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Q & A: WORLD AIDS DAY
2 December 2008
1. Is the HIV and AIDS and STI Strategic Plan launched in April 2007 a new plan to deal with this challenge?
The HIV & AIDS and STI Strategic Plan for South Africa 2007-2011 is not an entirely new program, but flows from the National Plan of 2000-2005 as well as the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment. In May 2006, the South African National AIDS Council (SANAC) mandated the Department of Health to lead a process of developing a 5-year National Strategic Plan (NSP) for the years 2007-2011. The plan represents the country’s multisectoral response to the challenge of HIV infection, STIs and the wide-ranging impacts of AIDS.
The NSP provides a broad framework for government, NGOs, business, organised labour and all sectors of society in responding to HIV and AIDS and to STIs. Each sector are expected to develop and implement more specific plans based on its role in society, its activities and its specific strengths. Sectors are encouraged to establish technical AIDS committees, guided by and according to the requirements of SANAC structures. The different sectors regularly reports to SANAC on their plans and activities.
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2. What are the primary aims of the NSP?
The primary aims of the NSP are to:
- reduce the number of new HIV infections by 50% by 2011, and to
- reduce the impact of HIV and AIDS on individuals, families, communities and society by expanding access to appropriate treatment, care and support to 80% of all people diagnosed with HIV.
The future course of the HIV and AIDS epidemic hinges in many respects on the behaviours young people adopt or maintain, and the contextual factors that affect those choices. The NSP therefore aims to reduce the number of new infections amongst particularly people in the 15- 24 age group.
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3. What are the key interventions that are needed to reach the NSP’s goals?
The interventions that are needed to reach the NSP’s goals are structured under four key priority areas:
- Prevention;
- Treatment, care and support;
- Human and legal rights; and
- Monitoring, research and surveillance.
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4. What is government's approach to HIV and AIDS?
Government’s approach to HIV and AIDS is based on the premise that HIV causes AIDS and that there is no known cure to AIDS. The strategic plan to deal with HIV and AIDS (NSP), combines prevention - to ensure that those who are not infected remain so - with treatment, care and support for those infected or affected.
It is based on a five-year strategic plan which has unfolded into what is probably the largest programme in the world, sustained by a budget which has expanded and is set to grow still further in order to sustain it. Essential to the programme is the strengthening of the national health system.
Government expenditure on HIV and AIDS increased substantially over years – it grew from R30 million in 1994 to over R3 billion in 2005/06 and continues to grow each fiscal year. The World Health Organisation’s progress report on the expansion of AIDS treatment, released in June 2005, noted that: ‘South Africa has committed US$1 billion over the next three years to scaling up antiretroviral treatment, by far the largest budget allocation of any low- or middle-income country’.
The programme's impact is reflected in very high levels of awareness; changes in behaviour, especially among the young; stabilisation in recent years of the level of prevalence which had been rising fast previously; and the creation of infrastructure to support and sustain voluntary counseling and testing, care, support and treatment across the country.
Critical to successful implementation is an active partnership of all of society with government. The partnership is embodied in the South Africa National AIDS Council (SANAC) and expressed in action which sees government, communities, non-governmental organisations (NGOs) and other role players (e.g. the business sector and trade unions) working together to implement all aspects of the comprehensive plan (NSP).
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5. What is the incidence of HIV and AIDS in South Africa? Is there any difference in incidence according to gender and age?
HIV and AIDS is one of the major challenges facing South Africa today. It is estimated that of the 39,5 million people living with AIDS worldwide in 2006, more than 63% are from sub-Saharan Africa. About 5,27 million people are estimated to be living with HIV in South Africa in 2005, with 17,64% of the adult population (15-49 years) affected.
According to the Annual HIV and Syphilis Survey for 2007 the HIV prevalence among pregnant women was estimated at 28,0% in 2007. The prevalence rate in the past four years has been levelling off, compared to the steep rise in the 1990s. The infection rates of the 15 - 19 year-old age category continued to show significant declines - from 15,9% in 2005 to 12,9% in 2007. This may be suggestive of prevention programmes having some impact in this age group.
