OPEN LETTER TO AARON MOTSOALEDI
Minister of Health Dr Aaron Motsoaledi's recent claim that over half a million people have been newly started on HIV treatment in less than six months has raised eyebrows. In this open letter, Anna Grimsrud and Sibongile Tshabalala-Madhlala, associated with CHANGE – South Africa, ask the minister to explain numbers.
Dear Minister Motsoaledi,
We write to you in response to your 15 May 2025 media statement and subsequent remarks in Parliament on the current status of the national HIV, Aids, and TB campaign.
You stated that since the launch of the Close the Gap campaign, 520 700 people have been initiated on HIV treatment, reaching 'more than 50% of the target'. You also stated that 5.9 million people are currently on antiretroviral therapy (ART).
However, at the campaign's launch on 25 February 2025, you reported the same number on HIV treatment - 5.9 million. This raises a critical question: if over half a million people have started or restarted treatment, why has the total number of people on treatment not increased?
If both figures are accurate, this would mean that approximately 520 000 people have been lost from care over the past few months - a deeply concerning and unprecedented level of attrition. We respectfully request that you provide the underlying data and clarify the current total number of people remaining on HIV treatment.
There are several reasons why we are concerned:
Static treatment numbers: As noted, the number on treatment was reported as 5.9 million in both February and May 2025. If 520 700 people have been initiated or re-initiated during this period, the same number must have exited care - a scenario that requires urgent explanation.
Slow growth in the number of people on treatment: According to official statements, the total number of people on HIV treatment increased by only 100 000 between March and December 2023 — from over 5.7 million to 5.8 million. The claim that the cohort has now grown by over 500 000 in a matter of months contradicts recent trends.
Declining lab numbers: National Health Laboratory Service data reported by the Daily Maverick and Reuters, show notable declines in viral load testing and early infant diagnosis in March and April 2025 compared to the same months in 2024. These indicators should increase alongside meaningful growth in treatment uptake — not decrease.
In light of these concerns, we believe it is essential that you provide a transparent accounting of the current number of people on treatment and the metrics being used to assess progress under the Close the Gap campaign. Specifically, we request data demonstrating that the programme is on track to meet its stated goal of increasing the number of people on treatment from 5.9 million to 7 million.
We share your commitment to a strong and effective HIV response, especially in this period of financial and operational strain. Like you, we believe it is vital that accurate and complete information is shared with the public and Parliament at this critical moment.
- Anna Grimsrud is an epidemiologist and writes in her personal capacity. Sibongile Tshabalala-Madhlala is openly living with HIV and currently serves as the national chairperson of the Treatment Action Campaign (TAC).' CHANGE is a coalition of more than 1 500 people from civil society organisations in South Africa and around the world. CHANGE stands for Community Health & HIV Advocate Navigating Global Emergencies.
*Published by GroundUp and Spotlight
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Boston Globe
39 minutes ago
- Boston Globe
Hundreds of laid-off CDC employees are being reinstated
Whole CDC programs were essentially shut down, including some focused on smoking, lead poisoning, gun violence, asthma and air quality, and workplace safety and health. The entire office that handles Freedom of Information Act requests was shuttered. Infectious disease programs took a hit, too, including programs that fight outbreaks in other countries, labs focused on HIV and hepatitis in the U.S., and staff trying to eliminate tuberculosis. Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up An estimated 200 of the reinstated workers are based in the CDC's National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention, HHS officials confirmed. Staffers at a CDC lab that does testing for sexually transmitted diseases are being brought back, said one CDC employee who wasn't authorized to discuss what happened and spoke to The Associated Press on condition of anonymity. Advertisement Also reinstated are an estimated 150 employees at the CDC's National Center for Environmental Health, including people staffing a lab that works on lead poisoning, according to the union and employees. Layoffs at federal agencies were challenged in lawsuits, with judges in some cases ordering federal agencies to halt terminations of employees. Advertisement Officials at HHS have never detailed how they made the layoff decisions in the first place. And they did not answer questions about why the notices went out, or how decisions were made about who to bring back. HHS spokesperson Andrew Nixon said the agency was streamlining operations and that 'the nation's critical public health functions remain intact and effective.' 'The Trump Administration is committed to protecting essential services — whether it's supporting coal miners and firefighters through NIOSH, safeguarding public health through lead prevention, or researching and tracking the most prevalent communicable diseases,' he said. The reinstatements don't undo the damage being done by Kennedy and the Trump administration to federal public health, said members of Fired But Fighting, a group of affected CDC workers who have helped organize rallies in Atlanta. The most recent was in the rain on Tuesday, at which some attendees called for Kennedy to resign. 'Bringing a few hundred people back to work out of thousands fired is a start, but there are still countless programs at CDC that have been cut, which will lead to increased disease and death,' one of the group's founding members, Abby Tighe, said in a statement. This is not the first time that employees at the Atlanta-based agency were told they were being terminated only to then be told to come back. After an earlier round of termination notices went out in February, about 180 CDC employees in March were told to come back.
Washington Post
an hour ago
- Washington Post
Doctors said I was ‘too young' to be seriously ill. I had Stage 4 cancer.
Three years ago, before I learned that I had metastatic cancer, doctors repeatedly told me I was 'too young' to be seriously ill. I was 26. My symptoms were brushed off as stress, bad luck or something I'd eventually get over. After more than five months of dead ends and dismissals, I even started questioning my sanity.
