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Dr Francois Venter, who is a public sector HIV physician in South Africa, spoke to a packed audience on the 28 March 2008 at the University of Cape Town (UCT) Graduate School of Business on the topic HIV: Crisis, What crisis? The talk was hosted by SABCOHA and was very well attended.

 "Southern Africa has been affected by HIV/Aids more than any other region in the world, but the crisis in South Africa is very worrying," says Venter. "In South Africa, roughly 1,000 people die of the disease every day. We have the highest number of HIV+ people in the world. I think South Africans are very informed about Aids and the vast majority want to help, but many of us haven't internalised just how bad this crisis is," says Venter.

"Africa has seen a doubling of TB rates in the last 15 years, while TB rates have gone down in the rest of the world. Major reasons for this are that HIV is fueling TB infections in inadequate healthcare systems. TB is just as scary as HIV and these two crises prey on each other."

Two years ago, cases of multi-drug resistant TB (MDR TB) were found in the Tugela Ferry region in KwaZulu-Natal. MDR TB is resistant to the two major drugs generally used to treat TB and has also been found in other Southern African countries, Europe and South America. Unlike many other African countries, South Africa has the resources to diagnose this potent form of TB. "In South Africa, levels of MDR TB vary from province to province," explains Venter. "Three to five percent of all TB patients in the country have MDR TB."

Unfortunately, the drugs used to treat MDR TB are very toxic and expensive. Even more deadly is the extreme drug resistant TB (XDR TB), which is resistant to several more TB drugs and is almost untreatable.

Not surprisingly, Venter describes his presentation at UCT as a "very sobering talk", but says he was encouraged by the number of people who attended and the interest they showed. "People are desperate for accurate statistics, information and advice on HIV/Aids and it was good to give this to them."

In response to the question from a member of the audience on traditional healers' role in the fight against HIV/Aids, Venter said that their role is complex and they are an important community that requires engagement, but often they are portrayed as this homogeneous, marginalised group, when in fact they are a complex and often organised group.

On answering an inquiry on women and HIV, Francois stated that women bear the brunt as they already lack power. "People often focus on the fact that women are more likely to get HIV, which actually is a complex issue. However, women have fewer resources to deal with the added burden of HIV, whether to themselves, their children or others in the extended family, and this has profound consequences. I think the country needs women-focused programmes that deal with these challenges."

Venter believes not nearly enough is being done to fight HIV in prisons. Not only does he believe prisons should scale up their efforts when dealing with HIV, he thinks universities should too.

According to Venter, most university students are HIV-, and so he says university campuses are ideal places to push prevention work. But he feels universities aren't doing enough to prevent HIV infections or get greater numbers of students to test for HIV. "Incredible amounts of money are invested in training university students. We have invested in them, they are the economic and intellectual future and they have the skills to build our country. We need to protect them from HIV."

Venter's other major project has been actively supporting the Department of Health in Gauteng and the North West Province on training and treatment in terms of rolling out antiretrovirals (ARVs). While he says lack of resources have caused the project to be a huge challenge, he adds that he's impressed with the way the North West is rolling out the programme considering it's a relatively poor province. On talking about the programme in Gauteng, he says: "This programme is doing well in Gauteng, but it could be better. The Gauteng Department of Health has done an impressive job in tackling the new mother to child transmission guidelines."

But these aren't the only strides Venter's programme is making with the Gauteng Department of Health, who want to integrate clinical services within Johannesburg's poor inner city. "We want to create one-stop shops throughout the inner city, where we place all services relating to HIV in the same place," explains Venter. "Within these health centres, we'd like to offer HIV testing, HIV support groups, TB treatment, antiretrovirals, contraception, legal services and good, trustworthy HIV/Aids information among other services."

While Venter believes they should be available nationwide, he acknowledges that they present major challenges. "The structure and severe resource limitations within our health care system make it very difficult to set up nearly as many centres as we'd like."

He points out that South Africa's severe shortage of medical staff is contributing to our weak health care system. "In the late 90s, many nursing colleges were closed down because government did not fund them," explains Venter. "We've lost a decade of nursing training and now we're trying to pick up the pieces and get it going again. Our health care workers are really sought after worldwide and many of them are leaving for better opportunities overseas."

Strong leadership is something Venter believes is critical if we are to win the war against Aids. "We need strong, calm, rational, scientific, inspirational leadership," he says. "We don't need the belligerence, ignorance and denial which has been shown by the health minister."

Dr Francois Venter is president of the Southern African HIV Clinicians Society, and cluster head of the Reproductive Health and HIV Research Unit at the University of the Witwatersrand and a Lecturer in the Department of Medicine at the University of the Witwatersrand. He has expertise in the use of antiretroviral therapy in developing countries.

Click here to read a question and answer interview with Dr Venter