NEWS & MEDIA

UPDATE ON SOUTH AFRICA’S NATIONAL HIV AND AIDS PROGRAM                    

09 October 2003

HIV and AIDS is a challenge for all of us, one that we can overcome by working together in a Partnership Against AIDS. Of 45 million South Africans, an estimated 5 million are HIV positive of which approximately half a million have clinically symptomatic AIDS.

Government has adopted a developmental approach in its fight against HIV and AIDS in the context of poverty, which is a legacy of Apartheid.

South Africa has a comprehensive Five-year HIV, AIDS and STI (Sexually Transmitted Infections) Strategy adopted in 2000 that addresses prevention, treatment and care, research and human rights aspects, further enhanced by the Cabinet statements of 17 April 2002 and 9 October 2002 reaffirming HIV and AIDS linkage.

In October 1998 the then Deputy President Mbeki, launched the Partnership Against AIDS, now represented by the South African National AIDS Council (SANAC), located in the Presidency, which has contributed substantially to coordinating various sectors at the highest level.

Government’s commitment to intensify implementation of the plan is backed by very large budgets for the HIV and AIDS program. The allocations are estimated at above R1 billion for 2002/03, and were again strengthened in the 2003 Budget. Additional allocations of R3, 4 billon for the next three financial years will enhance key national programs. Dedicated funding for HIV and AIDS (that is, excluding allocations from the provincial equitable shares) is set to increase somewhat more than 10-fold from R342 million in 2001/02 to R3, 6 billion in 2005.

Since there is no known cure for AIDS and drugs are still unaffordable, prevention of HIV infection remains critical. Government’s prevention strategy is to raise public awareness, promote abstinence, to make condoms widely available and to develop the life skills of young people to deal with the challenges of a world in which AIDS is prevalent. The nutritional status of an individual is known to play an important role in decelerating the progression of HIV to AIDS, improving the quality of life, and decreasing the prevalence and severity of the infectious complication of HIV and AIDS, in this regard government is implementing appropriate poverty alleviation and nutrition programs.

Government has established at the South African Medical Research Council an Indigenous Knowledge Systems Unit to assess the efficacy and safety of traditional medicines. On August 31, 2003, South Africa celebrated Africa Traditional Medicine Day and opened a WHO Collaborating Centre on Traditional Medicines.

Ensuring access to confidential and voluntary HIV counselling and testing is one of the essential elements of the Strategic Plan, as it provides an important entry into other health interventions, e.g. TB and STI treatment. This goal focuses on expanding access to Voluntary Counselling Testing (VCT) in both the private and public sector.

Government also has an expanding program to prevent mother-to-child transmission (PMTCT) of HIV through intensified efforts towards universal access to Nevirapine, already the largest on the African continent. Since its initiation in April 2001, the number of PMTCT feeder sites has increased from 193 to over 658 health facilities (February 2003). Most provinces are now extending this comprehensive package to more public health facilities.

By the end of December 2002, over 101, 202 women had visited the facilities attached to the 18 PMTCT sites, with 63, 217 accepting voluntary counseling and testing, 17,274 of whom tested HIV-positive. Nevirapine was dispensed, along with the package of support, to 10,043 women who accepted it and to 6,947 babies born to women in the programme.

In April 2001, Cabinet took a decision to offer anti-retroviral drugs to survivors of sexual assault as part of a comprehensive package of support. The post-exposure prophylaxis programme (PEP) includes counseling on the effectiveness and risks of using ARVs for this purpose. The guidelines for needle stick injuries and occupational exposure have been available since 2000. The relevant protocols and drugs are available in the public sector for this intervention. Universal precautions are also in place in health facilities to reduce the risk of occupational exposure.

The South African AIDS Vaccine Initiative (SAAVI) has made unusually fast progress for a biotechnology project of this nature. But even if its products were to be successful (and this cannot be guaranteed), the manufacture of a vaccine for the public would still be about eight years away.

SAAVI has two locally generated “candidate vaccines” ready to begin Phase 1 trials in 2003. Government contributes R20 million towards the program. South Africa is also involved in trials of candidate vaccines that have been developed outside the country.

Government is providing comprehensive free primary health care services to South Africans. This includes the provision of free treatment of opportunistic infections such as Tuberculosis (TB) and others.

Government is working with pharmaceutical companies to lower the cost of drugs to treat opportunistic infections. Much groundwork has been laid. The Medicines Control Council (MCC) has thus far licensed 17 anti-retroviral drugs, including generics, for use in the country. The agreement reached by WTO at the end of August will enable poor countries to import generic versions of expensive patented drugs and for countries with capacity to manufacture generic drugs.

In November 2002, the Diflucan partnership, which provides free medication for two significant AIDS-related conditions, has been extended indefinitely. In the first two years of the Partnership 1,5-million doses of Diflucan were dispensed and 11 000 health workers trained in managing relevant conditions.

On 8^th August 2003 Cabinet reiterated government’s principled approach that anti-retroviral drugs do help improve the quality of life of those at a certain stage of the development of AIDS, if administered properly. Cabinet further noted that, as we consider details pertaining to this enhanced treatment programme, it is critical that we do not lower our guard as a nation, because there is no cure for AIDS. Based on the Joint Health and Treasury Task Team report on options for enhanced HIV and AIDS related treatment, Cabinet requested the Department of Health to develop an operational plan to put it into effect. The operational plan has been completed and is being considered by the various government structures prior to it being submitted to Cabinet for consideration.