manage to meet them as we go along.”
Treatment Action Campaign, an activist group, says it will be monitoring the implementation of the testing as well as updating of the treatment regime. Revised guidelines for antiretroviral treatment came into effect early in March and will see earlier treatment for pregnant women, people with HIV and tuberculosis, and HIV-positive babies.
“We want this campaign to be properly implemented and we are facing a health care shortage,” said Catherine Tomlinson, a senior researcher with TAC. “We don’t want this to be a short-term campaign.”
An estimated 5.7 million South Africans are HIV-positive. The new campaign, which receives support from international agencies including UNAIDS and the U.K.’s Department for International Development, will see free testing available at the health department’s 4,300 clinics and hospitals, as well as at hundreds of retail pharmacies around the country. At least 1 million more people will begin treatment in the next few years as a result of the increased testing and access to AIDS medicines, according to the government. As part of prevention efforts, 1.5 billion condoms will be distributed this year.
Jonny Steinberg, author of "Three-Letter Plague: A Young Man’s Journey Through a Great Epidemic," described the campaign’s planned expansion of antiretroviral treatment to as many as 2 million people as “the greatest challenge the country’s rickety health care system has faced” since the end of apartheid.
“At a time when everyone is bemoaning the weakness of service delivery, this is a project of great scope and ambition. Far-flung clinics that have not offered decent health care in years will administer life-saving medicine,” he wrote in Johannesburg’s Sunday Times newspaper.
The campaign kicked off with President Jacob Zuma releasing the results of his fourth HIV test, a continuation of the clear break with the health policies of former president Mbeki, whose government questioned the link between HIV and AIDS, failed to provide sufficient life-saving antiretroviral drugs and instead promoted beetroot and garlic. A Harvard study linked Mbeki’s policies on HIV/AIDS to the premature deaths of 365,000 people in South Africa.
Zuma revealed his HIV-negative status at the launch of the testing campaign, to applause from the thousands of people who gathered at a hospital east of Johannesburg.
"The purpose is to promote openness and to eradicate the silence and stigma that accompanies this epidemic," he told the crowd.
But after Zuma disclosed his HIV status, some South Africans expressed disbelief. “Did you use expired HIV tests?” wondered Toni Molefe in a letter to The Times.
Zuma has been criticized for promoting unsafe sex with his well-publicized risky behavior. Zuma has three wives, has fathered at least 21 children by eight different women and came under fire earlier this year when it was learned that he fathered another child out of wedlock. In 2006, while successfully defending charges of raping a HIV-positive woman, Zuma told a court that he did not wear a condom but had showered afterwards in an attempt to prevent HIV transmission.
Kevin Kelly, director of the Centre for AIDS Development, Research and Education, a South African non-profit organization, says the campaign’s focus on “getting the numbers” — the target of 15 million tests — could be a distraction from the quality of care.
“Of course it’s important that people know their status,” Kelly said. But what is crucial, he added, is the counseling before and after the test, including follow-up visits and referrals when necessary.
Kelly worries about the standard of counselors under the broad new campaign, and says there is a risk associated with rapid-fire testing and insufficient counseling, citing a mental health survey conducted by his organization of 900 HIV-positive people that found elevated levels of anxiety, depression and other mental health issues.
“Finding out your HIV status is not in and of itself a complete intervention,” he said. “We should not imagine that simply knowing your status is going to lead to HIV prevention or to better access to care or a decrease in the degree of stigma, discrimination and denial.”