The MEC for Health, Dr Sibongiseni Dhlomo, is at Amajuba District (Dannhauser) where he will be addressing local leaders (Amakhosi, Councilors and community structures) to work with government in the fight against HIV and social ills in general. The fundamental question that the government programmes seek to answer, with regards to health, is; why treat people without changing the conditions that make them sick?
The MEC is visiting Amajuba as a joint cluster programme champion for that district. The Joint cluster flagship programme seeks to ensure that we create healthy and sustainable communities by implementing joint programmes (by all government departments) to address the drivers of and eliminate risks to diseases and other social ills.
On this World AIDS Day 2009, the MEC will emphasise the need to improve the health of people living with HIV, reducing the number of new HIV infections and saving lives. The key message is to encourage people to know their status by getting tested regularly. This will enable those who test negative to remain so if they reduce the risk of being infected and those who test positive to get immediate assistance to live healthier and longer.
The availability and uptake of HIV testing and counselling services continued to increase however there are behavioural tendencies that are reversing the gains in this regard such as the cross generation relationships such as “sugar daddies” or “sugar mamas”. The estimated coverage of antiretroviral therapy is reaching the desired numbers (with more than 300 000 currently enrolled into the programme in KwaZulu-Natal) despite the scarce resource (financial and human) availability in the province. Access to services for preventing mother-to-child transmission continue to expand in the province giving hope to expecting mothers that their children will be born free of HIV.
Tuberculosis (TB) continues to be the leading cause of death among people living with HIV and this call’s on government to decide on providing people with co-infection of HIV and TB (currently at 73 percent) to be enrolled earlier into the ARV programme at CD4 >350 before their CD4 count drops to 200.
Lastly, considering the role of HIV testing and counselling services as the gateway to other key health sector interventions, scaling up knowledge of HIV status is a necessary condition for achieving the ambitious goals of government and reversing the scourge of the epidemic. Significantly scaling up HIV prevention interventions requires combining multiple disciplines and methods, including behavioural, biomedical and structural approaches. We, in the health sector, are a key entry point for providing and delivering HIV prevention services and must continue to advocate for expanding them.
Progress in scaling up access to key prevention, treatment and care interventions for women and children, including interventions to prevent mother-to-child transmission, has been substantial.
We understand, and backed by scientific evidence, that women (including pregnant women) in need of ARV drugs for their own health should receive life-long ART. We also know that longer provision of antiretroviral ARV prophylaxis for HIV positive pregnant women with relatively strong immune systems who do not need ART for their own health. This would reduce the risk of HIV transmission from mother to child. We need to provide ARVs to the mother or child to reduce the risk of HIV transmission during the breastfeeding period.
We must further strengthen prevention programmes aimed at people living with HIV, whose circumstances and needs require the development of specific strategies, including health and social interventions. Such programmes must aim to improve the health and well-being of people living with HIV, to reduce HIV transmission and to promote collaboration between the health sector and communities of people living with HIV.
Late initiation of antiretroviral therapy often because people do not know their HIV status and because of underlying stigma and discrimination is the major cause of the high mortality rates observed in the first year after adults and children initiate treatment. Expanding access to HIV testing and counselling services must continue to be a priority to ensure timely diagnosis of HIV infection and access to treatment and care and the capacity of health facilities to absorb new demand must be reinforced as a matter of urgency. In this regard we are rolling out roving teams to ensure that people are enrolled near where they live.
One concern is that only a very low number of pregnant women who are identified as living with HIV during access to services for preventing mother-to-child transmission are currently assessed for their eligibility to receive antiretroviral therapy for their own health and to minimize transmission to their infants. Increased attention is needed to follow up children born to mothers living with HIV, including increasing access to cotrimoxazole prophylaxis and virological HIV testing at six weeks of age as well as antiretroviral therapy.
Harnessing and strengthening the resources and systems needed to sustain such an increase in service availability will be one of the greatest challenges we face in the coming years. The push to achieve improved access presents a major opportunity to leverage funding for HIV programmes to have a lasting and broad-based transformative effect on health systems.
We welcome the pronouncements by the state President and wish to assure him, the Premier and the people of KwaZulu-Natal that we are ready and believe that these pronouncements will make a huge difference in the course of the epidemic.
Issued by: Department of Health, KwaZulu-Natal Provincial Government
1 December 2009
