An article written for The Conversation explores the reasons why, in an era of antiretroviral therapy (ART), so many people around the world are still dying of HIV.
Despite fierce resistance under Thabo Mbeku’s leadership, ART became widely available in South Africa. Yet in 2019, despite the world’s largest ART programme with 71% coverage, there were still 72 000 HIV-related deaths in South Africa.
Medecins Sans Frontieres (MSF) supports hospitals across Africa in treating people with HIV, but because patients present with advanced HIV up to a third die during their hospital stay.
HIV is a lifelong disease, and requires lifelong treatment. Some struggle to take tablets on a daily basis, risking drug resistance.
People with advanced HIV now typically have interrupted or failing treatment. MSF-funded studies in Kenya and the DRC showed that only 20-35% of patients with advanced HIV had never received ART.
The “Welcome Back Services” provided by Medecins Sans Frontieres in Khayelitsha, Cape Town are an example of getting patients who have lapsed back into care.
In deprived settings, TB is the leading cause of death for people with HIV, along with cryptococcal meningitis and bacterial infection. These are all treatable if caught in time; cryptococcal meningitis effectively has a zero survival rate but mortality can be reduced by 40% when treated with flucytosine and amphotericin B. By testing patients before they reach the stage where hospitalisation is necessary, survival rates can be greatly improved.
