HIV in SA: a tale of hope and despair

Science has changed patients' lives. Now with a pill a day, infected South Africans can live almost as long as those without HIV.

Despite advances in treatment and prevention, infection rates remain too high.

"HIV is a very gratifying disease to treat," says University of the Witwatersrand Professor Ian Sanne.

Patients arrive at death's door but leave hospital healthy and, after a few months, need only one pill a day to keep them that way.

Sanne and his colleague, Wits Reproductive Health and HIV Institute deputy director Professor Francois Venter, agree it's a far cry from the early 2000s when people were dying on the floors of crowded hospitals and little could be done to save them.

Science has changed patients' lives. Now with a pill a day, infected South Africans can live almost as long as those without HIV.

Kuthula ain't heavy -- he's my brother

"What other chronic diseases have made such strides in treatment over 25 years?" asked Venter, as South Africa commemorated World Aids Day on Thursday.

But he feels immense frustration that, despite the country having the highest number of patients on antiretroviral treatment in the world - 3.5million - and it being on the cusp of eliminating mother-to-child transmission of HIV, the rate of infection remains stubbornly high.

About 1,000 people are infected with HIV each day in South Africa. Although this is an improvement on the approximately 3,000 infections per day in 2006, many young girls in KwaZulu-Natal and parts of Gauteng "have a risk of contracting HIV as high as sex workers", Venter said.

Sanne, who is CEO of NGO Right to Care, said: "People have not modified their risk-taking behaviour, not enough men have been circumcised and not enough HIV-positive people have been tested and treated for HIV."

Scientific efforts to find effective preventive options are unrelenting.

About 300 HIV trials are being funded by the US government in South Africa, the embassy said this week.

The fight to stem infections is double-barrelled. Some projects focus on medication that HIV-negative people can take to diminish their chances of being infected, while others aim to get HIV-positive people to take their medicine correctly, because people on treatment are virally suppressed and non-infectious.

A trial is under way to determine if the tide of new infections can be stemmed by antibodies infused via a drip.

These "broadly neutralising antibodies" are made naturally by only one in five people and "neutralise" most strains of the virus. It is hoped that giving them to people every two months will prevent them contracting the virus.

No drugs at all -- and still alive No HIV drugs at all -- and still alive

Wits Professor Lynn Morris, named one of the world's top 1% of scientists last week by Thomson Reuters, is leading the South African leg of the trial.

The largest vaccine trial to be held in South Africa, involving 5400 people between 18 and 35 years old, was launched this week. Results are expected in five years.

If the vaccine offers some protection, it could "dramatically alter the course of the epidemic", said lead investigator Glenda Gray.

A trial of a long-acting ARV drug injected into the muscle is also due to be launched. The ARV, which has been designed to offer two months of protection against HIV, is already being tested among gay and bisexual men in Cape Town, said Desmond Tutu HIV centre deputy director Linda-Gail Bekker.

In another effort to prevent infection, South African women are part of two trials, "Hope" and "Dream", in which young, high-risk women use a ring inserted in the vagina that secretes an anti-retroviral gel. Initial results suggest the ring cuts the risk of infection by 30%.

Other ways to stem infection rates are focused on getting HIV-positive people to take their ARVs regularly. They include the roll-out of an ATM-style medicine dispensing machine later this month in Alexandra, Johannesburg.

Last week the Department of Health, along with Boston University, unveiled software that allows the four million viral-load tests conducted annually in South Africa to be viewed as heat maps, revealing where people are not responding to treatment, thus allowing early intervention. All HIV patients are tested annually to measure their response to treatment.