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HIV/AIDs in South Africa
 

 

Key Terms

Monitoring and Surveillance

Government Response

Examples of Interventions

The main role players

Contacts and Websites


Key Terms

  HIV prevalence: Is the estimated percentage of the adult population living with HIV at a specific time.[1] Prevalence is always expressed as a percentage.

  HIV incidence is the number of infections that have taken place over a period of time. Incidence is always expressed as a number.

  Mortality Rate - Mortality rates are the measure of number of deaths per number of persons in a given area and time.

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Monitoring and Surveillance

  The first reported cases of HIV occurred in South Africa in the early late 1980s. South Africa is one of the countries most severely affected by HIV in the world.

National Antenatal HIV Prevalence Survey (Download)

  In South Africa regular monitoring and surveillance of the epidemic is conducted by the Department of Health through a national Antenatal Clinic Survey. Such surveys have been conducted since the early 1990s.

  The survey involves analysis of blood drawn from approximately 18 000 women in their third trimester in October each year and tests are done for HIV and for syphilis. Results are analysed by province and by age and estimates are made for the population as a whole.

  According to the Antenatal Survey undertaken in 2001,[2] it is estimated that nationally 24.8% of pregnant women were infected with HIV by the end of 2001. It was also estimated that approximately 4.74 million people in South Africa were living with HIV/AIDS by the end of that year.

  The survey is limited to the 15-49 year age group, and does not provide information on race or geotype, and takes place only in public sector clinics.

HSRC/Nelson Mandela HIV Household Survey (Download)

  A national HIV prevalence household survey of South Africans over the age of two was conducted by the HSRC, MRC, CADRE and ANRS in 2002. Funded by the Nelson Mandela Foundation, the survey provided detailed information on HIV infection rates by age, race, sex, province and geotype, as well as information on knowledge, attitudes and behaviours.

  This study drew a sample of 9 963 people countrywide and included anonymous saliva-based HIV tests from 8 840 participants. It estimated that 11.4% of South Africans, 4.5 million people, were living with HIV/AIDS.

  In a response to the HSRC/Nelson Mandela HIV Household Survey, the Actuarial Society of South Africa (ASSA) drew attention to the small samle size and its relation to the provincial prevalence breakdown, race and the prevalence rate found amongst children aged 2-14.

 

 

National Antenatal HIV Prevalence Survey 2001

HSRC/Nelson Mandela HIV Survey 2002

National HIV Prevalence

24.8% of pregnant women

4.74 million South Africans

11.4% of South Africans

4.5 million South Africans

 

Prevalence by age

National Antenatal HIV Prevalence Survey 2001  

Prevalence by age

HSRC/Nelson Mandela HIV Survey 2002

<20

15.4%

Children (2-14)

5.6%

20-24

28.4%

Youths (15-24)

9.3%

25-29

31.4%

=>25

15.5%

 

Provincial Prevalence

National Antenatal HIV Prevalence Survey 2001

HSRC/Nelson Mandela HIV Survey 2002

Gauteng Province

29.8%

14.7%

Mpumalanga

29.2%

14.1%

KwaZulu Natal

33.5%

11.7%

Free State

30.1%

14.9%

North West

25.2%

10.3%

Eastern Cape  

21.7%

6.6%

Northern Province

14.5%

9.8%

Northern Cape

15.9%

8.4%

Western Cape  

8.6%

10.7%

 

Prevalence by race

HSRC/Nelson Mandela HIV Survey 2002

African

12.9%

White

6.2%

Coloured

6.1%

Indian

1.6%

AIDS Mortality in South Africa

  AIDS affects mortality rates in South Africa. According to a report by the MRC (September 2001), the pattern of mortality from natural causes has shifted from old to the young over the last decade.

  The ASSA600 AIDS and Demographic model of the Actuarial Society of South Africa (ASSA) was selected to model the impact of AIDS on mortality in the above report.

  The model was calibrated to reproduce the prevalence of HIV recorded by the national antenatal care (ANC) surveys up to 1997.

  The following table gives the estimated percentage of adult (15+) deaths due to AIDS.

