South Africa’s painful past failings help country fight Covid-19

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Two decades ago, the country’s health minister announced that beets or garlic could treat HIV / AIDS.

In total, official denials and misinformation from South Africa have claimed the lives of more than 300,000 people, according to several studies.

“We cannot kill large numbers of people,” said Dr. Yogan Pillay, a senior official in the Ministry of Health. “We come from a time when large numbers of South Africans were dying of HIV. We can’t repeat this now and we shouldn’t. “

An ambitious initiative

It is the memory of this past failure, say South African health officials, that drives their fight against this new virus and it is the considerable resources they have accumulated since then against HIV, which could provide their best weapon. in the fight against Covid-19.

After years of procrastination under Mbeki, the South African government has radically changed course against HIV due to lawsuits from civil society and a change of direction.

They put millions of people on ARVs and recruited an army of community health workers to educate the public about the dangers of AIDS and the importance of testing.

They were able to mount this fight, in large part, thanks to an ambitious initiative launched by another American Republican president.

President George W. Bush’s AIDS plan (PEPFAR), announced in 2003, is arguably the most successful international public health response in the United States.

More than 14 million people are on ARVs because of PEPFAR. At first, less than 50,000 people in sub-Saharan Africa could access life-saving medicines.

“Frankly, without PEPFAR’s investment in South Africa, we would not have more than a million people on treatment, a significant reduction in the number of deaths from HIV and tuberculosis, or a significant increase in our life expectancy, “said Dr. Dit Pillay.

Pillay said there are currently about eight million HIV-positive people in South Africa, including more than two million infected people who are not taking antiretrovirals.

A radical lock

These figures mean that South Africa has the greatest burden of HIV in the world, which has helped convince South African scientists and officials to recommend a blanket ban while Covid-19 struck the country.

Countries around the world are locked in, but South Africa is one of the strictest and it was instituted before a confirmed Covid-19 death and in a country already in economic recession.

“It was a very difficult decision for the government,” said Dr. Pillay, “but they made it because they didn’t want to repeat the mistakes of … our early response to HIV. “

In a middle-income country with the highest levels of inequality in the world, South Africa has managed to significantly flatten its infection curve at first, while much richer countries like the United Kingdom and the United States -United States struggled to do so.

South Africa has distinct disadvantages for these wealthy nations. Millions of people live in cantons and informal settlements across the country where closures make sense in principle, but not really in practice.

Cantons like Thokoza, southeast of Johannesburg, are a nightmare scenario for fighting respiratory disease.

But here too, the country’s experience with HIV helps in its battle.

Thousands of health workers target townships and informal settlements in South Africa.

According to Pillay, approximately 35,000 health workers supported by government and PEPFAR are currently actively screening for the disease in the communities where they work, performing routine health checks.

They have already screened nearly six million people for Covid-19, according to the latest figures from the country’s health ministry.

Community health worker Anito Pato said that the trust she had built with the community allowed her to face fear of the new virus right away. She goes door-to-door in Thokoza to check for symptoms of Covid-19 and refer the patients for tests.

“They didn’t know much about Covid-19 and they think it affects the wealthy, not them,” said Pato. “We are trying to explain to them why we are screening and what the crown is. “

Anita Pato has worked as a community health worker for over 10 years.

A man in a blue work shirt called Pato during his visit. He wanted a test. Pato explained that there are not enough tests right now and that he should go to the clinic or the mobile test center that they have set up if he experiences the symptoms.

“AIDS is better because we have treatment,” the man, Salvin Tawananda, told CNN, “but corona, people are just scared.”

The United States government and the Centers for Disease Control (CDC) are closely monitoring efforts in Thokoza and other cantons, where social distancing is almost impossible, and the failure could be disastrous.

“It is very difficult for the people here to comply with these locking rules and this is all the more reason why we should seek out the disease before it takes control of these communities,” said the Dr Meredith McMorrow, a CDC official based in the South. Africa.

“South Africa has certainly been the hardest hit by HIV and we fear it will also be the hardest hit by Covid-19, which is why we are doing everything we can to prepare now. “

The effect of Covid-19 on HIV patients

McMorrow’s concern comes from not yet knowing the effects of Covid-19 on people with HIV.

Studies to date in China and elsewhere have been inconclusive to date, but Megan Doherty, head of the WHO’s global HIV program, said it is extremely prudent to deal with any emerging disease.

“Because it is an unprecedented pandemic, we just do not know how it reacts in all situations,” she said. “We just don’t know enough about the interactions between HIV and Covid-19 and how patients with both infections will cope. “

ARVs are being tested as possible therapies for COVID-19 in clinical trials.

Dr. Larry Corey, now president and director emeritus of the Fred Hutchinson Cancer Research Center in Seattle, helped develop the first effective ARV treatment.

He said he is skeptical that ARVs designed for HIV will become a broad-based treatment for Covid-19.

“The best ARVs discovered are very specific to each virus,” he said.

Corey, who now heads the global HIV vaccine trial network, said that regardless of the results of ARV trials in Covid-19 treatment, South Africa is well positioned to play a key role in the next phase of this pandemic, due to its HIV infrastructure and experience with HIV vaccine trials.

“I am proud of my communities,” said Pato, as she took a narrow path to another section of corrugated iron huts. “I feel like I’m being shot to shoot this disease. It must not control us. We have to control this crown. “

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