Correspondence
4 Haut Conseil de la Santé Publique. Prévention
de la maladie d’Alzheimer et des maladies
apparentées. Dec 22, 2017. https://www.hcsp.
fr/explore.cgi/avisrapportsdomaine?clefr=645
(accessed Dec 16, 2018).
5 Stozicka Z, Zilka N, Novak M. Risk and
protective factors for sporadic Alzheimer’s
disease. Acta Virol 2007; 51: 205–22.
6 Haute Autorité de Santé. Médicaments de la
maladie d’Alzheimer: un intérêt médical insu
sant pour justi er leur prise en charge par la
solidarité nationale. Oct 21, 2016. https://www.
has-sante.fr/portail/jcms/c_2679466/fr/
medicaments-de-lamaladie-d-alzheimer-un-
interet-medical- insusant-pour-justi er-leur-
prise-en-chargepar-la-solidarite-nationale
(accessed Dec 10, 2018).
HIV in South Africa
South Africa is home to the largest
HIV seropositive population in the
world, with 7·2 million individuals.1
Since the country’s first case of HIV in
1982, South Africa has come a long
way to reduce HIV/AIDS-related rates
of infection, morbidity, and mortality.
Some responses to the epidemic
fostered improvement, whereas
others exacerbated the crisis. As a
dramatic lesson, the denialist line of
Thabo Mbeki should be mentioned.
Outlawing the use of antiretroviral
therapy is estimated to have led to
330 000 AIDS-related deaths.2 These
health policies and witnesses from
the past remind us of the cornerstone
condition of high-level political
leadership in this public health issue.
In line with the National Strategic
Plan 2017–2022,3 we suggest imple­
menting interventions enhancing
the existing policies. First, the risk
of infection needs to be reduced by
strengthening HIV education through
awareness campaigns. Deconstructing
myths about HIV such as the so-called
virgin cure might reduce behaviours
that increase the risk of infection. In
addition to increasing knowledge
about the virus and its transmission,
encouraging individuals to know their
HIV status is crucial. A special focus
should be granted to the population
who is most at risk and neglected,
such as sex workers. Second, the
linkage to care should be reinforced
www.thelancet.com Vol 394 August 10, 2019
by eliminating anonymous testing
and establishing a clear follow-up
system similar to that of Kenya.4,5
Third, the quality of care should be
ensured by regular quality control of
health-care workers. Fourth, once the
patient’s compliance with treatment
is ensured and their CD4 cell count
becomes stable, the frequency of
the medical prescription can be
reduced from every month to every
3 months so as to be less binding.
Finally, multisectoral cooperation has
to be promoted and involve different
actors.
As scientific knowledge improves,
interventions get more efficient. Social
sciences should also take a greater
role as they offer an insight into popu­
lation behaviour and beliefs, helping
to adapt the response with tailored
interventions.
We urge all political leaders of
South Africa, regardless of political
party colours, to rally under the cause
of HIV/AIDS. Improvement has to
be no­ticed. However, it should not
shadow our willingness to not only
improve the fight, but to win fiercely.
We declare no competing interests.
Suzuka Satoh, *Elisa Boyer
elisa.boyer@sciencespo.fr
SciencesPo, Paris 75007, France
1 UNIAIDS. UNAIDS Programme Coordinating
Board sees South Africa’s AIDS response
first-hand. Nov 7, 2018. https://www.unaids.
org/en/resources/presscentre/
featurestories/2018/november/pcb-field-
visit-south-africa (accessed Dec 18, 2018).
2 Chigwedere P, Seage GR 3rd, Gruskin S,
Lee TH, Essex M. Estimating the lost benefits
of antiretroviral drug use in South Africa.
J Acquir Immune Defic Syndr 2008; 49: 410–15.
3 The South African National Aids Council.
Let our actions count. South Africa’s national
strategic plan for HIV, TB and STIs: 2017–2022.
March 9, 2018. https://sanac.org.za//wp-
content/uploads/2017/06/NSP_FullDocument_
FINAL.pdf (accessed Dec 18, 2018).
4 National AIDS and STI Control Programme
Ministry of Health. The Kenya HIV testing
services guidelines. November, 2015. https://
www.nascop.or.ke/?p=2536 (accessed
Dec 18, 2018).
5 National AIDS and STI Control Programme,
Ministry of Health. National AIDS/STD
control programmes. HMIS for HIV/AIDS.
Training materials. November, 2010.
http://guidelines.health.go.ke:8000/media/
Participants_Notes_5RenAdH.pdf (accessed
Dec 18, 2018).
Ending diabetes in
Mexico
Diabetes leads to thousands of deaths
and billion-dollar spending even though
AFP Contributor/Getty Images
it is a predictable lifestyle disease.
In Mexico, 10·4% of the population
had diabetes in 2016, 1 compared
with 7% of the population in 2006.2
The country also has one of the
highest rates of deaths attributable
to diabetes and disability-adjusted
life-years, which is particularly
concerning. Obesity is tightly linked
to diabetes. In Mexico, 65% of the
population is overweight, and 30% of
the population is obese—the second
highest rate in the world after the USA.
This high prevalence of obesity can be,
at least partly, attributed to economic
progress and free-trade agreement.
Taxes and campaigns with shock­ing
and moralising messages are insuf­
ficient ways of fighting the diabetes
epidemic, so we highly recommend
adopting short-term strategy with a
positive attitude.
The Mexican Government should
focus on the earliest days of life to help
change mindsets. Breastfeeding, which
is the best nutrition to prevent obesity,
should be promoted. Children in school
must be taught basic nutritional
knowledge, and healthier meals should
be provided in cafeterias to develop
healthy habits.3
Physical activities should be pro­
moted. A campaign might use sports
celebrities and benefit from the
opportunity brought by hosting the
2026 football World Cup.
The country’s water issue should be
solved. 8% of Mexicans experience
water scarcity and water network
contamination.4 Short-term measures
must be taken: sugary drinks, which
are cheaper than water, must be
forbidden in schools, and free drinking
water fountains must be set up.
A reorganisation of the distribution
system should begin with the help of
federal government, and concession
rights granted to factories should be
reviewed and repealed if necessary.
467