ACW Interview: Dr D.M. Moloi, South Africa
Dr D.M. Moloi is the Senior Manager of the HIV & AIDS, STI & TB Directorate at the Department of Health and Social Development in Polokwane, South Africa.
ACW: The vast majority of people living with HIV/AIDS (PLWHA) do not have access to antiretroviral (ARV) drugs. Can you comment on current progress in scaling up of ARV provision in your local context?
Dr Moloi: The progress is too slow based on the number of people enrolled. People do ‘qualify’, but don’t have access to antiretrovial therapy (ART) sites for various reasons such as lack of transport and funds needed to get there.
The consequences of not receiving ARVS are firstly an increased bed utilization rate and tuberculosis (TB) infection rate resulting in a raised mortality rate as we are currently in the phase where people who were infected are becoming ill or dying.
ACW: Aside from ARVS, which care and treatment options do you think are likely to add years or quality to someone’s life?
Dr Moloi: Firstly the treatment of opportunistic infections is essential as drugs are available, but regimens are not always used correctly.
Prophylactic treatment, for example isoniazid therapy (INH ) for TB which should be provided in a controlled setting as without this resistance could develop. DOTS (Directly Observed Short erm Treatment) should be used to address this. Cotrimoxazole, which is freely available and well applied. Diflucan would also be helpful, but this is not as yet freely available.
Nutritional support is vital as it prevents the CD4 cell count from dropping and can extend the time before ARV ‘s are taken. Basic things like the use of a balanced diet and support with micronutrients and supplements. The later are rather costly, however in the long term, this would be meaningful.
This does not replace ARVs. This is in fact what the South African Minister of Health is advocating.Palliative care must also be provided along the continuum of life.
ACW: What are the reasons for the rapid progression towards AIDS – related illnesses in developing countries? What measures can you recommend that may alleviate this more rapid progression.
Dr Moloi: Poverty, is by far one of the main differences between the rich and the poor countries. We need to scale up our poverty alleviation projects as well as providing nutritional support. I feel that the rich countries should assist us with funds in the forms of donors but without all the conditions and not with their own agendas either. Drugs could be supplied for the treatment of opportunistic infections.
ACW: People living with HIV have a much higher lifetime risk of developing a range of common, potentially fatal, and yet treatable diseases, such as TB and meningitis.
Is adequate or appropriate attention given at National or international level to preventing and treating these conditions? Would greater attention add years or quality to PWHA lives?
Dr Moloi: No, neither at national at international level. The TB control programme is failing. INH prophylaxis is not rolled out.
ACW: In what ways do you think affected people can be empowered to take more control of their own health? What impact do you think this will have on their day to day lives?
Dr Moloi: People living with HIV/AIDS need to be involved and empowered so that they are able to decide [issues related to care and treatment] for themselves. They must play an active role, such as form their own non governmental and community based organisations, and/or get more involved in government projects to help themselves.
ACW: What is your feeling about the initiatives and policy activities in 2005? Do you consider 2005 to be a significant year? What are your hopes?
Dr Moloi: In terms of the millenium development goals (MDG), the infant mortality rate is a concern. Use of polymerase chain reaction (PCR) to follow up babies as a strategy would help to address this.
Obviously the 3 by 5 goal is unrealistic, 2005 is a tipping point year.
My hopes are that the prevalence rate would be reduced. That people will stay negative and that challenges will be less than what they are at present.
(ends)
ACW: The vast majority of people living with HIV/AIDS (PLWHA) do not have access to antiretroviral (ARV) drugs. Can you comment on current progress in scaling up of ARV provision in your local context?
Dr Moloi: The progress is too slow based on the number of people enrolled. People do ‘qualify’, but don’t have access to antiretrovial therapy (ART) sites for various reasons such as lack of transport and funds needed to get there.
The consequences of not receiving ARVS are firstly an increased bed utilization rate and tuberculosis (TB) infection rate resulting in a raised mortality rate as we are currently in the phase where people who were infected are becoming ill or dying.
ACW: Aside from ARVS, which care and treatment options do you think are likely to add years or quality to someone’s life?
Dr Moloi: Firstly the treatment of opportunistic infections is essential as drugs are available, but regimens are not always used correctly.
Prophylactic treatment, for example isoniazid therapy (INH ) for TB which should be provided in a controlled setting as without this resistance could develop. DOTS (Directly Observed Short erm Treatment) should be used to address this. Cotrimoxazole, which is freely available and well applied. Diflucan would also be helpful, but this is not as yet freely available.
Nutritional support is vital as it prevents the CD4 cell count from dropping and can extend the time before ARV ‘s are taken. Basic things like the use of a balanced diet and support with micronutrients and supplements. The later are rather costly, however in the long term, this would be meaningful.
This does not replace ARVs. This is in fact what the South African Minister of Health is advocating.Palliative care must also be provided along the continuum of life.
ACW: What are the reasons for the rapid progression towards AIDS – related illnesses in developing countries? What measures can you recommend that may alleviate this more rapid progression.
Dr Moloi: Poverty, is by far one of the main differences between the rich and the poor countries. We need to scale up our poverty alleviation projects as well as providing nutritional support. I feel that the rich countries should assist us with funds in the forms of donors but without all the conditions and not with their own agendas either. Drugs could be supplied for the treatment of opportunistic infections.
ACW: People living with HIV have a much higher lifetime risk of developing a range of common, potentially fatal, and yet treatable diseases, such as TB and meningitis.
Is adequate or appropriate attention given at National or international level to preventing and treating these conditions? Would greater attention add years or quality to PWHA lives?
Dr Moloi: No, neither at national at international level. The TB control programme is failing. INH prophylaxis is not rolled out.
ACW: In what ways do you think affected people can be empowered to take more control of their own health? What impact do you think this will have on their day to day lives?
Dr Moloi: People living with HIV/AIDS need to be involved and empowered so that they are able to decide [issues related to care and treatment] for themselves. They must play an active role, such as form their own non governmental and community based organisations, and/or get more involved in government projects to help themselves.
ACW: What is your feeling about the initiatives and policy activities in 2005? Do you consider 2005 to be a significant year? What are your hopes?
Dr Moloi: In terms of the millenium development goals (MDG), the infant mortality rate is a concern. Use of polymerase chain reaction (PCR) to follow up babies as a strategy would help to address this.
Obviously the 3 by 5 goal is unrealistic, 2005 is a tipping point year.
My hopes are that the prevalence rate would be reduced. That people will stay negative and that challenges will be less than what they are at present.
(ends)
posted by AIDS-Care-Watch at 3:12 pm
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