Outline of the national HIV Counselling and Testing (HCT) campaign by Dr Aaron Motsoaledi, Minister of Health
25 March 2010
I wish to begin by taking this opportunity to remind the nation that in August 2009 the distinguished medical journal The Lancet revealed that South Africa is apparently facing a quadruple pandemic, meaning we are going through four different pandemics:
* HIV and AIDS and tuberculosis (TB) - South Africa is only 0.7 percent of the world population, but we are carrying 17 percent of the global HIV burden, and one out of every 100 South Africans has TB.
* The second pandemic is that of maternal, infant and under five mortality.
* The third pandemic is violence and injury.
* The fourth pandemic is that of non-communicable diseases â€" high blood pressure, heart diseases, diabetes mellitus and cancer.
As a result of this and other research reports, on the 11th of March 2010, the Cabinet announced that the country intends to launch a massive HCT campaign. This was a decision taken at the Cabinet fortnightly meeting. This groundbreaking decision was part of a process to take forward the 2009 World AIDS Day announcements by the President and to try to help us achieve the targets of the National Strategic Plan on HIV, AIDS and Sexual Transmitted Infections (STIs). To remind those of us who might have forgotten, on that day last year, the President announced a new approach to HIV and AIDS, in terms of a massive prevention and HIV testing promotion strategy, as well as new treatment protocols.
We are ready
Today we have gathered here from all walks of life to announce to South Africa that we are absolutely united and ready the take the bull by its horns. We have gathered here under the banner of the South African National AIDS Council (SANAC) and government.
We are from all the 19 sectors of SANAC, which include the religious sector, labour, business, youth, women, children, disability, menâ€™s sector, traditional leaders, non-governmental organisation (NGOs), clinicians, researchers, sports and entertainment, and many other South Africans, who in their own right, declare that we are ready to launch this campaign.
We need to stand up and confront our challenge as South Africans.
On 15 April, the President and Deputy President will officially launch the biggest HCT campaign South Africa has ever undertaken. The launch will take place at Natalspruit Hospital in Ekurhuleni District in Gauteng. While the national launch is on 15 April as mentioned earlier, provinces will launch simultaneously on 19 April.
National Ministers, Deputy Ministers and provincial leaders as well as SANAC leaders will take the lead and test first. This campaign will be run under the theme: I am responsible, We are responsible, and South Africa is taking responsibility.
A plan is in place
We as South Africans should confront the scourge of HIV and AIDS through this prevention and HIV testing promotion campaign, and we shall be engaged in the following activities:
* Information, education and mass mobilisation
* Detection and management of sexually transmitted infections
* Massive voluntary HIV counselling and testing
* Widespread provision of condoms â€" male and female
* Embarking on a plan to introduce medical male circumcision on a large scale
* Prevention of mother to child transmission aimed at totally eradicating the prospects of being children born with HIV
* Safe blood transfusions
* Post exposure prophylaxis for rape survivors at all health facilities
* Life skills education for learners.
The counselling and testing shall take place at the following facilities:
* All government hospitals and clinics
* All universities and FET campuses, subject to confirmation by the various university principals and CEOs of colleges
* Mobile units mainly from clinics into villages, rural areas, and other remote areas of the country.
Over the last month I have met with many leaders, and as a result, I am happy to announce the following major commitments for the campaign:
* The Clicks and Link Pharmacy Group has pledged to make available 470
pharmacy clinics to provide free tests throughout the whole campaign These are available as testing sites. The government will provide them with testing kits and condoms and they will provide staff and expertise. I would like to take this opportunity to heartily welcome the CEO of the Clicks Group who is here amongst us.
* The Life Care private hospital group has pledged R500,000 and to support training of health workers. They say the full scope of their contribution is still being discussed.
* Last night, I have met with approximately 500 general practitioners from around Gauteng Province, who pledged that all their practices will be available as free testing sites. Government will provide them with testing kits and condoms and they will provide the rest. Details of these GPs will be made available.
* The independent pharmacies have also agreed to make their facilities available.
* The South African Progressive Pharmacy Association (SAPPA), have proposed to their 2,000 community pharmacists to offer testing services. A proposal is being finalised with them.
We encourage all organisations in South Africa to consider how they can contribute to this campaign and to inform the nerve centre of their pledges. Contact the nerve centre at 012 338 9300 or firstname.lastname@example.org.
Improving all aspects of care
This campaign is not just about HIV counselling and testing. Our intention is that anybody who enters a testing station anywhere in the country shall also have the following services:
* Blood pressure to check for hypertension
* Blood sugar measurement to check for diabetes mellitus
* Haemoglobin measurement to check anaemia
* Symptomatic TB screening â€" five questions asked and if one answers positively to any, then screen for TB using sputum and x-ray.
HIV testing is confidential. People need not disclose their status publically, but are encouraged to disclose their status to friends and family. Part of this campaign is to fight stigma.
