9 October 2002
An update on Cabinet's Statement of 17 April 2002 on fighting HIV/AIDS
|Note: Grey sections contain matter updating the 17 April statement|
On the fourth anniversary of the Partnership Against AIDS let us join hands so that we can together build on the progress that has been made in the fight against the epidemic, to intensify the campaign of hope.
HIV/AIDS is a challenge for all of us, one that we can overcome by working together in the Partnership Against AIDS.
Our policy, which starts from the premise that HIV causes AIDS, is set out in the five-year strategic plan adopted in 2000. It is in line with international trends, and is amongst the best in the world.
On 17 April 2002 government launched the Campaign of Hope, calling on all sectors of society to join hands in intensifying the campaign to prevent HIV infection and deal with its consequences.
With each month the campaign grows from strength to strength.
What is government doing to step up prevention?
Since there is no known cure for AIDS, preventing HIV infection is critical.
Each of us must exercise our individual and collective responsibility to take care of our own lives. Promoting public awareness and the life skills programme is therefore the core of the efforts to prevent transmission of HIV.
Though the high level of awareness about HIV/AIDS in South Africa - over 90% - is beginning to translate into behavioural change, especially amongst the youth, much more needs to be done.
The latest annual survey of pregnant women receiving care in the public health sector indicated HIV prevalence amongst those less than 20 years old declining for the third year.
A new phase of the awareness campaign started in September 2002, joining government with partners such as loveLife, and focusing on youth prevention, support for orphans and vulnerable children, and living positively. This includes gender-focussed education for young women to resist peer and other pressures and take full charge of their bodies. Government is providing R98 million for this new effort to change lifestyles.
In order to support the behaviour change necessary for safer sexual practices, government has been continually expanding access to both male and female condoms. Access through non-traditional outlets such as clubs, shebeens, and spaza shops has been made possible. Surveys indicate close to universal availability of condoms at clinics - and this year we will be supplying 350-million condoms for free. Access to the female condom has been increased to 114 outlets in 2002.
What about Sexually Transmitted Diseases?
The effective management of Sexually Transmitted Infections (STIs), which render people more vulnerable to the HIV, plays a critical role in reducing the risk of HIV transmission. This programme, which has so far ensured that there are trained healthcare workers in 80% of our public sector clinics, is being extended.
|The latest survey shows that the steady decline in the prevalence of syphilis amongst pregnant women attending public health sector clinics continues, amounting to a 50% decline over three years.|
Is there progress in the search for a vaccine?
In the South African AIDS Vaccine Initiative (SAAVI) scientists are working with government support and funding to develop a vaccine that will make people immune to HIV infection. It is important however to remember that success will not be quick and is not guaranteed - so prevention through awareness remains the key message.
|But the programme is moving forward at a pace that is extremely quick for such a biotechnology program. SAAVI continues to develop subtype C HIV vaccines and is at an advanced stage of laboratory testing of certain of these candidate vaccines. The next step is to choose those that should be manufactured, and these will be manufactured during late 2002 and 2003 for clinical trials starting in late 2003.|
What about prevention of mother to child transmission of HIV (PMTCT)?
Following the ruling of the Constitutional Court on Nevirapine, all provinces have been provided with guidelines for the implementation of the PMTCT package.
|Provinces will expand the services according to their differing capacities, monitored by national government. Training is in progress on the basis of the provincial rollout plans. Already, KwaZulu-Natal, Gauteng and North West and Western Cape Provinces have extended coverage to a significant number of their health institutions and other provinces are following suit.|
And are we still on track for universal roll-out?
The PMTCT research programme continues.
|By the end of June 2002, over 101 202 women had visited the facilities attached to the 18 PMTCT research sites, with 63 217 accepting voluntary counselling and testing, 17 274 of whom tested HIV-positive. Nevirapine was dispensed 10 043 women who accepted it and to 6 947 babies who have been born to women recruited in the programme.
With regard to the Universal Roll-out Plan, the most critical challenges are: training, budget, proper health facilities and community attitudes. Training has started in all provinces. We continue to upgrade health facilities for testing, counselling and monitoring. Funds will be made available for the roll-out. And we should all work together to stop discrimination against HIV-positive mothers.
What has happened to the package of support for survivors of rape?
