Comment by the Treatment Action Campaign on the 12th National Antenatal Survey 13 June 2002 The Treatment Action Campaign (TAC) welcomes the publication of the 12th antenatal survey on HIV and syphilis sero-prevalence in South Africa. The survey is an important scientific instrument for measuring HIV prevalence and thereby testing the efficacy of South Africa's prevention programmes. TAC notes the marginal increase in HIV prevalence from 24,5% to 24,8% between 2000 and 2001, but welcomes the drop in HIV prevalence that appears to be taking place amongst people under the age of 20. We also welcome the survey's finding of a continued decline in national syphilis prevalence. Despite these promising signs, TAC believes that no comfort can be drawn from the results. This is because: · National HIV infection is still rising, even if the rate at which it is rising is slowing down; · HIV prevalence is still rising in six provinces and apparently stabilized at a relatively low level in one Province, the Western Cape. · HIV prevalence amongst pregnant women between 30 and 39 has risen significantly. · 85 581 babies were infected with HIV through MTCT during 2001. TAC believes the survey results call for an urgent national and provincial assessment of HIV prevention programmes - and discussion about how to improve them A large amount of money is being poured into prevention by the public and private sectors, and much more money is being promised, with relatively limited results. In particular we are concerned that although there are signs of declining (but still high) levels of infection among young women under 20, HIV prevalence rises again as women get older. This trend was also noted in the 2000 survey. it suggests that prevention programmes that target youth, but are not complemented by equally strident messages targeting older people (and particularly married people), lose their benefits as people enter relationships where they have less sexual autonomy and control. In addition TAC believes: * Legitimate questions have been raised about the continued delays in publication of the survey results and denying researchers access to the raw data. In the spirit of the Cabinet Statement of 17 April 2002, TAC urges the Department of Health to develop an open approach to the availability of this data in the public interest and as a guarantee of scientific freedom and independence. In particular, we call for the publication of the HIV ante-natal results on a clinic-by-clinic basis (the survey was conducted in 421 clinics). This will allow a much more thorough scientific and public assessment as well as better targeting of HIV prevention at high and low prevalence areas. Independent researchers have been denied access to the clinic-by-clinic results for the last three years. * Over the last few years, relationships of trust between the independent scientific community and the government have been undermined. This can be rebuilt through ensuring that access to information is not impeded and that additional surveillance systems for HIV are jointly developed. TAC urges the government to work with independent academics and researchers to identify additional sentinel survey sites for HIV that include men, as well as sites that establishes a race and class balance in our epidemiological surveillance. Finally, the survey, once again, confirms the need for a comprehensive National Treatment Plan. For example, it a. notes an estimated 83 581 infant infections during 2001, underlining the need for rapid roll out of a universal MTCT programme. b. admits that "high HIV prevalence rates have significant implications on the future burden of HIV-associated disease and the ability of the health system to cope with provision of adequate care and support facilities." This finding again confirms why a sensible national response to HIV has to take advantage of antiretroviral drugs that have the potential to reduce this impact. In this context, the government must change its policy position on not providing ARVs in the public sector for treatment. A majority of the paediatric infections were predictable and the consequent deaths can still be avoided with ARV treatment for infected children. We must all work together to develop better prevention strategies and to ensure that the lives of the 5 million people with HIV/AIDS are valued and saved through treatment