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Update on Cabinet's Statement of 17 April 2002 on fighting
HIV/AIDS
9 October 2002
Lend a
hand in the campaign of hope against HIV/AIDS!
Note - Grey sections contain matter updating the
17 April statement
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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.
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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.
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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.
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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.
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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. |
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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.
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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. |
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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.
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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. |
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And are we still
on track for universal roll-out?
The PMTCT research
programme continues.
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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.
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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.
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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. |
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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.
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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.
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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.
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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.
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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. |
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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.
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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. |
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A role for
all of us in the treatment campaign
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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.
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All of us,
especially people living with AIDS, should help monitor the
availability of drugs, and report any problems as we come across
them.
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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.
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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.
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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.
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Strengthening the health care system
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.
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Training for better HIV/AIDS care
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.
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Guidelines on treatment
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.
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Better information on antiretroviral treatment
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.
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Towards more affordable drugs
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.
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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.
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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.
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In March
2002, the Traditional Leaders AIDS programmes were
launched, joining traditional leaders and other
sectors.
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In April
2002 a programme was launched to form a partnership
with organisations operating in high-risk
environments, such as bars, taverns and shebeens.
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In May
2002 the awareness campaign was launched with
commuters and drivers in trains, taxis and buses.
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In the
same month the hospitality industry came on board.
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In
August 2002 government and the scientific community
met for a two-day intensive session on the
evaluation of research and its translation into
practical programmes.
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In
October 2002 a Men's March in Cape Town signalled
another dimension to 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.
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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.
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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.
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SANAC has now endorsed a second round of submissions to
the Global Fund. |
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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.
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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. |
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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.
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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.
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For more information
on this and other programmes, consult:
www.health.gov.za and
www.aidsinfo.co.za
Issued by:
Government Communications (GCIS)
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