South Africa has come a long way in its fight against HIV and Aids, with the epidemic shifting from a dismal life sentence to a chronic but manageable condition. Prof Linda-Gail Bekker talks about the challenge that comes with this shift, as well as why and how the Desmond Tutu HIV Foundation (DTHF) has turned its focus to prevention.
What is the history and mission of the DTHF?
Beginning in 1995, the organisation focused on clinical research into HIV and Aids. It became the DTHF in 2004 and was the first organisation to undertake clinical trials to move new antiretroviral (ARV) therapy into care. As understanding about the scope of the problem grew, the team worked to get treatment into communities. Money was raised to build the first community- based ARV clinic, called the Hannan- Crusaid Treatment Centre. We aim to reduce the impact of HIV and related illnesses in individuals, families and communities. Archbishop Tutu referred to HIV as ‘the new apartheid’. In addition to the biomedical and behavioural aspects, we care a great deal about the human rights component, as well as the reduction of stigma surrounding the disease.
How has the developmental response to HIV evolved over the past two decades?
Without a doubt, the miracle has been the development of ARV treatment. It changed the disease from a death sentence to a chronic but manageable condition. We now have to think about the sustainability of keeping millions of people on ARVs.
While we continue to care about quality treatment and treatment access for all, DTHF’s current emphasis is on prevention, as well as new solutions to tuberculosis. We have divisions each focusing on a particular group of the population: adolescents and youth, mothers and children, and gay, bisexual and heterosexual men. In the eighties, the approach was simply telling people to abstain, condomise and be faithful, but now we are approaching prevention with more nuance. The prevention innovation pipeline has improved a great deal over the last decade. There are now also pre and post-exposure prophylaxis, microbicides and innovative ways of administering them.
What are some of the key elements of a holistic response to HIV-related diseases and infections?
One cannot take on this epidemic purely as a clinician. It’s been extraordinary, as a specialist physician, having to think way out of the box and bring in behavioural sciences, education, traditional and community development specialists, as well as working directly with communities. A multisectoral approach is key. We’ve really had to learn that if you want to design something for the people, then you need to ask the people what it is that they want.
Years ago, we found that people were coming into HIV care with very low CD4 counts and impaired immune systems. Aiming to reach them sooner, DTHF acknowledged the need to take treatment to the people. The ‘Tutu Tester’ vehicle emerged from that. It was a bold step to have a rainbow-coloured vehicle going into communities to provide free testing for diabetes, hypertension, tuberculosis and HIV. A decade later, people still queue to access this service. Providing a fleet of these vehicles is where policy needs to go next. The Tutu Tester dismisses the myth that health seeking is low in Africa.
What has DTHF’s experience been, working with government and using your research to influence policies in healthcare?
We have mostly enjoyed a productive relationship with government, particularly provincially. The Western Cape Health Department has always embraced innovation. During the ‘denial period’, we joined hands with civil society to advocate for public access to ARVs. Citing evidence, we pushed ahead to provide excellent care and treatment to as many people as we could, while ensuring that the world was aware of what was going on. In situations like that, it is the job of non- profits to push boundaries, be bold and bring government along in a collaborative way, ensuring that successful innovation influences policy.
Around the new innovation called pre-exposure prophylaxis, for instance, government has been open to hearing about responsible implementation. In the Western Cape we’ve seen how collaboration between our organisation, a funder and the government can really move things forward. However, getting good science into policy still takes too long and often there are too few pockets of best practice, most of which aren’t taken to scale.
How can corporates get involved in supporting healthcare programming and research?
Some corporates have done well. For instance, Anglo American Platinum was one of the first to provide their employees with ARVs and tried to help other communities during a very emotive time when treatment was scarce. There is growing complacency now that treatment is widely available but, sadly, South Africa still has a long way to go because we have the greatest treatment burden in the world.
For the long haul, we need to position HIV within broader healthcare. We need a sustainable model and this is where the corporate sector can play its part by keeping HIV on the agenda, because it affects their workforce. We now have tools to ensure that those with HIV can live long and healthy lives, but we also have tools to prevent onward transmission. Corporates should review their healthcare programmes, what they are doing in the communities that their workforces live in, and how they are supporting organisations that work in this space. PROF LINDA-GAIL BEKKERDeputy director of the Desmond Tutu HIV Centre and COO at the Desmond Tutu HIV Foundation info@hiv-research.org.za www.desmondtutuhivfoundation.org.za
Business in Society Handbook 2018