In April 2002 government decided it would provide a comprehensive package of support for survivors of sexual assault. This includes counselling on the effectiveness and risks of using antiretrovirals as preventive drugs. This is to ensure that they can make an informed choice.
|The relevant protocols were developed and distributed by May 2002 to provinces, and implementation has started. In order to maximise the impact of the programme, government services such as health institutions, the police and social workers as well as NGO's working with rape survivors are encouraged to work together. Additional funding is being provided to cover the training, drugs and HIV test requirements of the programme for provinces.|
What about treatment?
The quality of life of those infected with HIV is a major concern of government. Their health can be improved greatly through the effective treatment, management and prevention of opportunistic infections.
|This is why it is important, for treatment, as well as prevention, to know your HIV status. The programme to provide voluntary HIV counselling and testing (VCT) was started in 2000 - by the middle of 2002, 691 VCT sites were operational. The number is still growing.|
There are a number of different kinds of treatment that can help.
- Treating opportunistic infections
Treatment for opportunistic infections, such as meningitis, oral thrush, TB and pneumonia, is available at public health care facilities irrespective of the person's HIV status.
|To further enhance this programme, the Department is continuing with the training of health care workers on the management of opportunistic infections. As part of the Diflucan Partnership Programme between the Department of Health, the pharmaceutical company Pfizer and IAPAC (the training partner), about 1 million tablets of Diflucan (Fluconazole) were processed by July 2002. Diflucan is provided free of charge in over 300 public facilities. Some 7800 health care workers have received training as part of the programme.|
Treatment for TB is free and available in the public health sector. It is curable even in the presence of HIV infection, and treatment will help both the individual concerned and assist in preventing the spread of TB to others.
|In addition to the treatment which is administered for opportunistic infections, antibiotics such as Bactrim are available which can prevent the onset of common infections in people infected with HIV.|
- Protecting and building a stronger immune system
Any strengthening of the immune system helps ward off infections. Therefore good nutrition is critical for those who infected by the HIV. Government's poverty alleviation programme and nutritional interventions are an essential part of the fight against HIV/AIDS. Likewise clean water supply; decent housing, creation of employment and access to social infrastructure all decrease the vulnerability of individuals and communities to ill-health and infections.
|Government encourages investigation into alternative or complementary treatments and medication for boosting the immune system. In this regard a protocol for research into such treatments is critical and such a protocol has been drafted for submission to the Medicines Control Council. Initial data indicates that complementary medicine can be beneficial in this regard.|
- A role for all of us in the treatment campaign
The success of a treatment programme depends on the availability of drugs. The challenge is to ensure an uninterrupted supply to all health facilities.
You can help by preventing theft of medicines and hospital supplies. Let us join hands to expose corruption and other crime in the public health sector.
All of us, especially people living with AIDS, should help monitor the availability of drugs, and report any problems as we come across them.
What about antiretroviral treatments?
Anti-retroviral treatments can help improve the condition of people living with AIDS if administered at certain stages in the progression of the condition, and in accordance with international standards.
However, these drugs are at present too costly for universal access. Some estimates have suggested that for one million people, this would require about R7-billion Rand. Further work on these and other cost implications is being done by the Department of Health and National Treasury. Besides, if incorrectly used and if the health systems are inadequate these drugs can cause harm. This underlines the need for the drugs to be used under supervision and monitoring.
Government is actively engaged in addressing these challenges, in order to create the conditions that would make it feasible and effective to use antiretrovirals in the public health sector.
It therefore continues to work for the lowering of the cost of these drugs, to intensify the campaign to ensure that patients observe treatment advice given to them by doctors and to strengthen the health system.
What does this mean, practically?
The ultimate objective is to ensure that South Africans living with AIDS can have access to the treatment they need under conditions that will benefit them.
A stronger focus on strengthening the health care system marks the work of a technical task team that has been formed between the Department of Health and the National Treasury. It will provide a picture of the cost implications of an expanded response to the impact of HIV/AIDS on all sectors of South African society.
Out of 27 000 registered medical practitioners only 2 000 have been trained in providing care for people with HIV/AIDS. For this reason the Department of Health is currently running a series of training programmes in collaboration with academic institutions and other role players such as: the Southern Africa HIV/AIDS Clinicians Society; the International Association of Physicians in AIDS Care, the Foundation for Professional Development and the South African Medical Association.