Year starting 1 July

% of deaths due to AIDS

1995

9%

1996

14%

1997

19%

1998

26%

1999

33%

2000

40%

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Government Response

  The Governments programme on HIV/AIDS is outlined in the HIV/AIDS /STD Strategic Plan for South Africa, 2000-2005. (Click here to download Strategic Plan) The goals of this strategy are:

o   To reduce the number of new HIV infections (especially amongst youth)

o   Reduce the impact of HIV/AIDS on individuals, families and communities

  The programme focuses on five main areas:

o   Prevention: Promoting safe and healthy sexual behaviour, improve the management and control of STDs, reduce mother to child transmission, address issues relating to blood transfusion and HIV, provide appropriate post-exposure services, improve access to voluntary counseling and testing (VCT).

o   Treatment, Care and Support: Provide treatment,care and support services in health facilities, provide adequate treatment, care and support services in communities, develop and expand the provision of care to children and orphans.

o   Legal and Human Rights: Create an appropriate social environment, develop and appropriate legal and policy framework.

o   Research, Monitoring and Evaluation: Ensure AIDS Vaccine development, investigate treatment and care options, conduct policy research, conduct regular surveillance.

  In terms of government budgeting on HIV/AIDS,  The Department of Finance allocated R1 billion in 2001/02 and R1.8 billion in 2004/05. The Minister of Finance indicated towards the end of 2002 that the budget for HIV/AIDS would be increased to R3.3 Billion.

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Examples of Interventions

Prevention

  The programme strongly emphasizes prevention aimed at encouraging behavioural or lifestyle changes. This focuses on funding HIV/AIDS awareness and prevention campaigns such as the Khomanani Campaign (R90 million for 2001-2002), support to Soul City, support to loveLife (R75 million over three years primarily in support of the Groundbreakers (Youth volunteer corps), the loveLife Games and the development of National Adolescent Youth Friendly Clinics.

   Prevention of mother to child transmission originally this was restricted to a pilot programme consisting of 18 sites. The definition of a site varied from being just a hospital to being a hospital and the clinics which are serviced by the hospital, in which case broadening the geographic and population served by the Programme. Following a ruling by the Constitutional Court government is compelled to expand its programme to areas which have the capacity to implement the programme. In his State of the Nation address to Parliament in February 2003, President Thabo Mbeki committed the government to implementing the decision of the court.

Treatment, care and support

  Treatment for opportunistic infections is  provided for  through the public health system. In December 2000  government concluded an agreement with the pharmaceutical company Pfizer for the provision of Fluconazole (Diflucan), to the public health sector for two years. Fluconazole is used primarily for the treatment of oral thrush associated with HIV/AIDS. This has now been extended indefinitely.

  Support to organizations providing care and support in particular home based care and support.

   Anti-retroviral Treatment access to treatment remains a source of contention between government, the pharmaceutical industry and civil society, led by the Treatment Action Campaign. In a statement in October 2002, Government committed itself to creating conditions that would make it feasible and effective to use antiretroviral in the public health sector. Government indicated that it will continue 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. In addition the Department of Health and the Treasury are currently engaged in a process of costing the implications of providing treatment.

  The National Economic Development and Labour Council (Nedlac) is currently in the process of working with Government, business, labour and civil society in developing a national treatment and prevention programme for South Africa. According to reports NEDLAC was close to reaching a consensus decision on the Framework prior to World AIDS Day but that government and the private sector have not signed the agreement. Government spokespersons consistently indicate that Government cannot sign the agreement as policy cannot be formulated by a multilateral forum such as NEDLAC and that it is awaiting the outcomes of the discussions between the Treasury and the Department of Health prior to making a recommendation to Government. (Download copy of the Draft NEDLAC Agreement)

Research

  Government is investing considerable resources in support of the South African AIDS Vaccine Initiative (SAAVI). SAAVI was established in 1999 with the national mandate to develop and test an affordable, effective and locally relevant preventative HIV vaccine for southern. (See if there is a web link).

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The main role players

South African National AIDS Council

  Chaired by the Deputy President Jacob Zuma, the South African National AIDS Council (SANAC) was launched in February 2000. It comprises representatives from government including key Cabinet Ministers, business, civil society and other sectors.

  SANAC provides a platform for government and civil society to interact and oversee the implementation of the Governments Strategic HIV/AIDS/STD National Plan.

