at the National Consultation on UN Processes - Declaration of Commitment on HIV
and AIDS, Kopanong, Benoni
2 March 2006
Greetings
It is a great pleasure for me to welcome you to this national consultative
meeting which is part of a review of the progress we have made as a country in
relation to the Declaration of Commitment on HIV and AIDS adopted by the United
Nations General Assembly Special Session on HIV and AIDS (UNGASS) in 2001.
We would also like to use this opportunity to begin the process of drawing
up a roadmap towards universal access to HIV and AIDS prevention, care and
treatment.
The revised 2006 Guidelines for the UNGASS Indicators recommend that the
Composite Index Questionnaire be completed by key informants from diverse
groupings or organisational background. The South African environment is one
where extensive consultation takes place in virtually all aspects of socio,
cultural and political activity. In the context of existing structures such as
the South African National AIDS Council, consultation regarding HIV and AIDS is
taking place on an ongoing basis and is presented in this report.
Right upfront, I would like to apologise that the document we are discussing
this morning has been made available to you at this meeting. We have had major
challenges in getting inputs from various organisations in all the sectors of
the response to HIV and AIDS that received the initial draft report. In fact as
we meet here today, many of these organisations have not provided their inputs
and we hope that this meeting will assist us in ascertaining the views of
various role-players.
There are number of questions we have to answer as a collective here which
will inform the perspective we take in the final report that will be submitted
to the UN. These questions are listed in the Composite Index section of the
report.
These questions relate to a number of issues which, in our view, are covered
in the National Strategic Framework for HIV and AIDS and sexually transmitted
infections (STIs) for 2000-2005 and the Comprehensive Plan for Management, Care
and Treatment of HIV and AIDS adopted by Cabinet in 2003.
The first set of questions relates to whether we have set up national
structures that facilitate and coordinate a multi-sectoral response to the
challenge of HIV and AIDS. The second set seeks to establish whether we have
policies or strategies in the area of prevention interventions including social
mobilisation and communication, access to essential preventive commodities such
as condoms and prevention of mother-to-child transmission of HIV.
There are also questions relating to issues of Human Rights. We have to
indicate whether we have laws that protect our people including people living
with HIV and AIDS from discrimination; and whether we have policies that
ensures progressive realisation of the equal right of access to prevention and
care for women, men and vulnerable groups.
In the area of care and support, we are asked whether we have policies to
facilitate comprehensive care and support, ensure access to HIV and AIDS
related medicines and cater for the needs of vulnerable children.
I think we will all agree that South Africa has policies and programmes on
all the areas that the United Nations wants us to report on as it will be
reflected in presentations that will be made later this morning.
Our view is that the debate on HIV and AIDS in this country is mainly about
the degree of success or the pace of progress in the implementation of these
policies. The UN does not require us to agree on our perception on the pace of
progress for the purposes of this reporting. As a democratic country, we will
continue to engage on the issues relating to the delivery of services as it is
happening now during this period of local government elections. We are
confident that the people of South Africa will continue to express their faith
in the African National Congress as the only organisation capable of taking
this country to a better future including better health.
The questions in the Composite Index capture the major elements of our
comprehensive national response to HIV and AIDS, which should guide our
individual action towards a common strategic direction as a country. Our
objective and subjective views on the pace of delivery, informed by our
ideological, historical and socio-economic background, should therefore not
derail us from achieving what the United Nations requires of us from this
meeting.
We have to pool together our efforts and complement each other in order to
achieve universal access to prevention, care and treatment programmes. In terms
of our Constitution, Universal Access means that we progressively make quality
services available in an equitable manner to ensure that all South Africans who
choose to utilise any of these services can have a reasonable access to
them.
It is critical that when we conduct a review of this nature, we locate it
within the appropriate historical context. The historical fact is that South
Africa is a relatively new democracy. It is a country that is emerging from a
history of social disruption and racial and gender discrimination, associated
with inequitable distribution of resources. These inequities resulted in a
bimodial society that reflects on the burden of disease with poverty related
diseases such as HIV and AIDS, tuberculosis (TB) and malaria affecting the
previously disadvantaged communities.
The first few cases of HIV and AIDS were identified in the 1980s. But it was
not until leadership from the National Liberation Movement, led by the African
National Congress in 1992 that there was a tangible effort to develop a
programme to raise awareness in society.
Over the past 11 years, much has been achieved in addressing these
historical challenges and meeting the basic needs of shelter, clean water and
sanitation, food security, the provision of health and other social services.
The economy continues to experience growth. However, the gap between the few
central actors in that economy and the majority at the periphery is still too
wide. The people in the periphery are the ones most at risk of infections and
of succumbing more quickly to diseases than the well-nourished and affluent
communities.
Much progress has been made in addressing particularly the challenge of HIV
and AIDS since the emergence of democracy in our country. Prevention programmes
have been scaled up to unprecedented levels. Through the implementation of the
Comprehensive Plan, there are service points in every district for the
provision of a range of interventions including prevention, nutrition,
management of opportunistic infections and treatment with antiretroviral.
The investment in the health system through infrastructural upgrades, the
improvement in commodity stock management, information management systems, the
improved human resources management and capacity development, the strengthening
of laboratory services and referral system is being increased
significantly.
Most of these interventions are funded from the government fiscus. The HIV
and AIDS budget allocation channelled through the Health Department increased
from R264 million in 2001 to R1.5 billion in 2005. This led to the UN Secretary
General Kofi Annan commending the country for substantial increase in budgetary
allocation in his report to the UN General Assembly Special Session on AIDS in
2003.
