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31 March 2009

Salutation

Programme director
Chairperson of Conference, Professor Linda-Gail Bekker
Ministers from different Southern African Development Community (SADC) countries
Other guests from abroad
Academics, scientists and researchers present
Representatives from various sectors of society
Distinguished guests
Ladies and gentlemen

It is a great honour for me to address you on this occasion of the fourth Southern African National AIDS Conference.

We thank the organisers of this event that its reach includes other countries in the Southern African region, so that we share innovative measures of preventing the spread of HIV and AIDS.

This year's theme, "Scaling up for Successes", compels us to reflect on the achievements and experiences, and to treat this pandemic with a sense of urgency through deepening our partnerships. I am informed that the discussions here will focus, among others, on prevention through mass mobilisation and mass communication, particularly in relation to stigma and discrimination.

Programme director,

Statistical figures from StatsSA, the Medical Research Council (MRC) and the Department of Health show us that in South Africa more than 5,2 million people live with HIV or AIDS, with between 900 and 1 000 daily infection. Approximately 250 000 people die annually from a variety of AIDS-related illnesses and nearly double that number become newly infected.

Many Southern African Development Community (SADC) countries record an HIV and AIDS prevalence of not less that 20 percent, with negative effects on the social fabric and the labour force in the region. However, there are indications that the epidemic is slowing down and even declining in the 15-19 year age group, but we must redouble our efforts against this disease.

As South Africa, we are ready to share with our SADC counterparts all the strategies we have employed since 1994, as well as methods of implementation and mass mobilisation. We all agree that the foundation of a strong anti-HIV and AIDS campaign lies in the buy-in of the broader citizenry, especially the infected and affected; hence collaboration with the civil society, private sector, community organisations and religious formations to develop a catholic response to HIV and AIDS.

Such a multi-sectoral approach brings together all these stakeholders at the South African National AIDS Council (SANAC) to assist in implementing the national response.

With more emphasis on prevention, the objective of our National Strategic Plan (NSP) 2007-2011, is to reduce new HIV infections by 50% in 2011. At the centre of this prevention endeavour is our ABC message which is Abstain, Be faithful and Condomise.

South Africa has also adopted the Government AIDS Action Programme (GAAP) to manage the national communication campaign – 'Khomanani' to spread messages of prevention to the millions of South Africans using the mass media. Among the successes of this initiative, the South African Broadcasting Corporation (SABC) audience rating results reveal that during the World AIDS Day celebration in 2007, about 30 million citizens were reached with the Red Ribbon Race campaign.

We are also scaling up the supply of male and female condoms. Through the Sexually Transmitted Infections (STI) programme, government distributes close to 40 million condoms every month to boost our prevention campaign. In Khayelitsha, Cape Town, about one million condoms are distributed every month, which reduced Sexually Transmitted Infections, hopefully including HIV. Even more impressively – less than five percent of children born to HIV positive mothers are infected.

The Vhembe health district in Limpopo has a very low HIV prevalence rate amongst women who attend public sector antenatal clinics and we have to draw lessons from these kinds of health districts. Our prevention programme will succeed if we combine interventions and adopt a human rights based approach, which take into account issues of class, gender and disability.

In this regard our Government Action Programme facilitated the development of HIV and AIDS brail materials as well as the training of blind people on the importance of the consistent use of condoms.

Ladies and gentlemen,

Voluntary Counselling and Testing (VCT) are key in our fight against HIV and AIDS. In 2000, we started implementing VCT and we currently provide such services in over 93% of all public health facilities in South Africa. We continue to encourage all our people, including the youth, to test for HIV and know their status and lead healthy lives.

In addition, life skills programme, including peer education initiatives, are implemented in many schools and community organisations, targeting youth in and out of school. As part of these efforts, 100% of schools provided life skills education on HIV and AIDS since 2007.