Medscape
an hour ago
- Medscape
AI and Home Dialysis: From Prediction to Personalization
VIENNA — 'We are going to change anemia treatment. We are going to change fistula control. The future is going to be AI (artificial intelligence),' declared Adrian C.M. Covic, MD, PhD, at the opening of a session dedicated to AI and home dialysis at 62nd European Renal Association (ERA) Congress 2025. Covic, vice-rector for scientific research at Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania, emphasized that dialysis has seen limited improvement in mortality over the past 30-40 years. 'We haven't changed much,' he said, 'but AI may be the game changer.' 'Home dialysis is a highly standardized process that generates a large volume of medical data,' he explained in his presentation. Different machine learning models are already used in a cycle of AI-based clinical decision support — a cycle from problem identification through algorithm development and validation to real-world deployment. These models can process data from up to half a million patients and uncover variables that clinicians might overlook. And AI, he reported, has outperformed traditional models like the Kidney Failure Risk Equation in predicting when dialysis should begin and in forecasting mortality. In a head-to-head study, only 2 of 10 experienced nephrologists outperformed an AI model in predicting survival at 30 and 90 days. And 'only one was better than AI at 1 year,' said Covic. Beyond survival, AI models are also accurately predicting major adverse cardiac event and gastrointestinal bleeding hospitalization risks with hemodialysis. Diagnostic capabilities are also improving, Covic added. He described how natural language processing applied to clinical notes identified symptoms with far greater sensitivity than International Classification of Diseases, 10th Revision, coding. In simulated clinical cases, the large language model-based AI system AMIE, which has been optimized for diagnostic dialogue, outperformed physicians in diagnostic accuracy. 'AMIE was far better than the doctors in picking the right symptoms,' he said. On the treatment side, AI models are helping clinicians anticipate intradialytic hypotension 15-75 minutes in advance, with an area under the receiver operating characteristic curve (AUC) of 0.89, and manage vascular access by classifying aneurysms and predicting stenosis. In one example, a model achieved 86% classification accuracy. Another AI-enabled device, the DeepVAQ system, used photoplethysmography data to detect stenosis with an AUC of 0.86. Covic also presented evidence that AI improved anemia control. A model trained on 170,000 clinical records achieved a mean absolute prediction error in hemoglobin concentration of 0.59 g/dL and led to improved hemoglobin levels during implementation. 'We are close, for the very first time, to a meta-analysis for anemia management in dialysis through AI,' he said. Even device integration is advancing, with AI-enabled tools like phonangiography and robotic tomographic ultrasound improving vascular assessments. You won't need a technician — the device itself will standardize the analysis, he said. Despite his optimism, Covic issued a strong caveat: AI models are increasingly opaque, and 'we are not going to learn the algorithms,' he said. 'This process is close to beliefs in divinity.' Expanding Access Through Policy Shifting the focus to access, Rajnish Mehrotra, MD, MS, argued for policy solutions that leverage home dialysis with peritoneal dialysis (PD) to close the global dialysis gap. 'Nearly 2 million people die with kidney failure every year because they have limited access to kidney replacement therapy care,' said Mehrotra, Belding H. Scribner Endowed Chair in and professor of medicine and head of the Division of Nephrology at the University of Washington School of Medicine, Seattle. PD is ideal for low-resource settings, he said. 'Hemodialysis is personnel-intensive. PD is personnel-efficient.' PD also has a markedly lower carbon footprint, less than a quarter that of in-center hemodialysis. 'It substantially reduces the transportation burden on patients,' he added. Mehrotra cited Thailand's 2008 PD-first mandate, which rapidly expanded access. 'People who previously would have died because they did not get dialysis lived,' he said. Even though the policy was later relaxed, PD rates in Thailand remain high. In the US, financial reform drove a doubling of PD use after 2011. Reimbursement parity and bundled payments neutralized the incentives that had favored hemodialysis. 'This public policy has safely grown the use of PD and has been a spectacular success,' said Mehrotra. Telemedicine in Daily Practice Finally, Sabrina Milan Manani, MD, Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy, turned to practical innovations that bring AI into patients' homes. 'Home dialysis is a corner[stone] of patient-centered care in nephrology,' she said. Her team uses a hybrid model of home visits and telemonitoring for home dialysis. With cloud-connected cyclers, clinicians review overnight dialysis sessions each morning and make remote prescription changes. 'It's a two-way communication system,' she noted. Manani presented outcomes from her center: Patients with remote monitoring had fewer urgent visits and fewer hospitalizations for disease-specific events. 'We observed that the patients felt more confidence with the care team and with the treatment,' she said. She also described a real-world protocol for integrating telemedicine, with frequent reviews of new patients' data during the first 15 days of treatment, tapering to weekly reviews for stable patients. We only invite the patient to come to the hospital if there is a clinical problem, she added. However, she acknowledged that not all patients benefit equally. Older individuals may struggle with connectivity or tech literacy, and the evidence for complication reduction remains mixed. 'The significant results were about disease-specific hospitalization and technical failure, but the evidence was low or very low,' said Manani. Still, she sees future promise in wearable devices and AI-enhanced alerts. 'Flexibility and innovation are essential for promoting home therapies,' she concluded. 'Remote monitoring could integrate the traditional follow-up, allowing safe, high-quality care.' The Road Ahead Key challenges in the integration of AI into kidney care remain. As Covic put it, 'Prediction is currently the most widely used application of AI and machine learning in dialysis,' but rigorous studies are needed. 'We should now move to this sort of randomized control trials,' he urged. The issues of trust and interpretability loom large with AI. 'It is really difficult, or even impossible, to know how they produce results,' Covic said of AI models. But the results, increasingly, are hard to ignore. 'Optimized machine learning models could enhance risk identification and drive preemptive interventions,' he concluded. No funding or relevant financial relationships were declared.
