South Africa’s President Jacob Zuma announced today that all HIV-positive pregnant women and TB patients with CD4 counts below 350 will qualify for immediate antiretroviral treatment from April 2010, and all children under one year of age will be provided with immediate ART if they test positive.
President Zuma also encouraged all South Africans to get tested for HIV, and told South Africans, “I am making arrangements for my own test. I have taken HIV tests before, and I know my status. I will do another test soon as part of this new campaign. I urge you to start planning for your own tests.”
He said that the South African government will launch a “massive” testing campaign shortly, as part of a break with previous mixed messages about HIV from senior politicans such as President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang.
"Let today be the dawn of a new era," he said. "Let there be no more shame, no more blame, no more discrimination and no more stigma.
"Let the politicisation and endless debates about HIV and AIDS stop.
“Let this be the start of an era of openness, of taking personal responsibility, and of working together in unity to prevent HIV infections and to deal with its impact.”
The South African announcement on earlier treatment follows a recommendation issued yesterday by the World Health Organization, which urged national governments to move to earlier treatment as quickly as possible.
WHO recommended that all people diagnosed with HIV infection should start treatment when their CD4 count falls below 350. South Africa’s decision to prioritise pregnant women and people with TB/HIV co-infection is a compromise designed to target treatment to the groups where treatment may have the greatest impact on new infections and deaths.
“All patients with both TB and HIV will get treatment with antiretrovirals if their CD4 count is 350 or less,” Zuma announced today in a World AIDS Day speech screened live on national television.
”At present treatment is available when the CD4 count is less than 200. TB and HIV/AIDS will now be treated under one roof. This policy change will address early reported deaths arising from undetected TB infection among those who are infected with HIV.”
“All pregnant HIV-positive women with a CD4 count of 350 or with symptoms regardless of CD4 count will have access to treatment. At present HIV-positive pregnant women are eligible for treatment if their CD4 count is less than 200.”
“All children under one year of age will get treatment if they test positive. Initiating treatment will therefore not be determined by the level of CD4 cells.”
The US government has pledged an additional $120 million over two years through PEPFAR to treat additional patients, but the South African government has issued no assessment of the additional numbers who need treatment, or the additional cost.