South Africa: HIV Infections May Be Declining At Last

Farai Chideya: Well John, now we’re going to go to Africa; Southern Africa specifically. There’s a new AIDS report that says that the numbers of South Africa’s infected with HIV AIDS has stabilized, that means plateaud. Is that a good thing? Is that true for example that the number of teens with HIV has decreased? This morning we are joined by Dr. Ernest Darkoh. He’s in Johannesburg. He’s the chairman of Broad Reach Healthcare, a group that works to create national Health programs. Dr. Darkoh was also one of the leading figures in Botswana’s national antiretroviral treatment program, the most successful public sector HIV/AIDS treatment program in Africa. Dr. Darkoh, I want to start with this report that says the number of people infected with HIV has stabilized at 10.9%. What does that mean?

Dr. Darkoh: Basically, it means that if you take a snapshot of the population, lets say over the last few years, that snapshot shows that the percentage of people infected has not changed, or has not changed significantly. And so, hopefully, what that means is that we are seeing a decrease in new infections such that those new infections are not keeping the prevalence growing higher and higher.

FC: So, do you believe, first of all, that those numbers are accurate? And by that, I mean both the stabilization aspect of the number and the 10.9% number.

DD: I do believe those numbers are accurate. For example, we’ve always said that there is five point something million people infected in South Africa. If you apply the 10.9% to the current population of South Africa, it is five point something million people who are infected. So that number we’ve always known and it’s not different. In terms of stabilizing, the work done by the HSRC is first class, top notch research and they conducted an excellent survey, probably one of the best in class and I do believe that those results are accurate.

FC: Now, one thing that this report does indicate is that HIV prevalence among young people is down and, do you get a sense of that in doing the work that you do why is it really important to track young people in this epidemic?

DD: I do believe that the data, the rates in young people are going down. And my belief is based, is more based on more anecdotal things, but it seems that youth are a little bit more responsive to messages. The slightly older age groups for some reason seem quite fixed in their behaviors and a little bit harder to reach. So, if there’s a group that would respond to messages in the same way that youth are quicker at adopting technologies, etc,… right now my three year old knows more about using the DVD remote than I do. I think if there is a change it will come from that group. And by the way, it’s critical that that group does reflect the change because that’s the group that’s uninfected right now – that increasingly becomes infected as they grow older. So, if we are going to break the back of the epidemic we have to have the youth demonstrate that change.

John Hockenberry: Well, I’m wandering if, and again, anecdotal information is hard to combine with broad hard statistical information, but are you seeing at the clinical level any signs of behavioral change that could be significant?

DD: At the clinical level we would not expect to see any change reflected because, keep in mind, right now in South Africa if we estimate, we have five point something infected people. Out of that five point something million, one million need treatment immediately. And currently maybe we have four hundred something thousand on treatment. So that leaves close to almost six hundred thousand people that need treatment right away and another four million who would need to come through for treatment or care through the pipeline. So actually, we would like to see more people showing up at the hospital at earlier points because currently, the problem we have is currently people showing up when they are on death’s door expecting a miracle and it makes it unsustainable.

FC: Well, speaking of the resources, there was a controversial report that came out about a year ago. The report was from the Harvard Public Health School and it said that 330,000 people died needlessly because the Thabo Ambiki government did not take responsibility for HIV and for bringing in enough medication. It was a very controversial report. Do you believe it is true?

DD: I can not attest to the actual number because I did not read the methodology behind that report and how they actually calculated that number. What I do believe however, and I think we’ve seen it a number of times particularly on the African continent, we’ve had many situations where certain policies that were put in place, whether, in many cases, well intentioned, I think have contributed in the overall suffering and death from HIV. And I think the stance taken by certain political leadership in this country definitely would have contributed in the delay in the response and therefore I think more death and suffering than otherwise if good leadership and proper sound action been taken much earlier

FC: Dr., we only have time for one quick and final question. What is the most important thing? Is it funding? Is it awareness? What is the one thing to do to drop these numbers?

DD: Behavior change. People have to change their behavior. HIV is 100% preventable. Nobody has to get infected starting tomorrow, if that choice was truly made and internalized. And therefore, behavior change is absolutely critical; does not require an ounce more funding if people are really able to change their behavior and take control of their own health and realize that they have a lot to do about whether they’ll become infected or not.

FC: Wise, wise words. Thank you so much. We were speaking with Dr. Ernest Darkoh, global health expert. He is working with Botswana’s national antiretroviral treatment program. And he’s in Johannesburg.