HIV, TB, STIs wreak havoc in SA

HIV, tuberculosis (TB) and sexually transmitted infections (STIs) have claimed too many South African lives.

Today, defeating these diseases is a national priority, with the mission of the latest National Strategic Plan to get our country on track to eliminate them as public health threats by the year 2030. But what happens when the treatments we use to fight them no longer work?

South Africa's biggest AMR problem

This is a reality for many people who are already living with drug-resistant strains of many common infections.

Antimicrobial resistance (AMR) occurs when bacteria, viruses, parasites or fungi evolve and become able to survive in the face of drugs designed to cure or prevent the infections they cause.

The World Health Organisation (WHO) reports that an estimated 19 000 people in South Africa developed drug-resistant TB in 2016. Indeed, multi-drug resistant TB is South Africa's biggest AMR problem — one caused by multiple factors, including inadequate diagnostic coverage, medicine stock-outs and patient adherence challenges.

But it's not only TB. Treatments for HIV and STIs, malaria, and gastro-intestinal, urinary tract, and respiratory tract infections are all under threat. Bacterial infections that are resistant to multiple drugs are commonplace in South African hospitals.

People with these infections face longer, more uncomfortable treatment regimens and have a lower likelihood of survival. Often, it is high-risk and vulnerable populations, including children, pregnant women and people with HIV, that suffer the most.

Incorrect use of treatments

Vanessa Carter was infected with an extensive MRSA (Methicillin-resistant Staphylococcus aureus) infection following a car accident in Johannesburg. "I had never heard of this super-bug before, but as I became more informed, I learnt that the bacteria causing infection in my face had become resistant to the antibiotics that were meant to heal me."

One culprit in the rapid spread of AMR is the incorrect use of treatments, particularly in the case of viral infections. Every time a doctor prescribes — or a patient demands — a treatment based purely on symptoms, rather than on the results of a diagnostic test, the likelihood of perpetuating the spread of resistance increases.

Common colds are often the result of a viral infection, which will not respond to antibiotics; there's no point in prescribing them to treat a cold. Another problem is the lack of prevention and infection control measures to limit transmission of resistant infections.

Carter, lucky to have survived her MRSA infection, is now an activist and founder of Health Care Social Media South Africa. She emphasises the need to change the way medicines are used, explaining that "we have to treat antibiotics and other antimicrobial medications as the precious resource they are. World health leaders have described antibiotic-resistant microorganisms as nightmare bacteria that pose a catastrophic threat to people in every country in the world, and South Africa is not exempt."

Indeed, the global impact of AMR could be devastating. Estimates suggest that by 2050 it could result in 10 million deaths per year across the globe and, according to the World Bank, have an economic impact that rivals the 2008 financial crisis.

According to Miriam Schneidman, the World Bank's Lead Health Specialist in the Africa region, low- and middle-income countries will suffer the most. "Estimates have found that low-income countries could lose more than 5 percent of their GDP and an added 28 million people could fall into extreme poverty by 2050 under a high impact AMR scenario. AMR can impede our ability to meet our poverty and global development goals."

Heidi Albert is Head of FIND South Africa, an NGO that enables the development and use of diagnostic tests for communicable diseases affecting low- and middle-income countries.