Changing attitudes and practice

Abstract

The infectious diseases landscape in Southern Africa is subtly changing. Although human immunodeficiency virus (HIV) and tuberculosis continue to dominate, the response to these major epidemics is maturing. With respect to HIV, we are making the transition from the desperate situation of the pre-antiretroviral therapy (ART) and “Manto” years, to having nearly two million South Africans on ART, and as the bar descends in terms of CD4 count starting levels, the numbers will only increase. Treatment as prevention could make a major impact on transmission. How long will it be before persons living with HIV are offered ART, irrespective of stage or CD4 count? However, continued challenges present themselves with this shift, no more so than sustaining adherence to drugs, whether or not one pill or multiple, and the quality-of-life issues associated with any chronic disease. However, the sense of learned helplessness with respect to HIV is gone and has been replaced with optimism for the future.