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HIV infection and tuberculosis in South Africa -- an urgent need to escalate the public health response

Lancet

The third paper documents SA's struggle with HIV/AIDS, with the chilling statistic that despite having just 0.7% of the world's population, the country has 17% of the global HIV burden. The paper is written by Professor Salim S Abdool Karim, CAPRISA (The Centre for the AIDS Programme of Research in South Africa), University of KwaZulu-Natal, SA, and colleagues.

SA also has one of the worst tuberculosis (TB) epidemics, made worse by rising drug resistance and HIV co-infection. The authors say: "Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes."

The authors detail the priority actions needed to control tuberculosis, including improving the cure rate (which is inconsistent nationwide); improve detection rates, integrating tuberculosis and HIV services, and identifying and treating drug resistant TB. To achieve HIV prevention, the priority areas for action are understanding the main drivers and risk factors for HIV locally and nationally; scaling-up of behavioural, prevention of mother-to-child transmission, and HIV testing interventions; implementing male circumcision, and legislative interventions on sex work, gender violence, and migrant labour. The authors also give their priority actions for HIV treatment--scale-up HIV testing, initiate HIV ART treatment in all patients with a CD4-cell count below 350 cells per uL; maintain viral suppression in patients on ART; and integrate HIV prevention and treatment services. The authors say that for these plans to be implemented 'as part of the aspirational 5-year Strategic Plans for SA will depend on the government's ability to build partnerships and to stimulate the development of health-care services. This is a complex task which will need a long-term perspective, with the prospect of many difficult and, perhaps, unpopular decisions'.

They conclude: "South Africa still awaits the opportunity to enjoy its newfound political freedoms without the overhanging threat of the HIV and tuberculosis epidemics."

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Professor Salim S. Abdool Karim, Pro Vice-Chancellor (Research), University of KwaZulu-Natal and Director: CAPRISA - Centre for the AIDS Programme of Research in South Africa T) +27-31-2604550 E) karims1@ukzn.ac.za

Full paper 3: http://press.thelancet.com/saser3.pdf

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