  The mandate of the South African National AIDS Council is to advocate, monitor and co-ordinate the effective involvement of all sectors and organisations in implementing programmes for the prevention of HIV/AIDS.

  It provides guidance on the implementation of the National AIDS Strategic Plan and revising these strategies.

  It is involved in creating and strengthening partnerships for an expanded national response among government agencies, NGOs, donors, the private sector and people living with AIDS.

  In a Statement following its 01 February 2003 meeting, SANAC announced that it would serve as Principal Recipient of funding from the Global Fund.

  It was also announced that SANAC would be reconstituted into a legal entity with its own Secretariat.

  According to the Draft NEDLAC Agreement, SANAC would be responsible for monitoring the progress and implementation of the Framework Agreement.

  Critics argue that SANAC has not proven effective owing to its silence on key issues of government policy relating to HIV/AIDS and in particular its silence on the issue of PMTCT, the controversial debate concerning the causal link between HIV/AIDS and issues pertaining to treatment.

The Directorate HIV/AIDS and Sexually Transmitted Diseases, National Department of Health
www.doh.gov.za

  The HIV/AIDS and Sexually Transmitted Disease (STD) Chief Directorate is the key national body within the Department of Health that deals with AIDS and is headed by Dr Nono Simelela.

  Most provincial governments have separate HIV/AIDS Directorates, or have integrated the HIV/AIDS function within a related directorate.

  The government provides key services through clinics and hospitals, but also through AIDS Training, Information and Counselling Centres (ATICCs) located in most major cities.

The Treatment Action Campaign (TAC) www.tac.org.za

Is a strong voice in the lobbying arena to gain access to treatment in South Africa. Launched on 10 December 1998 its objectives are to campaign for greater access to treatment for all South Africans living with HIV by raising public awareness about issues surrounding the availability, affordability and use of HIV treatments. TAC is chaired by Zackie Achmat, who is HIV positive and has made an inspiring stand with his decision not to take anti-retroviral drugs until they are made freely available to all South Africans. TAC successfully mounted a legal challenge against Government to provide the anti-retroviral drug Nevirapine to all HIV positive mothers to prevent mother-to-child transmission (MTCT). The Pretoria High Court found that restricting provision of these drugs to certain research sites only was unconstitutional, a decision ultimately supported by Constitutional Court of South Africa.

The National Association of People with AIDS (NAPWA)
www.napwa.org.za

Founded in 1994, NAPWA, represents the interests of these people infected and affected by HIV/AIDS. NAPWA is headed by Thandoxolo Doro, who also represents people living with HIV/AIDS on the South African National AIDS Council (SANAC). NAPWA aims to provide care and support for people living with AIDS (PWAs); Co-ordinate and establish support groups for counseling; enhance HIV/AIDS awareness and empower PWAs through seminars and workshops throughout South Africa.

The AIDS Law Project (ALP)
www.alp.org.za

Specialises in helping people with HIV deal with HIV/AIDS issues including stigma and discrimination. Situated at the Wits University Centre for Applied Legal Studies the ALP researches legal, social and human rights issues surrounding HIV/AIDS. This research provides the basis to advocate to changes in law, policies and recommendations around issues like AIDS and employment, AIDS and women, AIDS and development etc.

The AIDS Consortium
www.aidsconsortium.org.za

The AIDS Consortium consists of a network of 815 organisations, many community-based, and 275 individuals dealing with HIV/AIDS. The Consortium provides access to information on any aspect of HIV/AIDS and lobbies for a human rights-based response to the epidemic.

