HIV_Nov04


THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE                                         november 2004 3

With the national ARV roll-out underway, despite being
somewhat slower than was hoped, antiretrovirals (ARVs) are
now recognised as the standard of care for appropriately
staged HIV-infected South Africans in both the private and
public health care sectors.  

As American and local experts point out in their article
‘Managing HIV as a chronic disease’ (p. 7), highly active
antiretroviral therapy (HAART) results in significantly better
survival rates but requires a streamlined system, a
multidisciplinary approach, accurate data collecting and
statistical analyses, and the full support of clinics and the
community.  

Clearly the public hospitals cannot carry on taking the brunt
of the pandemic, as shown in research conducted at Red Cross
Children’s Hospital in Cape Town (p. 32) confirming that
current admission policies regarding inpatient treatment of
HIV/Aids appear unsustainable.  This is of great concern, as the
HIV prevalence in the Western Cape lags behind that of other
provinces and sub-Saharan Africa. With finite resources
(including money, health care workers and hospital beds) this
is another compelling reason to speed up the ARV roll-out in
all provinces, i.e. to reduce the present high admission rates
for opportunistic infections and terminal care.

In developing countries there is a huge need to incorporate
HIV/AIDS into the health care system as another chronic
disease, as opposed to creating parallel structures for HIV
infection, which is time consuming and unnecessary.   Optimal
use of human resources and appropriate division of labour,
coupled with adequate training in the long-term management
of HIV infection, is essential.   This means the full continuum,
from voluntary counselling and testing (VCT) through the
early (pre-ART) stages, to HAART and eventually terminal care.
With this in mind, a Society guidelines committee met in
Johannesburg recently to formulate pre-ART guidelines to

assist health care workers through the phases before HIV-
positive patients require HAART (p. 18).  Any comments on this
document would be welcomed. 

Approximately 90% of patients will develop one or more skin
diseases during the course of their infection. KZN
dermatologist, Dr Ncoza Dlova, shares her experience and
visuals of HIV-associated dermatological conditions with us in
a series of articles. In Part 1 (p. 12), Dr Dlova points out that
the course of cutaneous manifestations is completely
different in patients on antiretroviral therapy and those who
are not, generally being less severe and chronic in patients on
HAART.  Another compelling reason to hope for a stepping up
of the provision of ARVs at approved public sector sites. 

Constant talk about ARVs in both the private and the public
sector is certainly not all that is on our minds.  Reduction of
transmission is a vital part of any successful HIV/AIDS plan.
Two articles in this issue deal with different aspects of this
problem, which seems to confound us in South Africa.  In the
first, Steve Andrews and Marilyn Keegan address the well-
known role of transport workers in global and national spread
of HIV in a novel way.  They stress the importance of
interventions at rest places, lending credence to the
importance of the PLACE method (which aims to improve
prevention programme coverage at geographical sites at
which HIV transmission is most likely to occur).   Another
prevention of transmission issue, the breast-feeding debate, is
addressed in an article and a letter to the Editor, so read on …

DES MARTIN
Editor, Southern African Journal of HIV Medicine

President, Southern African HIV Clinicians Society

F R O M T H E
E D I T O R