Programme Director,
My fellow panellists,
Distinguished guests,
Ladies and gentlemen.
Good afternoon!
I wish to thank the organising committee for their kind invitation to me to open the 6th South African AIDS conference. This conference is being held at a momentous time in the history of our country!
Why do I say this? It’s June – and you know that June is youth month and we have just commemorated the 37th Anniversary of the Soweto uprisings. This year we also celebrate the 50th anniversary of the establishment of the Organisation of African Unity (OAU/AU).
Finally we also know that we are very close to the 2015 deadline for the Millennium Development Goals (MDGs) – with less than 950 days to achieve the targets that were set in 2000!
Let me start with youth month!
Depending on the definition of the youth – a significant proportion of the population of the country can be classified as youth! The latest census data suggests that 49% of the population is below the age of 24. We also know that unemployment among the youth is high, at 23.6% – some people have called this a ticking time bomb!
This issue is acknowledged in the National Development Plan (NDP). Let me therefore quote what the NDP says about the youth:
We know that keeping young people, especially girls, in school until matric protects them from both pregnancy as well as HIV infection! We must therefore, as a society do everything possible to keep young people in school. However, this is not sufficient.
We know that many learners fall prey to older men who have resources to buy sex – this is the “sugar daddy” syndrome or intergenerational sex. I am informed that there are sessions in the Conference that will be discussing this issue. I look forward to getting some input on what works and what we can take to scale in dealing with decreasing the number of new infections in young girls and young women in particular.
I would like to add however, that the issue of teenage pregnancies need to be tackled head on. I have said before that we cannot continue to pretend that our young people are not sexually active. I have therefore mandated that sexual and reproductive health services be part of the integrated school health programme.
I met, together with the Deputy Minister of Basic Education, with the leadership of associations of school governing bodies and explained to them why we need to introduce this topic in schools in a responsible manner.
They agreed that each SGB (School Governing Body) should discuss this issue and then make this service available to learners in high schools.
In addition, the National Health Council adopted a new contraception and fertility strategy and guidelines. I will be launching this Strategy soon – the idea is to focus on dual protection.
I have said before that because of the HIV epidemic we started the ABC (Abstain, Be Faithful, and Condomise) Campaign, which of course is very important. But unfortunately in doing so, it looks like we in Sub-Saharan Africa inadvertently threw Family Planning as we used to know it out of the window. This resulted in massive teenage pregnancy and very high levels of abortions.
I am sure that some of you have already looked at the recently released publication on causes of mortality by Statistics South Africa (STATSSA). I will highlight a few issues that I think are noteworthy.
Firstly, the number of deaths reported has decreased from 613 108 in 2006 (which it was at its peak) to 543 856 deaths in 2010. Most researchers as well as STATSSA have attributed this decline to the HIV programme – both the distribution and use of condoms as well as the ARV programme. This decline has resulted in the increase in life expectancy in our country, according to researchers, both local and international. This is very good news indeed.
However, a closer look at the STATSSA data suggests that 15.5% of all deaths reported occur in people 24 years of age and younger with 8.7% under the age of 5. Additionally, 37.4% of the reported deaths were in people aged between 25 and 49 years of age. What do these statistics mean? It means that the very young and those in their productive years are vulnerable!
What are they dying from?
The major causes of under 5 mortality according the Ministerial Committee that deals with under 5 mortality are: HIV & AIDS (which contributes 50% of deaths); diarrhoea; pneumonia; and severe malnutrition – with TB becoming the fifth major contributor.
Similarly, we know that women of reproductive age are also largely dying in child birth and that HIV and AIDS is also associated with 50% of these deaths.
We also know that a significant number of people living with HIV and AIDS die from TB. It is therefore not surprising that the STATSSA mortality report found that 12.6% of those that died from natural causes of death had TB as the immediate cause of death in 2008 – declining to 11.6% in 2010. This decline has been attributed by researchers to the increased number of HIV positive patients on ARVs as well as the screening for TB and putting eligible patients on IPT (Isoniazid Prevention Therapy).
A recently published paper looked at the impact of moving the treatment eligibility threshold from CD4 of 200 and less to CD4 of 350 and less. These researchers found a 46% decline in early mortality (defined as death within 91 days after initiation of treatment) in 2001/12 compared to 2008/09. This is very good news!
Recent modelling on HIV and AIDS, using the best possible data that we have, done by a consortium of UN agencies and development partners led by UNAIDS also found that we are making a difference.
This consortium found that we now have 2.1m people in antiretrovirals, that 80% of eligible HIV+ women are on treatment and that 65% of men and children are on treatment. These data are very similar to the data from the Human Science’s Research Council (HSRC’s) 2012 HIV survey which I am informed Dr Shisana and her team will be presenting at this Conference.
