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 disease.

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 world.

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 message.

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What progress are we making on preventing mother-to-child transmission?

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 in this.
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 needlestick injuries)

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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 infections.

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 drugs;
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 so on.

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 HIV/AIDS?

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 campaign.

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 HIV/AIDS.

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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Last modified: 23 September 2004 10:46:40.