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This blog first appeared on What'sUpHIV as part of a series covering the 8th South African AIDS Conference.
There are many “missed opportunities” in the National Strategic Plan (NSP) for HIV and TB, said Fareed Abdullah, the head of AIDS and TB research at the Medical Research Council and former SANAC CEO, at the closing of the South African AIDS Conference.
The NSP has been criticized by a number of civil society groups and this has culminated in two demonstrations being held during the conference – one by a general group of activists and another by sex worker activists.
At a press briefing on the closing day of the conference, the South African National AIDS Council (SANAC) defended the NSP, saying that while it was “imperfect”, it had incorporated viewpoints from many sectors of society. SANAC largely blamed the critique of the plan on individuals and organizations who were unhappy with their loss of leadership in SANAC and the transformation that was taking place within its structures. They also rejected claims of corruption within the council.
“We now know that we cannot treat our way out of this epidemic,” said Abdullah. Rather, prevention interventions would be the answer, where the social and structural drivers around HIV were focussed on.
He said that a lot of work would need to be done to find the “sweet spot” of how much money should be invested in specific interventions such as the contribution of gender-based violence to HIV transmission, the role of alcohol as well as social factors such as hunger.
While the NSP provides a “good broad framework”, there are areas that are lacking, believes Abdullah. However, he said that there is still the possibility of improving the NSP.
One of Abdullah’s concerns is that the “toolbox” provided in the NSP “doesn’t match the impact that we’re looking for”. The NSP aims for a 37% reduction in new HIV infections by 2022.
He said that there is the need for a prevention agency that has substantial resources, a large reach and is able to implement multiple programs at community level.
“But at the moment we don’t really have an agency with the wherewithal, the authority and the institutional capacity [to do this].”
While there were “many steps forward on TB”, Abdullah said that “TB is nothing short of a national crisis”. A crisis that he believes needs to be addressed through leadership, management, logistics and an investment in drugs.
“It needs nothing short of a revolution in a short space of time,” said Abdullah.
As for the NSP’s much-talked about failure to include a recommendation for the decriminalization of sex work, Abdullah said that this was another “missed opportunity”.
Low targets were set for pre-exposure prophylaxis (PrEP), something that could be rapidly scaled up for key population groups such as sex workers, men who have sex with men and transwomen, said Abdullah.
“For 20 years [we] have always said that key populations are not essential but I think [we have] been proven to be fundamentally incorrect about that.”
He also warned about drug use becoming a major contributor to HIV transmission in the next five years.