We are targeting people from the age of 12 years and older, and hope to reach 15 million people by June 2011. We are appealing to the media to take this campaign forward positively, through radio, television, newspapers etc.
The SANAC website (http://www.sanac.org.za) shall also be the source of information. In our endeavour to run a very smooth campaign, we have set up a nerve centre in Pretoria, at the Sol Plaatjie building. The SANAC Chief Operating Officers and a Chief Director from the Department of Health will operate the nerve centre on a full time basis.
Each hospital CEO is being instructed to establish a nerve centre in every health facility. Other operations like pharmacy stores, general practitioners, universities and any other site shall be attached to each hospital nerve centre. CEOs of hospital have further been instructed to select one person to be dedicated full time to the campaign in each and every hospital and every clinic attached to it.
I have met hospital CEOs from six provinces and still have to meet those from Northern, Eastern and Western Cape, but they are all busy with preparations. Provinces shall soon also establish nerve centres.
Due to the size of the campaign, a lot of human resources are going to be needed:
* The NGOs sector has pledged to mobilise 9,000 lay counsellors
* The South African National Defence Force (SANDF) has pledged their medical personnel
* We have asked medical universities to release all their final year medical students for at least five days in the first week of the campaign. Medunsa and the University of the Free State have already obliged. I am waiting for a response from the other medical universities
* I have written letters to all retired nurses, doctors, pharmacists and social workers and I am hoping for a favourable response. Over 4000 retired health workers have already offered to assist.
Condoms and test kits
In terms of test kits for the campaign, 2.1 million kits are already available in all nine provinces, and an additional 1.9 million test kits have been ordered. The rest shall be ordered as the campaign progresses. In terms of condoms, the government is distributing 450 million male condoms currently. In this campaign, we will increase this drastically.
Each person receiving HIV counselling and testing will receive 100 condoms. Hence we need 1.5 billion condoms for 15 million people tested. Furthermore, we wish to distribute another 1 billion condoms to public facilities, especially FIFA accredited hotels, hospital and clinics.
We shall then need 2.5 billion male condoms over the next year. For this purpose, 177 million condoms have been purchased for the initial phase of
the campaign and of this, 91 million were distributed last week ready to be handed over to 910,000 people.
In terms of laboratory capacity, we have met with the National Health Laboratory Service (NHLS) and they are busy establishing the necessary capacity.
I wish to take this opportunity to recap and clarify the World AIDS Day
= announcements pertaining to treatment. There were four major announcements:
* Pregnant women with a CD4 count of 350 or below will receive treatment. Alternatively, if they show symptoms of advanced HIV infection, regardless of the CD4 count
* Infants, that is children below one year who are HIV positive will start treatment, regardless of their CD4 count
* All pregnant women whose CD4 count is above 350 will start PMTCT at 14
weeks, instead of 28 weeks as is the practice now
* All TB and HIV co-infected people will start treatment at CD4 count of 350 or below.
In addition to all four announcements, we wish to state that we took a decision as a country to scale up INH prophylaxis for people who are HIV positive, but who donâ€™t have active TB. This is to protect them from acquiring TB. We regard this as a very serious intervention that will help us to control the TB epidemic.
I wish to take this opportunity to thank our development partners:
* United Nations Programme on HIV and AIDS (UNAIDS)
* The United States (US) government with its various agencies, United States Agency for International Development (USAID), CDC and the US Embassy
* PEPFAR programme
* The United Kingdom through Department of International Development (DFID)
* The Swedish government, through Sweden International Development Agency (SIDA)
* The German government, through its various agencies â€" GTZ, KfW, DED and
* The European Union
* The Bill and Melinda Gates Foundation
* The Clinton Foundation
* The role played by other United Nations (UN) agencies like World Health Organisation (WHO), United Nations Children's Fund (UNICEF), United Nations Population Fund (UNFPA), United Nations High Commissioner for Refugees (UNHCR), International Labour Organisation (ILO) and International Organisation for Migration (IOM)
The role they have played is immense.
The contribution of the World Bank and the Global Fund to fight AIDS, TB and Malaria, is also difficult to express in words. Ladies and gentlemen, as you can notice from attendance at this meeting, you as South Africans have really shown your commitment to this campaign. Each one of you did not come here as spectators.
Over the past two weeks, I met with several of you as representatives of organisations and sectors, but also in your individual capacities. You agreed to come here to pledge your support and be part of the campaign. I met you as:
* religious leaders
* disability sector
* childrenâ€™s sector
* traditional healers
* health workers
* youth sector
* human rights sector
* womenâ€™s sector
* menâ€™s sector
* lesbian, gay, bisexual and trans-sexual sector
* sport and entertainment sectors
* celebrities and many others
I am overwhelmed by your support.
I regard what we are about to embark on as attempting to climb Mount Everest. But I am confident that working together in this enthusiastic manner, Mount Everest is possible to conquer.
I thank you.
Issued by: Department of Health
25 March 2010
Source: South Africa National AIDS Council (http://www.sanac.org.za)