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HIV treatment and eradication in South Africa.

After going through a gloomy period of increased infections, no sign of affordable treatment for the majority of infected patients, no vaccines in human trials, denial that HIV causes AIDS and stigmatization of infected persons, Southern Africa, the epicentre of the AIDS pandemic,1 is in a state of renewed hope. We begin to think in terms of eradicating new infections and substantially reducing the fatality rate in those infected. What has changed? Clearly, the main reason for optimism is a drastic reduction by pharmaceutical companies in the price of antiretroviral drugs and the roll-out of treatment through Government support. A second is the initiation of a phase I trial to test vaccines that incorporate the antigens of Southern African HIV subtype C. A third is the increased empowerment of women, who through unequal and submissive relationships have often been deprived of choices in protecting themselves against the virus. Finally, in a limited number of groups in and around major cities of South Africa, antiretroviral treatment under ideal conditions—skilled clinical staff, appropriate infrastructure, monitoring of compliance and viral load—has achieved success rates very similar to those in Europe and the USA. This indicates that antiretroviral therapy can work in South Africa, though treatment centres especially in the rural areas will need to be greatly upgraded to meet the challenges.