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Contacts

Government

National Department of Health and the South African National AIDS Council
Dr Nono Simelela
Chief Director: HIV/AIDS & STDs
Tel: 012 312 0121
Email: simeln@health.gov.za

Jo-anne Collinge
Chief Director: Communications
Tel: 012 312 0713
Fax: 012 312 0690/ 312 0694
Email: collij@health.gov.za
Website: www.health.gov.za

Statistics

Social Aspects of HIV/AIDS, Human Sciences Research Council (HSRC)
Dr Olive Shisana
Tel: 021 467 4420
Fax: 021 467 4424
Email: oshisana@hsrc.ac.za
Website: www.hsrc.ac.za

Medical Research Council (MRC)
Mark Colvin
Tel: 031 288 4008
Fax: 031 202 0950
Email: mark.colvin@mrc.ac.za
Website: www.mrc.ac.za

Actuarial Society of South Africa (ASSA)
Contact Person: Sarah Bennett
Telephone Number: 011 509 3045
Fax Number: 011 880 5005
Email address: sbennett@nmg-levy.co.za
Website: www.assa.org.za

Centre for Actuarial Research, University of Cape Town
Prof. Rob Dorrington
Tel: 021 650 2475
Fax: 021 689 7580
Email:
care@commerce.uct.ac.za
Website: www.commerce.uct.ac.za/care

The Health Economics & HIV/AIDS Research Division (HEARD), University of Natal
Prof Alan Whiteside
Telephone: 031 260 2592
Fax: 031 260 2587
Email:
a.whitesid@nu.ac.za

freeman@nu.ac.za
Website: www.heard.org.za

Bureau of Marketing Research, University of South Africa
Prof CJ van Aardt
Tel: 012 429-2940
Fax: 012 429-3170
E-mail
vaardcj@unisa.ac.za

Prevention Campaigns

Partnership Against AIDS
Thami Skenjana
Tel: 012 312 0133
Fax: 012 325 5706
Email:
Website: www.doh.gov.za

Department of Health
Rentia Agenbach
Tel: 012 312 0152
Fax: 012 325 5706
Email: agenbr@health.gov.za
Website: www.doh.gov.za

Khomanani Campaign
Dr Saul Johnson/Adri Mari Vilonel/Leanne Harris
Tel: 011 880 8868

Email: actpso@ochre.co.za
Website: www.aidsinfo.co.za

Information on HIV and AIDS Calendar days or Partnership Against AIDS
Maria Djordevic
Tel: 011 772 1000
Email: mariad@meropa.co.za

LoveLife
David Harrisson
Angela Stewart-Buchanan
Tel: 011 771 6800
Fax: 011 771 6801

Email:

angela@lovelife.org.za

davidh@loveLife.org.za
Website:
www.lovelife.org.za

Soul City
Dr Sue Goldstein
Dr Shereen Usdin
Dr Garth Japhet
Tel: 011 643 5852
Email:
suegold@soulcity.org.za

Shereenu@soulcity.org.za
garthj@soulcity.org.za
Website: www.soulcity.org.za

YouthAIDS
Tshepo Matladi
Tel: 011 482 1427
Fax: 011 482 3333
Email:
tsepo@sfh.co.za
Website:
www.youthaids.co.za

Planned Parenthood Association of South Africa (PPASA)
Sipho Dayel

Tel: 011 880-1162
Fax: 011 880-1191
website:
www.ppasa.org.za

Vaccines

South African AIDS Vaccine Initiative
Dr Tim Tucker
Tel: 021 938 0262
e-mail: saavi@mrc.ac.za

Treatment

National Association of People living with HIV/AIDS
Thandoxolo Doro
Tel: 011 872 0975
Fax: 011 872 1343
Email: napnat@apc.sn.org
Website: www.napwa.org.za

Treatment Action Campaign
Zachie Achmat, Nathan Geffen
Tel: 021 788 3507

Fax: 021 788 3726
E-mail:
info@tac.org.za
Website: www.tac.org

AIDS Law Project (ALP)
Mark Heywood
Tel: 011 717 8600
Fax: 011
Email: heywoodm@law.wits.ac.za
Website: www.alp.org.za

AIDS Consortium
Mapule
Khanye
Tel: 011 403 0265
Fax: 011 339 4450
Email: tech@aidsconsortium.org.za
Website: www.aidsconsortium.co.za

NEDLAC
Jennifer Wilson, Communications Coordination
Tel: 011 328 4200
Fax: 011 447 6053
Email: jnnifer@nedlac.org.za
Website: www.nedlac.org.za

 

[1] UNAIDS, AIDS Epidemic Update, 2002. www.unaids.org

[2] Department of Health, National HIV and Syphilis Sero-Prevalence Survey of women attending antenatal clinics in South Africa, 2001www.doh.gov.za

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