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 1980’s. 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 & STD’s
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
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