HIV/Aids and TB remain the chief public health challenges to the country and Ekurhuleni, and will continue for many years to come.
“While there have been considerable advances, we remain with challenges, which threaten to hamper our progress in eliminating these diseases,” said DA councillor Geoff Fenn.
Treatment works well, provided patients remain on their therapy loyally.
Treatment, for most, has become simplified with only one pill once a day for most patients.
Some patients do experience side effects, which results in a more complicated treatment with more tablets, more often.
Side effects are, however, rare on the fixed dose combination pill and are mostly related to sleep disturbances.
Patients with kidney problems, however, are unable to use the combination pill because of possible further kidney damage.
“In Ekurhuleni, we currently have 167 698 people on ARV’s. Of these, 7 243 are children under 15,” Fenn said.
“In the year 2013/14, we started 39 127 new patients on treatment.
“Our latest statistics suggest an incidence of 14 per cent, on a population of 3.2-million, so that would mean 450 000 HIV positive residents in the metro.
“Bearing in mind that all who are positive don’t require treatment, however, we are getting there, with an estimated 37 per cent of those infected on treatment.”
Fenn added that clinics in the metro offer exactly the same treatment and monitoring offered to those patients on medical aid and, in fact, this compares with the treatment in first world countries.
The one measure used in first world countries that is rarely used here, in both the public and private sectors, is resistance testing due to its huge expense, running into several thousand Rand per test.
This is a test on the virus infecting a patient to determine if the virus is resistant to any ARV’s.
In first world countries, this test is done routinely on diagnosis.
“One of our biggest challenges used to be the diagnosis of TB.
“It was not easy to diagnose TB, even with X-rays and sputum analyses, which often resulted in false negative results.
“We now use a gene Xpert test in the clinics and in private practice that is highly sensitive.
“It can tell you if the TB is a resistant strain and gives a result in under 24 hours.
“This is important because you always want to treat TB first before starting ARVs, as a severe life-threatening reaction can be triggered by starting ARVs before TB treatment,” said Fenn.
Now, it is recommended to treat the TB for two weeks prior to commencing the ARVs.
The emergence of resistant TB has been a worrying development requiring treatment even longer than the usual six months with other medication.
Once again it is essential that patients adhere to their therapy and if they don’t, that’s when resistance develops.
“Areas where we have challenges are in certain highly vulnerable groups, such as men who have sex with men (MSM) – we use this term as this group does not always identify themselves as homosexual, sex workers and intravenous drug users.
“We are fortunate that injecting drug use (IDU) isn’t widespread in South Africa because, if it was, with our high incidence of HIV, it would spread like wild fire, as sharing of syringes is one of the easiest ways of acquiring HIV,” said Fenn.
“In these instances, needle exchange programmes have been shown to be effective in reducing transmission rates.
“De-criminalising sex work has been effective in reducing HIV transmission as sex workers don’t feel threatened and can voluntarily seek help without threat of legal action.
“In much the same way, we need programmes to engage with MSM.
“It’s especially so in the townships, where these groups are discriminated against and need constant education about risky behaviour.
“It is difficult to identify this group and engage with them because they are secretive and nervous about exposure.”
Fenn also said that Prevention of Mother-to-Child Transmition (PMTCT) programmes have started bearing fruit, with under 2 per cent of babies being born HIV positive.
“Less than 2 per cent sounds good but transferred to raw numbers that still accounts for 297 babies born with HIV in 2013/14.
“There are still some pregnant mothers who aren’t testing for the virus.
“The unborn child’s rights to not be born with a potentially fatal virus needs to be recognised.
“We need to re-look at informed consent in the present.
“Informed consent was important when you had nothing to offer the patient after a positive test,” Fenn said.
