There are a number of areas where firm action could save thousands of lives.

Mother-to-child transmission is a key area that could result in fewer new infections. According to the report, every year about 30 000 babies are needlessly infected with HIV in this way, when prevention is possible. Although this number has decreased in the past few years it is still unacceptably high ? there should be no more than 4 000 of this type of infection per year.

The strategy for preventing mother-to-child transmission (PMTCT) does not reach all babies. When successful, the programme reduces transmission to less than 5 percent, but the report revealed that for various reasons, at most only about 66 percent of infants who need PMTCT actually benefit from it. The main reason is that testing doesn?t extend to all pregnant women, and many of those who are tested, and found to be HIV-positive, are later neglected by the health system.

Testing also falls short with regard to tuberculosis, as incidence of the two diseases are closely related and more than 50 percent of tuberculosis patients also have HIV. The successful detection of tuberculosis in HIV-positive people must increase.

For every two pregnancies in South Africa, there is one HIV infection. This is largely as a result of higher risk in the social environment, since young girls often drop out of school during this time and become insecure about their financial situation. There is also a greater physiological vulnerability to infection.

The report recommends a focus on the prevention of teen pregnancy, but failing this, there must be a greater use of condoms during pregnancy as well as the return of new, young mothers to the school system as soon as possible.

While condom use has increased among young men between the ages of 15 and 24, the same cannot be said of women in the same age group. Furthermore, not enough condoms are distributed, as seen in the high incidence of HIV in KwaZulu-Natal, Mpumalanga and the Free State ? the provinces where condom distribution is lowest. Female condoms are expensive and not readily available.

Some of the most vulnerable groups, such as prisoners, are not protected by easy access to condoms. This is especially dangerous because each year 25 percent of all prisoners are released back into society. ?We must flood prisons with condoms,? said Harrison.

Disabled people, Aids orphans, and commercial sex workers are also at particular risk of contracting HIV. The group most at risk of infection are those living in informal settlements, whether urban or rural. Most-at-risk groups are neglected in general, and this is an area that needs urgent attention.

Taking action

Another strategy that could drastically reduce the infection rate is the introduction of a national male circumcision programme, as this medical procedure has been proven to reduce HIV incidence ? when performed properly.

Behaviour change and the reduction of risk tolerance must also be addressed. Such programmes do not address all age groups and there is too little focus on high-risk groups.

The report recommends that healthcare be improved generally, as well in specific areas relating to most-at-risk groups, men and those with sexually transmitted infections.

More funding is needed. Although currently about R1-billion (US$130.6-million) is spent on HIV prevention, the gauge reported that the investment of another billion into a comprehensive national programme will result in three times that amount in annual savings within a decade.

Finally, government needs to be firm and clear on how it is tackling the spread of HIV and tuberculosis, and it must form joint partnerships with the civil and corporate sectors to strengthen its work.

Source: MediaClubSouthAfrica.com.