These targeted interventions are beginning to reveal an encouraging trend. The National HIV Survey among pregnant women between 20 and 24 year of age show a decline from 30% in 2005 to 28% in 2006. Our Prevention of Mother to Child Transmission of HIV programme (PMTCT) has been implemented throughout the country from the year 2002. Since the adoption of this programme, we are happy to share with you that:

* PMTCT services are offered in all public hospitals with antenatal, obstetrics as well as gynaecology services. It is also offered in over 95% of all Primary Health Care (PHC) facilities provided by government
* over 70% of antenatal attendees were counselled and tested in 2007 with 66% of HIV positive pregnant mothers receiving Nevirapine
* the comprehensive PMTCT policy guidelines have been reviewed and approved in February 2008, introducing dual therapy. The National Health Council (NHC) played a significant role in the process of adopting the guidelines
* however, the essence of our response is not only limited to prevention, but also includes other dimensions such as treatment, care and support
* in this context, all districts have at least one service point accredited to provide Antiretroviral (ARV) treatment.

As such, the following can be noted:
* About 435 facilities have been accredited, 16 of which are correctional centres and seven belong South African National Defence Force.
* Government has a system of monitoring ARV Adverse Drug Reaction, and has formed partnership with three universities, namely; Limpopo (Medunsa Campus), Western Cape and Free State to assist with pharmacovigilance.
* In terms of laboratory services, 55 CD4 count and 15 viral load testing machines are being used in the eight (8) laboratories that do the PCR tests.
* To date over 690 775 patients are on ART and 10% of them are children.
* More than 670 000 patients received macro and micro nutrients.

In January 2007, the government had succeeded in enrolling 245 190 people into the ARV programme, with an increase to 695 293 two years later. Despite this enormous effort and achievement, we are only treating about half of the people who need ARVs today. About 80 percent take their medicine consistently which reduces chances of drug resistance.
Ladies and gentlemen,

While we deal with the HIV epidemic, we also have a challenge of strengthening the health system to deal more effectively with various other causes of morbidity and mortality, such as TB, cholera, diabetes, hypertension and cardiovascular diseases.

TB affects largely our poorest of the poor, goes largely undetected and infection control is inadequate. As government, we are committed to addressing this challenge. It is encouraging that this conference will also be considering research and clinical experience in integrated diagnosis and treatment of HIV and TB. SANAC expects that integration of approaches and collaboration of efforts from national and provincial health ministries as well as non-governmental organisations (NGOs) will scale up the response to the scourge.

In that context we as SANAC are discussing ways to strengthen the functioning of our structures, including the various sectors. We cannot ignore the fact that HIV and AIDS has resulted in many orphans and child headed households in the region. In our country, just over one million orphans and vulnerable children are receiving free external support through the child support grants, feeding schemes, and provision of school uniforms.

Women and girls are still raped almost everywhere, which makes it necessary for our health system to address the health needs of rape survivors. The NSP has set clear targets for access to health services by rape survivors and SANAC must ensure that this target is reached.

Despite our constitutional provisions, discrimination based on sexual orientation persists, resulting in rapes for gays and lesbians. The NSP requires that we develop "a supportive legal environment for the provision of HIV and AIDS services to marginalised people."

In this regard, I want to congratulate the Western Cape Health Department, the Paediatric HIV Research Unit and PEPFAR for opening the Ivan Toms Men's Health Clinic at Woodstock Hospital in Cape Town, which provides health services to gays. It will hopefully be a model for other regions planning the same facility.

All the plans we have to fight this disease will not succeed if there is no political will and financial commitment from the government. I repeat; political will and financial support is the key to any success! We are happy to share with you that the Department of Health's budget allocation for HIV and AIDS has increased from R676 million in 2000 to R4,8 billion in 2008.

However, many challenges still remain. These include the reality that at the current medicine price regime and escalating private health costs, the provision of anti-retroviral therapy will not be affordable. As government, we will exploit various options to make medicine affordable, including through the amendment of the Patents Act and regulating the private health sector.

This intervention will ensure that 15% of those accessing private healthcare services are properly managed and maintained within that sector, thus reducing the dumping of patients in public health facilities.

Ladies and gentlemen,

We are proud once more to share with you the South African experience. We are looking forward to also drawing from experiences of our partners in the SADC region.

On behalf of the people and the government of South Africa, I wish you success in all your deliberations, and looking forward to an HIV-free generation.

I thank you.

Issued by: The Presidency
31 March 2009
Source: SAPA