August 10, 2006

S.Africa AIDS data paints picture of epidemic’s future

By Gordon Bell

CAPE TOWN (Reuters) - Nokhwezi Hoboyi never imagined she
would live to see her 25th birthday.

The petite woman's playful smile masks memories of her life
slipping away just two years ago, when she lay in a hospice on
the brink of becoming yet another South African AIDS death

"I had given up ... I would say to my parents, 'Please,
tell my friends to come to my funeral,"' the 26-year-old told
Reuters, recalling her battle with a virus that infects an
estimated one in nine South Africans.

Hoboyi's survival, made possible by anti-retroviral (ARV)
drugs, makes her a new South African HIV statistic --
reflecting the growing number of people with the virus living
normal lives in one of the countries worst hit by the AIDS

But it also represents a maturing stage in the epidemic,
bringing new policy dilemmas for officials seeking to track
Africa's expanding AIDS crisis and to make long-term plans to
treat millions of infected people.

Experts on the disease will discuss these challenges and
other issues at the 16th International AIDS Conference in
Toronto next week, billed as the biggest global AIDS meeting.

South Africa's health department said new data released
last month showed the rise in the percentage of people testing
positive for the virus slowed down over the past year -- an
indication that the epidemic was stabilizing.

From its annual survey of pregnant mothers attending public
prenatal clinics, the department estimated about 5.4 million of
population of about 45 million were HIV positive, a slight
decrease from earlier projections.

This was largely due to government prevention strategies,
officials said.

Some health experts, however, say the picture is not that
clear-cut, or that optimistic.

The fact that HIV prevalence -- the proportion of the
population estimated to be infected -- is no longer rising or
is even declining may merely mean that deaths from AIDS are
equal to or outstripping new infections, researchers say.

"We need to start understanding the epidemic differently
now," said Olive Shisana, director of the state-funded Human
Sciences Research Council (HSRC). Experts say authorities need
to find new ways of measuring and tracking the disease.

"The leveling off does not necessarily mean that we don't
have a problem," she said. "What it may mean is that infections
are continuing to rise and at the same time more people are
actually dying."


The distribution of ARVs in South Africa from 2004, after
an about-face by President Thabo Mbeki's government which had
refused for years to fund a state program, is prolonging tens
of thousands of lives.

As more people receive treatment, the number of those
infected with HIV will rise, as fewer people die.

"In the long run, if we see more people start using
anti-retrovirals we will probably see an increase in the
prevalence of HIV. I think this is something we need to clarify
... this is a very complex issue," Shisana said.

The government needs to take this complexity into account
as it looks at the future of its ARV program: While it may be
congratulating itself on a stabilization of the epidemic, in
fact it may need to prepare for an expensive expansion of one
of the world's largest public AIDS drugs programs as people
live longer and need continuous treatment for the incurable

The government's prenatal survey -- a standard method of
measuring HIV prevalence in Africa -- showed an infection rate
among the pregnant women of 30.2 percent, compared with 29.5
percent previously.

But other data also show AIDS deaths are soaring, hinting
that the percentage of new infections would be even higher if
the epidemic was truly being brought under control.

A Statistics SA study of mortality between 1997 and 2002
found death increased by 62 percent among people over the age
of 15.

The study looked at a period before AIDS drugs were
publicly distributed and showed a massive rise in deaths from
diarrhea, TB and pneumonia -- diseases typically associated
with HIV.

Activists say deaths in South Africa are still rising with
up to 900 people succumbing to the epidemic every day as the
drugs still only reach a small proportion of people.


The Treatment Action Campaign, the country's most
influential AIDS lobby group, said there was little evidence to
support the government's statement that its prevention efforts
are cutting into AIDS prevalence.

"A decline in prevalence may not be a good thing," national
manager Nathan Geffen said in a statement.

"Infected people are living (so) if the number of people
with HIV is declining, it could be because (people who do not
have access to ARVs) are dying of AIDS instead of getting
treated," he said, adding greater emphasis should be placed on
the rate of new infections.

The debate over the figures may also have lessons for other
countries at the center of the global AIDS epidemic.

South Africa's neighbor Botswana is battling stubbornly
high prevalence of around 24 percent, possibly a consequence of
one the best ARV programs in the world that reaches up to 85
percent of those infected with the virus.

For HIV-positive South Africans like Hoboyi -- who herself
lost two infants to AIDS -- the debate over South Africa's AIDS
data is of secondary importance, even though it may influence
how government and ultimately global AIDS funds are allocated.

"Here I am today, I am able to wake up in the morning," she
said. "I never thought I would ever be able to wake up and go
to work again."