Summary of Government's position on HIV/AIDS
17 April 2002
Intensifying our comprehensive programme against HIV/AIDS in
partnership with all sectors
Government is intensifying the campaign to prevent infection
by the HIV and to deal with its consequences. In that regard our
starting point is the premise that HIV causes AIDS.
HIV/AIDS is a challenge for all of us. Defeating it depends
on strengthening the Partnership Against AIDS launched in
October 1998, in which all sectors society work with government
to implement a comprehensive programme. Together we can overcome
The policy framework which government is following is set out
in the "HIV/AIDS and STI (Sexually Transmitted Infections)
Strategic Plan for South Africa 2000-2005". It is in line with
international trends, and it is in fact among the best in the
As we continue to work within that broad framework, we are
intensifying and expanding the programme; addressing problems of
implementation; and improving our approach in line with changing
circumstances. (Total funding in 2002/2003 is over one billion
rand, three times more than the year before.)
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Why does the programme put so much emphasis on prevention?
Because there is no cure for AIDS, preventing infection by
the HIV 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 and HIV/AIDS
education programme are the core of the efforts to prevent
transmission of HIV. The latter is now a compulsory part of the
school curriculum and full implementation is expected by the end
of 2003. Though we have achieved a high level of awareness -
over 90% - which is beginning to have an impact especially
amongst the young, we are intensifying the work so that more
people translate awareness into change of lifestyles. A new
phase of the campaign by the agencies contracted by government,
working with partners such as Lovelife, will start in June 2002.
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.
Amongst other things there has been a steady decline in the
prevalence of syphilis amongst pregnant women attending public
health sector clinics, and antenatal surveys show that that the
rate of HIV infection is levelling off.
In the South African AIDS Vaccine Initiative 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
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What progress are we making on preventing mother-to-child
The Prevention of Mother-to-Child Transmission of HIV (PMTCT)
is being run through 18 research sites accessed through over 230
hospitals and clinics. Over 38,000 mothers have gone through the
programme. At the sites women are offered voluntary counselling
and testing for HIV. Those who are HIV-positive are offered
Nevirapine for themselves and their babies, vitamins to improve
their health during pregnancy and after; preventive measures and
prompt treatment of infections and formula-feed if they choose
not to breast-feed. Babies are also given multivitamins and
prophylaxis for opportunistic infections.
Where there is capacity to provide the package of care that
is needed, and where the demands of research dictate, sites are
being extended. Towards the end of the year, tests will be done
on the babies and mothers being monitored, for us to then
consider moving to universal access of Nevirapine. A Universal
Roll-out Plan in this regard is being worked on and will be
released in due course.
In the meantime, government is implementing the temporary
Constitutional Court order; and we have provided guidelines to
hospitals on the package of care they need, to be able to
administer Nevirapine against mother-to-child transmission
beyond the research sites. A special Task Team set up by the
Health Minister in consultation with MECs will assist hospitals
Regarding use of antiretroviral drugs following cases of sexual
assault, government will endeavour to provide a comprehensive
package of care for survivors, including counselling, testing
for HIV, pregnancy, STIs. Survivors will be counselled,
including on the risks, so that can make an informed choice, and
will be provided with the drugs if they so choose in accordance
with guidelines and protocols (as is done in the case of
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What does government's programme offer in the way treatment?
The quality of life of those infected by HIV is a major
concern of government. Their health can be improved greatly
through the effective treatment and management of opportunistic
It is important for those with recurrent opportunistic
infections to know their HIV status. The programme to provide
voluntary HIV counselling and testing (VCT) was started in 2000
- at the moment 359 VCT sites are operational out of 495
identified by provinces.
However, no one should be sent away and not treated, whatever
their HIV status. Therefore treatment of opportunistic
infections is available at public health care facilities
irrespective of HIV status. Government will continue working
with pharmaceutical companies to lower the cost of drugs to
treat these infections.
As part of this programme Government signed an agreement with
the pharmaceutical company Pfizer in December 2000 for the
provision of Fluconazole (Diflucan) to the public health sector
for two years. The agreement includes funding for the training
of healthcare workers in the diagnosis and management of oral
thrush and cryptococcal meningitis. So far 20,000 patients have
benefited from the programme.
We call on the public, especially People Living with AIDS, to
help us in monitoring the availability of such drugs; so that we
can work together to improve treatment for the infected, and
public health care in general.
Government recognises that anti-retroviral drugs can improve
the quality of life of People Living with AIDS, if administered
at certain stages in the progression of the condition and in
accordance with international guidelines and protocols. Because
these drugs are costly and can cause harm if incorrectly used or
if health systems are inadequate, we will:
- continue working to lower the cost of anti-retrovirals,
including through discussions with the producers of the main
drugs, and investigation into possible production of generic
- work through the Global Fund to fight HIV/AIDS, TB and
Malaria to access resources for the overall campaign against
the spread of HIV, TB and Malaria;
- intensify the campaign to ensure that patients
generally, and those infected with TB, thrush, meningitis
and HIV in particular, observe the treatment advice given to
them by doctors.
Though antiretrovirals are not generally available through
the public health sector, guidelines for their use in the
private sector have already been developed and research on their
targeted use will continue.
A further initiative arises out of the fact that conditions
of poverty lower the body's natural immune system making it more
susceptible to infection, and more vulnerable to its effects.
Alongside poverty alleviation and nutritional interventions
government will encourage investigation into alternative
treatments, particularly on supplements and medication for
boosting the immune system.
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What about care and support?
Government is deeply concerned about the conditions of
families affected by the HIV/AIDS epidemic. We are intensifying
the campaign to assist these families, including foster care
grants, assistance to child-headed households, food parcels and
We are also improving the programme of home-based care. In
this regard the budget allocation for home-based care and
community-based care increases from R25,5 million in 2001/02 to
R94,5 million this fiscal year, to R138 million in 2004/5.
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What can be done about discrimination against people with
This is a very important matter. Negative attitudes in our
society can result in people being denied the treatment, care
and support they need. They discourage people from being tested
to find out their status or from declaring the cause illness or
death in their family. Amongst other things this leaves us
without vital information our country needs to know the extent
of the disease and its patterns.
Government will intensify its campaign and awareness
programme against discrimination and continue investigating
further legal avenues to the affected and infected.
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What does partnership mean in practice?
Because of the scale of the disease, because it affects every
aspect of our society, and because of the need for awareness,
care and support, defeating it depends on a partnership of all
sectors of society with government to implement a comprehensive
In the beginning the response to HIV/AIDS came just from the
Health sector. The launch of the Partnership Against Aids in
1998 by then Deputy President Mbeki brought other government
departments and key sectors of society together in a broad-based
and multi-sectoral fight against the disease.
In January 2000 the partnership was formalised in SANAC, the
South African National Aids Council under the leadership of
Deputy President Jacob Zuma. SANAC has been reviewing its
two-years of work and is preparing to strengthen itself to play
the key co-ordinating role in our national effort against
Government will strengthen its own contribution to the
partnership, establishing a Presidential Task Team on AIDS
consisting of Ministers led by the Deputy President.
As government focuses its efforts and resources ever more
intensively on the public policy challenges of HV/AIDS, it will
draw whatever it can from science to use in this fight. As in
all areas of science research and debate will continue, but
government is not a protagonist in those debates.
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