Three years later, we are gathered here to consider our input to the second
report on global progress in responding to HIV and AIDS since the adoption of
the Declaration of Commitment on HIV and AIDS in 2001. As the world prepares to
discuss this matter during the sitting of the UN General Assembly in May this
year, South Africa has been honoured by an invitation from the World Health
Organisation (WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS) to serve in
the Global Steering Committee.
This is the Committee tasked with identifying key obstacles to the scaling
up of comprehensive and integrated prevention, treatment, care and support
programme. The Minister of Health of South Africa chairs a working group on
financing of HIV and AIDS programme in this Committee.
The expenditure particularly on prevention programmes is making a difference
on the ground. Most of the surveys indicate a very high level of awareness
about HIV and AIDS amongst our people ranging between 92-98%.
This is as result of the awareness campaigns which encourage particularly
young people to abstain from sex and to be faithful to one partner. These
messages are critical in improving our moral fibre and building strong families
that are free of violence and abuse of women and children.
We also provide free, high quality condoms for prevention of sexually
transmitted infections including HIV infection and re-infection as well as
unwanted pregnancies. Male condom distribution has increased from 270 million
in 2003 to 346 million in 2004; and female condom distribution doubled from 1,3
to 2,6 million, during the same period.
There is a need to sustain the positive sexual behaviour that is emerging
amongst the youth into early adulthood and beyond. As part of our activities to
mark 2006 as "the year of accelerated HIV and AIDS prevention", government will
intensify its interventions targeted at particular risk groups including people
between ages of 25-29 years. There is a need to also intensify interventions
aimed at improving the socio-economic status of women, people living in
informal settlements and other vulnerable groups.
We have doubled the number of health facilities providing voluntary
counselling and testing (VCT) from 1 500 in 2002/03 to more than 3 700 in
2004/05. The number of people that have utilised these services also increased
two-fold from 691 000 in 2002/03 to more than 1,3 million in 2004/05.
There are many services that we provide as Government to delay the
progression from HIV infection to development of AIDS defining illnesses and to
maintain optimal health for people living with HIV and AIDS. We firmly believe
that delaying this progression is the critical area where we need to make
maximum impact.
We have engaged in the Healthy Lifestyle awareness campaign encouraging
people to exercise regularly and to eat nutritious food particularly vegetables
and fruits and this is supported by initiatives to promote community vegetable
gardens and food security. At least 374 000 people have also benefited from the
provision of nutritional supplementation within the Comprehensive Plan.
We provide rigorous treatment of opportunistic infections and most of our
facilities have the capacity to deal with these illnesses. We have developed a
TB Crisis Management Plan which we will be formally unveiled during the World
TB Day on 24 March.
We are mobilising extra resources to ensure tangible improvements in at
least four districts and two provinces facing most challenges in terms of
prevalence of TB and low cure rates.
We are also encouraging the use of African traditional medicines that are
effective in alleviating symptoms associated with HIV and AIDS by boosting the
immune system. We are working with the Medical Research Council and other
scientific institutions and individual scientists in the research and
development of these medicines.
More than R3,4 billion has been allocated for procurement of antiretroviral
drugs for the period to the end of 2007. An accumulative number of people
initiated on antiretroviral therapy in the 204 accredited sites in the country
were more than 100 000 by December 2005. Accredited health facilities are
evaluated on the basis of their capacity to render quality service and detect
complications arising from side effects associated with antiretroviral
drugs.
The report we are discussing today clearly demonstrates the challenges we
are still facing in terms of monitoring and evaluation of our programmes. There
are challenges in establishing the impact of the Prevention of Mother-to-Child
Transmission of HIV programme and data collection for the Comprehensive Plan is
still limited to:
* Accumulative number of patients assessed; Accumulative number of patients
initiated on treatment;
* CD4 counts and viral loads done and;
* The number of accredited health facilities We are making efforts to expand
the monitoring and evaluation programme to include patients lost, deaths,
adherence, adverse events, antiretroviral treatment (ART) regimens adopted and
be able to categorise it by gender and age groups. Discussions are also ongoing
with both non-profit and for-profit private sectors to ensure the harmonisation
of indicators.
We have to address the issue of shortage and uneven distribution of certain
health professionals in the country. We are finding innovative ways to address
the issue of human resources for health including the development of mid-level
health worker category which includes medical, pharmacist and nursing
assistants. All these interventions are within the framework of the Human
Resources Plan for Health which will be launched on the World Health Day, 7
April.
We have met and even surpassed all the Declaration of Commitment on HIV and
AIDS requirements on policy formulation and in terms of the management of HIV
and AIDS programme. We have developed and are implementing policies on
prevention, protection and promotion of human rights as well as interventions
in the area of care and support.
The Constitution, various labour laws and the National Health Act promotes
human rights and outlaws various forms of discrimination. Support and care for
those affected by HIV and AIDS is expanding, through increased social grant
registration and increases in the grants, as well as expanding home and
community-based care programmes.
More than 61 000 community care-givers are providing support and service to
those in need and more than 7 million vulnerable children are receiving child
support grants, have free access to health services and education.
There is hope that our determination to address this challenge is beginning
to render results. Overall HIV prevalence is no longer increasing as
significantly as it was in the early 1990s. Particularly encouraging is that
the prevention messages regarding abstinence, faithfulness and condom use are
being taken to heart, especially by the young.
There is a need for all South Africans to increase their level of
involvement and for all sectors to complement each other in addressing the
challenge before us. It is only through active and meaningful partnerships that
we can address the challenges posed by HIV and AIDS. All citizens should heed
the call for a responsible sexual behaviour and adopt healthy lifestyle.
We are looking forward to a meaningful engagement today and we hope that we
can find consensus on the issues being presented to us today.
Thank you.
Enquiries:
Solly Mabotha
Tel: (012) 312 0609
Cell: 083 678 9860
Issued by: Department of Health
2 March 2006
