After years of denial, South Africa is finally facing up to the challenge of HIV/AIDS. The nation on the southern tip of the continent is the most heavily affected country in the world, with some 7.5 million people – 11 percent of the population – infected with HIV.

But South Africans are fighting back. A community-based project called Total Control of the Epidemic (TCE) provides care and support to entire communities in South Africa heavily affected by HIV/AIDS. The TCE program reaches about 10 million people in nine southern African countries, and has been operating in South Africa for eight years. In that time they group's officers have managed to reach more than three million people in five of the country's nine provinces.

Most of the funding comes from PEPFAR, the U.S. President's Emergency Plan for AIDS Relief, and the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Locals are employed as field officers for a period of three years and each one works with 2,000 people. They go from house to house, person to person to get each individual involved in the fight against HIV/AIDS. According to Corp Commander of the TCE program in Ilembe Province, Ruth Makembe, one of the goals of the program is to make sure people know their HIV status.

"If they are positive, they should know where to go and get support—in clinics or hospitals where they can get medication. If they are negative, we encourage them to stay negative for the rest of their lives," she said.

Preventing transmission

Outside the Ndulinde Clinic, a child and maternal health clinic in Ilembe, pregnant women and mothers holding their babies sat on two long benches patiently waiting to see a nurse. The clinic specializes in the Prevention of Mother-to-Child Transmission of HIV. Around 70,000 babies are born with HIV every year; it's one of the main contributors to South Africa's high infant mortality rate.

At the clinic, HIV-positive pregnant women receive the necessary medication and care to give birth to a child free of HIV. Among them was Mhlongo, a 25-year-old mother of three. She's eight months pregnant with her fourth. She said she got tested for HIV after learning she was pregnant again because her boyfriend was sick and she became worried. She's HIV-positive.

"I came to take my treatment for the baby and to see how the baby is feeling. How he is kicking and all that stuff and I do everything what they say I must do," she said. "When they are giving us a treatment, they say it is for the baby, to protect the baby."

Under dual therapy, from 28 weeks of pregnancy, HIV-positive women receive the anti-retroviral drug, azidothymidine (AZT) as well as a single dose of nevirapine. Their babies receive AZT for seven days after birth, and a dose of nevirapine.

The ultimate aim

23-year old Nonhlanhla Masuku lives alone with her three-year old son and six-week old baby in a one-room mud hut with a beehive-thatched roof, situated in a poor, remote, rural area. There are few neighbors and the distances to the water well, the clinic, and the school, are long.

Masuku explained through a translator that she got herself tested and learned she's HIV-positive, but didn't yet know whether her baby is infected. She got the medication for the baby immediately after she delivered. Six weeks after the baby's birth she, just like any mother who is enrolled in the Prevention of Mother-To-Child Treatment Program, has to bring her baby to the clinic for injections against childhood illnesses, such as measles and polio. According to Yogan Pillay, acting director of the National Department of Health that oversees the HIV/AIDS and TB epidemics in South Africa, the baby's HIV status is checked at the same time.

"And we're finding that fewer children are being born HIV positive to HIV positive moms. Our target for 2011 is five percent. The national average at the moment is heading towards seven percent. So, with the introduction of dual therapy two years ago we have already seen a significant improvement in the PMTCT (Prevention of Mother To Child Treatment) program," he said.

In fact, the results have been so good the government is planning to expand its treatment program throughout the country. Pillay said he's sure the target of five percent transmission rate will be reached with the dual therapy approach. And while this is good, the ultimate aim is to completely eliminate mother-to-child transmission of HIV.

Author: Lisa Schlein
Editor: Mark Mattox