Women are disproportionately affected; accounting for approximately 55% of HIV positive people. Women in the age group 25-29 years are the worst affected with prevalence rates of up to 40%. For men, the peak is reached at older ages, with an estimated 10% prevalence among men older than 50 years. HIV prevalence among younger women (20 years) seems to be stabilising, at about 16% for the past three years.
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6. What progress has been made in implementing the country's comprehensive plan for the period 2007 to 2011?
Progress has been made in the various aspects of the plan:
- 250 laboratories have been certified to provide support to the programme
- Three pharmacovigilance centres have been established to monitor and investigate adverse reaction to treatment.
A total of 93% of public health facilities were reported to be offering Voluntary Counselling and Testing (VCT) Services by the end of the September 2008. The NSP target was 60% of public health facilities for 2007.
By the end of September 2008, a cumulative number of 600 556 adults and children had been initiated for ART and there is now stock out in all facilities.
To date, 436 facilities had been accredited to provide the Comprehensive HIV and AIDS Plan (CCMT) service including anti-retroviral therapy (ART) in the public sector. At the end of April 2008 all 52 health districts and 84% of health sub-districts (municipalities) had at least one accredited facility for the Comprehensive Plan for HIV and AIDS Care, Treatment and Management. Within all 52 health districts, there is at least one operational accredited facility for CCMT.
A total of 721 female condoms distribution sites were established which has exceeded the set target of 385 sites. At the end of the second quarter of 2008/09, 1 894 000 million female condoms were distributed against the 2008/09 target of 3,5 female condoms. During second quarter of 2008/2009, 88 million male condoms were distributed against the 2008/09 target of 450 million male condoms.
The National Health Laboratory Services (NHLS) have designated a total of 57 laboratories for CD4 tests and 18 laboratories for viral load tests found in all provinces. There are currently 8 laboratories designated to perform HIV PCR tests.
A total of 3 404 654 CD4 cell count tests were done in the period January 2007 to August 2008.
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7. What place does prevention have in South Africa’s HIV and AIDS programme?
South Africa’s approach emphasises the centrality of prevention, so that those not infected remain so; and the importance of strengthening the national health system to provide a complete continuum of care and other interventions that would mitigate the impact of HIV and AIDS and other diseases.
A significant reduction in sexually transmitted infections has been reported over the last few years due to communication and treatment programmes.
Government programmes are complemented by private-sector, NGO and civil-society initiatives. A new phase of the awareness campaign started in September 2002, joining government with partners like loveLife, and focusing on youth prevention, support for orphans and vulnerable children, and living positively.
Prevention activities have further been strengthened through the Khomanani (Caring Together) Campaign, a multimedia mass communication campaign supporting all aspects of the comprehensive programme and driving the ABC message for sexual behavioural change. The Khomanani Campaign is being decentralised to provinces.
The distribution of condoms increased to 480 million male and 24 million female condoms in 2006/07.
The prevention progamme includes prevention of mother-to-child transmission, with 3308 facilities in operation, covering 91% of health facilities, Post-exposure prophylaxis is provided in almost all hospitals and trauma centres for sexual assault survivors and health professionals exposed to HIV.
Health facilities providing voluntary counseling and testing increased from 3 969 in 2004/05 to 4130 in 2005/06 and 4189 in 2006/07.
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8. How is the country approaching human resources in the public health system?
More than 1 060 health professionals have been recruited to support the programme and 9 107 health professionals have been trained in the management, care and treatment of HIV and AIDS.
Government is also improving working conditions so that it can recruit and retain more health professionals. This includes providing scarce skills allowances for certain categories of health professionals (doctors, pharmacists and specialist nurses) and rural allowances for health professionals working in less developed parts of the country. This is in addition to steadily improving salary packages.
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9. What treatment is offered in the public health sector?