This means that whilst we are doing well with putting women on treatment, we need to do better on men and children. Now, we know why we are not doing as well with putting men on treatment – we are simply not testing sufficient number of men. We saw this during the national HCT campaign which was launched by the President in April 2010. Of all those tested, only one third were men!
This means that we must do better in getting to men at workplaces, in communities and their homes. I again will look forward to innovative ideas on this from this Conference.
What is the problem with putting children on treatment?
I am informed that there are two problems: (1) we are not finding children early and (2) many clinicians (doctors and NIMART trained nurses) are still not confident enough to put children on treatment. The latter is not too surprising because the treatment algorithms for children are much more complex than those for adults!
We therefore need to hear from this Conference how we can deal with these two issues so that all children who are HIV+ are on treatment.
I said that this occasion is momentous. We are less than 950 days to meeting the MDG targets. There are many meetings that are already discussing the post MDG 2015 period! But as we think about what needs to happen post 2015, we must do everything we can to accelerate progress towards meeting the current targets. Again, I am sure that this Conference will discuss some of the game changers that can move us more rapidly towards our targets. This must be one of the challenges that we set ourselves.
With respect to the post 2015 MDGs, without pre-empting the many discussions that are taking place globally, there seems to already be some degree of convergence in thinking. Three issues appear to be surfacing as important post 2015:
- to continue with the current health-related MDGs as for most of us the work is not complete;
- the need for equity, fairness and affordability with respect to access to health services – again there appears to be agreement that universal health coverage (which takes the form of NHI in South Africa) is the only strategy that will help us achieve equity, fairness and affordability; and
- a focus on non-communicable diseases (NCDs) – which are on the rise in developing and developed countries alike.
I have made this point in many meetings including in a meeting of African Health Ministers – we cannot hope to treat our way out of the looming NCD epidemic. This means that we must prevent them at all costs. We are already dealing with tobacco use, use of transfats, curbing the use of salt in processed food, tackling alcohol advertising etc. But we need to do more and quickly!
As people with HIV live longer they too will be susceptible to chronic diseases – this is also why I am focusing on NCDs in this speech. We must ensure that people eat healthy, stop smoking, stop alcohol abuse, and must exercise.
Incidentally, we also know that smokers and diabetics are also more prone to having TB. In addition, we know that people who abuse alcohol are more likely to behave recklessly and also to default on TB and HIV treatment!
You are now aware that the country has got a National Development Plan (NDP) or Vision 2030. It is for the first time in the history of our country, both pre- or post-apartheid, that the country ever produced such a Plan. We cannot put up any programme on HIV and AIDS without reflecting on what the NDP says about the pandemic. I am now referring you to the Plan:
A health system that works for everyone and produces positive health outcomes is not out of reach. It is possible to:
- Raise the life expectancy of South Africans to at least 70 years
- Ensure that the generation of under-20s is largely free of HIV
- Significantly reduce the burden of disease
Achieve an infant mortality rate of less than 20 deaths per thousand live births, including an under-5 mortality rate of less than 30 per thousand.
I would like to conclude with the final reason that this is a momentous moment. This is the year in which we celebrate the 50th birthday of the establishment of the OAU/AU.
In line with this South Africa will be hosting an international Conference on maternal and child health between 1-3 August. You may recall that South Africa launched the Campaign on the Accelerated Reduction of Maternal and Child Mortality in Africa (CARMMA) not far from here – in May last year. Most African countries have now launched their CARMMA strategies.
This planned Continental Conference will review progress in reducing maternal and child health and seek examples of good practices and progress and also examine the continuing bottlenecks to improvements. There may be some good examples of how dealing decisively with HIV contributed to reduction in maternal and child mortality presented at this Conference. We may wish to gather these for discussion during the international Conference as well.
In conclusion, I must briefly speak to issues of research in HIV and TB – given that this is a research Conference!
Yesterday, I spent some time at a research symposium at which we were reviewing the collaboration between the USA’s National Institutes of Health (NIH) and our Medical Research Council (MRC). We explored key issues that we need to focus on as a country – for our own needs as well as for the international community. We acknowledged that South Africa has eminent, world class researchers and a sound research platform.
We need to agree on the next level of research that we need to conduct and create the conditions for this research to be done in South Africa.
Programme Director,
I am sure that by now you may think that I have asked much from this Conference! However, I am equally sure that this collective of researchers, academics, implementers and development partners is up to the task!
In conclusion, may I take this opportunity to thank all the community members, health workers, the research community, development partners and civil society organisations that have done so much and continue to work hard to ensure a healthy life for all South Africans!
I thank you!
