From treatment to prevention: The interplay between HIV/AIDS treatment availability and HIV/AIDS prevention programming in Khayelitsha, South Africa Authors
Cite this article as: Levy, N.C., Miksad, R.A. & Fein, O.T. J Urban Health (2005) 82: 498. doi:10.1093/jurban/jti090 Abstract
There is a paucity of research that illustrates the interplay between HIV/AIDS treatment and prevention programs. We describe the central role that public access to antiretroviral (ARV) medication has played in the development and efficacy of HIV/AIDS prevention programming in Khayelitsha, a resource-poor township in the Western Cape of South Africa. We document the range of preventive interventions and services available in Khayelitsha since the early 1990s and explore the impact of ARV availability on prevention efforts and disease stigma on the basis of extensive indepth interviews, supplemented by data collection. The information gathered suggests that the introduction of the mother-to-child-transmission (MTCT) prevention programs in 1999 and the three HIV treatment clinics run by Doctors Without Borders/ Médecins Sans Frontières (MSF) in 2000 were turning points in the region’s response to the HIV/AIDS epidemic. These programs have provided incentives for HIV testing, galvanized HIV/AIDS educators to reach populations most at risk, and decreased the HIV incidence rates in Khayeltisha compared to other areas in the Western Cape. Lessons learned in Khayelitsha about the value of treatment availability in facilitating prevention efforts can inform the development of comprehensive approaches to HIV/ AIDS in other resource-poor areas.
Keywords HIV/AIDS HIV prevention HIV treatment MTCT South Africa References
Creese A, Floyd K, Alban A, Guinness L. Cost-effectiveness of HIV/AIDS intervention in Africa: a systematic review of the evidence.
2002;359:1635–1643. Erratum in
Marseille E, Hofman PB, Kahn JG. HIV prevention before HAART in sub-Saharan Africa.
Groenewald P, Nannan N, Bourne D, Laubscher R, Bradshaw D. Identifying deaths from AIDS in South Africa.
UNAIDS. Report on the global HIV/AIDS epidemic 2002. Available at: http:// www.unaids.org/barcelona/presskit/report.html. Accessed June 18, 2002.
McNeil DG. Plan to fight AIDS overseas is floundering.
The New York Times. March 28, 2004. Available at: http://query.nytimes.com/gst/health/article-page.html?res=9 9F00E5D91130F93BA15750C0A9629C8B63. Accessed July 3, 2004.
International AIDS Vaccine Initiative. Scientific, operational and resource challenges. Progress and challenges. Available at: http://www.iavi.org/viewpage.cfm?aid=29. Accessed May 6, 2005.
African AIDS vaccine trial approved.
BBC News. June 19, 2003. Available at: http:// news.bbc.co.uk/1/hi/world/africa/3005050.stm. Accessed May 6, 2005.
Newman PA, Duan N, Rudy ET, Anton PA. Challenges for HIV vaccine dissemination and clinical trail recruitment: if we built it, will they come?
AIDS Patient Care Stds.
Leithead A. Townships hold breath for HIV decision.
BBC News. June 6, 2003. Available at: http://news.bbc.co.uk/1/hi/health/2968748.stm. Accessed May 6, 2005.
South African Government Information. Summary report of the Ninth National HIV Survey of Women attending antenatal clinics of the public health facilities in South Africa, October/November 1998. South Africa, Government Communications: Department of Health; 1999. Available at: http://www.info.gov.za/otherdocs/1999/hivwomen.htm. Accessed July 21, 2005.
Health HIV pandemic tightens its grip.
BBC News. November 24, 1998. Available at: http://news.bbc.co.uk/1/hi/health/220581.stm. Accessed June 18, 2002.
South Africa AIDS crisis worsens.
BBC News. April 19, 2000. Available at: http:// news.bbc.co.uk/1/hi/health/719183.stm. Accessed June 18, 2002.
Cauvin HE. South African Court orders medicine for H.I.V.-infected mothers.
The New York Times. December 15, 2001. Available at: http://query.nytimes.com/search/query? query=Cauvin%20HE%2012%2d15%2d2001&clean_query=Cauvin%20HE%2012% 2d15%2d2001&sort=closest&date_select=full&srchot=s&srchst-nyt&srcht=s&frow=40&. Accessed May 6, 2005.
Walgate R. AIDS conference ends with plea for nevirapine: south Africa’s Medicine Control Council petitioned to allow continued use of AIDS prevention drug.
The Scientist. August 7, 2003. Available at: http://www.the-scientist.com/news/20030807/04 Accessed May 6, 2005.
Tassie JM, Szumilin E, Calmy A, Goemaere E. Highly active antiretroviral therapy in resource-poor settings: the experience of Medecins Sans Frontieres.
Coetzee d, Hildebrand K, Boulle A. et al. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa.
Wole Nani Annual Review 2001–2004. Available at: http://www.wolanani.co.za/wola %20nani%20ann%20review%2004%20final.pdf. Accessed May 6, 2005.
Tutu and Mbeki in war of words.
BBC News. November 29, 2004. Available at: http:// news.bbc.co.uk/1/hi/world/africa/4052199.stm. Accessed May 6, 2005.
Reverend Rachel Mash; Fikelela
Annual Report 2003. Available at: http://www.fikelela.org. za/ministries.htm. Accessed May 6, 2005.
On the Move.
The Center for AIDS Development Research and Evaluation (CADRE) and the South African Department of Health. 2002. Available at: http://www.cadre.org.za/ pdf/pdf/On_The_Move_Final_Report.pdf. Accessed May 6, 2005. Copyright information
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