Treatment at public health facilities is covered in the Operational Plan for Comprehensive Treatment and Care for HIV & AIDS and STI in the country. This covers the areas of voluntary counseling and testing, the Comprehensive HIV and AIDS Plan (CCMT) and access to ART, access to laboratory services, home- and community-based care, TB and HIV as well as care and support.
Public health facilities have a duty to treat opportunistic infections, irrespective of the patient's HIV status. The Department of Health is continuing with the training of healthcare workers in the management of opportunistic infections. Currently, all health facilities are providing treatment for opportunistic infections.
Nutritional supplements are provided to those who need them, as part of the comprehensive response to HIV and AIDS, as a complement to the appropriate forms of treatment.
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10. What is done to provide care and support and to fight discrimination?
Support and care for those affected by HIV and AIDS is expanding, through increased governmental social grant registration and increases in grants, as well as growing home- and community-based care programmes.
According to the data report for Comprehensive HIV and AIDS conditional grant in 2007/2008, there were 24 252 active Home-based carers receiving stipends against the NSP target of 23 494. More than 12 247-care givers were recruited and newly trained against the NSP target of 10 000.
More than 85 Step-down facilities has been established in all provinces by the end of the 2007/2008 financial year.
At the end of the first quarter of 2008/09, at least 580 000 people living with HIV, AIDS and TB had received nutritional support through the public health system - and this has therefore increased macro and micronutrient requirements.
The Khomanani Campaign is tapping public willingness to help alleviate the suffering caused by HIV and AIDS.
A tool kit on how to live positively with HIV and AIDS has been developed in collaboration with people living with the disease. It aims to put faces and share experiences to reduce the stigma, and is being distributed to support groups
Government efforts are further complemented by initiatives of the private sector, and non-governmental, community-based and faith-based organisations aimed at addressing the impact of HIV and AIDS on individuals and the broader society.
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11. Did the rate of increase in HIV prevalence slow down?
Although the rate of the increase in HIV prevalence has in the past five years slowed down, the country is still to experience reversal of the trends. There are still too many people living with HIV, too many still getting infected. The impact on individuals and households is enormous. AIDS has been cited as the major cause of premature deaths, with mortality rates increasing by about 79% in the period 1997-2004, with a much higher increase in women than in men. Children are a particularly vulnerable group with high rates of mother-to-child- transmission as well as the impacts of ill-health and death of parents, with AIDS contributing about 50% to the problem of orphans in the country. Household level impacts are the most devastating effects of HIV and AIDS in the country. Increases in maternal and childhood mortality are some of the devastating impacts, threatening the country’s ability to realise the MDG targets of 2015.
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12. What are the major determinants of the spread of HIV in South Africa?
Whilst the immediate determinant of the spread of HIV relates to behaviours such as unprotected sexual intercourse, multiple sexual partnerships, and some biological factors such as sexually transmitted infections, the fundamental drivers of this epidemic in South Africa are the more deep rooted institutional problems of poverty, underdevelopment, and the low status of women, including gender-based violence, in society.
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13. How is the multisectoral response to HIV and AIDS managed by different structures and different levels?
The national multisectoral response to HIV and AIDS is managed by different structures at all levels. Provinces, local authorities, the private sector and a range of CBOs are the main implementing agencies. Each government department has a focal person and team responsible for planning, budgeting, implementation and monitoring HIV and AIDS interventions. In this plan, communities are targeted to take more responsibility and to play a more meaningful role.
Cabinet is the highest political authority, and the responsibility of dealing with common HIV and AIDS related matters has been deferred to the Inter-Ministerial Committee on AIDS (IMC) composed of eight Ministries. SANAC is the highest national body that provides guidance and political direction as well as support and monitoring of sector programmes. The newly formed SANAC will operate at three levels, viz;
- High level Council – the actual SANAC, chaired by the Deputy President, and co-chaired by a representative from civil society
- Sector level – with sectors taking responsibility for their own organisation, strategic plans, programmes, monitoring, and reporting to SANAC
- Programme level organisation- led by the social cluster.
LEADERSHIP AND UNITY TO OVERCOME HIV AND AIDS
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