Work will start soon to establish public sector Centres of Excellence for HIV/AIDS Care in all nine provinces. Their main objective will be to ensure development of curricula on HIV/AIDS and TB care, to ensure dissemination of guidelines, and to ensure health care workers are adequately skilled in providing care and support to those who need it.
Further, government will urgently start investigating the experience of HIV/AIDS treatment in South Africa's health private sector: the costs, the impact, issues of resistance, compliance with drug prescriptions and so on. (To date the Medicines Control Council has registered 17 antiretroviral drugs for use in the country, including some of which are generics.)
In addition to this research on experience in the private sector, consideration is being given in some submissions from provinces to the Global Fund to fight AIDS, TB and Malaria, (through SANAC) for operational research within the public sector, in the medium term, on the practical impact of antiretroviral treatment.
In consultation with the main pharmaceutical companies, government has drawn up regulations that will facilitate the import and manufacture of cheap and generic drugs. The regulations are expected to come into force after some technical amendments to the law.
In this regard, the World Summit on Sustainable Development has confirmed the World Trade Organisation/TRIPS agreement on intellectual property rights, facilitating access to affordable drugs for major health problems, including HIV/AIDS, TB and malaria.
Within NEPAD is a programme for a number of African countries urgently to work with pharmaceutical companies towards the manufacture on the continent of affordable drugs for dangerous diseases, including HIV/AIDS and TB.
Some of the projects detailed above will source their funding from the Global AIDS Funds. But ultimately, the decisions we take should not rely on immediate opportunities. They must be sustainable.
Above all, we should all remember: there is no cure for AIDS. The campaign to prevent HIV infection is therefore most important challenge we all face.
What has been done to strengthen the Partnership Against AIDS?
HIV/AIDS is a challenge for all of us, in every sector of society. Together we can overcome the disease by working in the Partnership Against AIDS now represented by the South African National AIDS Council (SANAC).
In addition to work in sectors such as transport, involving truck drivers and others, new sectors are constantly becoming involved with the Partnership.
SANAC met on 5 October 2002, to review its effectiveness over the first two and a half years of its existence in strengthening the partnership of all sectors of South African society to fight HIV/AIDS. It decided to streamline its operations; strengthen its Secretariat, broaden non-governmental sector representation and to move to a position in which sector representatives are selected by the sectors themselves in a transparent manner. A new structure is to be set up during the first half of next year.
What additional resources are being allocated?
New resources are being introduced in the fight against the dual epidemics of HIV/AIDS and TB as well as other infectious diseases.
|Government's special HIV/AIDS budget increased from R350 million in 2001/02 to R1 billion in 2002/03 and will reach R1,8 billion in 2004/05.|
South Africa has been allocated a total of R1, 8 billion through the Global Fund to fight AIDS, TB and malaria in the Fund's first round of allocations. An additional R100 million has been provided by the United States Government for expansion of the PMTCT Programme. All these donor resources will be utilised in accordance with the country's policies and laws.
|SANAC has now endorsed a second round of submissions to the Global Fund.|
What about care and support for those affected by the HIV/AIDS epidemic?
Government is intensifying efforts to assist families affected by the HIV/AIDS epidemic. The Departments of Health, Social Development and Education work together on this.
This includes foster-care grants, assistance to child-headed households and food parcels.
The budget for home-based care and community-based care is increasing from R25 million last year to R138 million in 2004/05.
|Following a conference on Home and Community Based Care in September the programme took another step forward. All provincial co-ordinators of the home and community based care programmes - of which there are now nearly 500, are to receive home/community care based care kits by November to be used by nurses and lay counsellors.|
What is being done to intensify the campaign to fight discrimination against people living with AIDS?
Negative attitudes can result in people being denied the treatment, care and support they need. They also discourage people from being tested. Government is therefore intensifying its campaign against discrimination.
|Government has drafted a National Policy on Testing for HIV which is to be incorporated into the National Health Act to be tabled in Parliament this year 2002.
Steps towards fighting discrimination include the drafting of a plan for national education on legal and human rights of people living with HIV/AIDS. This will be another tool to make both PLWAs and HIV negative people aware about the rights of People Living with HIV/AIDS.
Issued by: Government Communications (GCIS)