Nkonyeni MEC for Health
19 October 2006
Honourable Speaker
Honourable Deputy Speaker
Honourable Premier
Leader of government business
All members of the provincial Legislature
Honourable members
As a department we are guided by the Constitution of the Republic that
requires of us to honour the right of every citizen to, among other things,
have access to healthcare services inclusive of reproductive healthcare. In
this regard we have put programmes in place to address the issues pertaining to
the ailments that afflict our people in their different stages of life. The
department is faced with many poverty related ailments including Tuberculosis
(TB), HIV and AIDS and malnutrition in children. Today we are here, we are to
brief the honourable members about our efforts to combat the scourge of HIV and
AIDS.
Members have to know that South Africa has one of the most extensive and
robust HIV diagnosis and management programmes in Africa, second only to
Brazil's in the developing world. Yet because this country has run its HIV
programme on its own terms rather than on those of the United Nations, the
international media have castigated its efforts. Today, as South Africa slowly
but steadily improves its progress in the implementation of the Comprehensive
plan for the management of HIV and AIDS, it is continuously attacked for
yesterday's rhetoric and practices, not praised for today's success in managing
HIV and AIDS.
KwaZulu-Natal as the most populous province currently has the highest HIV
prevalence in South Africa. The antenatal HIV prevalence has steadily increased
from 32,5% in 1999 and peaked to 40,7% in 2004. The 2005 National HIV and AIDS
sero-prevalence survey found that the HIV prevalence in women attending
antenatal clinics has decreased for the first time to 39,1%. The figures within
the antenatal survey are representative of the people in the high risk groups
as the mere fact that they are pregnant is indicative of their indulgence to
unsafe sex.
However, when these figures are extrapolated to the general KwaZulu-Natal
population they translate to a general 16,5% prevalence in the province. The
province of KwaZulu-Natal has always had the most progressive approach to the
management of HIV and AIDS starting as early as 1998 with the launch of the
Cabinet AIDS initiative followed by the launch of the AIDS Challenge 2000 in
1999. All these programmes were aimed at putting HIV and AIDS at the top of the
agenda of the government of this province.
Our provincial HIV and AIDS programmes subscribe to the National Government
Comprehensive Plan for the management of HIV and AIDS as approved by the
National Cabinet in 2004. The pillars of the Plan which are prevention,
treatment, care and support are being vigorously implemented by this
province.
As the province we have deliberately increased funding for our HIV and AIDS
programmes from R35 million in 2000 to R800 million in 2006. We have further
engaged the external funders to assist us to enhance the implementation of our
programmes.
These funders are:
* Global Fund
* Presidential Emergency Programme for AIDS Relief (PEPFAR)
* Secure the Future Foundation (Bristol Myers Squibb)
* Department for International Development (DFID)
* Belgian Foundation
As the province we are implementing all the pillars of the Comprehensive
Plan including the provision of antiretroviral drugs in all our accredited
sites. However, the challenge still remains the stigma associated with HIV thus
leading to the reluctance of people to come forward and test for HIV.
The programme was seen as the entry point into prevention, treatment, and
care interventions. Some of the public pressures that we have faced are not
cognisant of the fact that people are unwilling to test, yet they expect to be
enrolled into our programmes e.g. the issue of the prisoners. The solution to
knowing the magnitude of the HIV and AIDS problem lies with testing. Can we
rely on the members of this house to lead in this regard, and offer themselves
for testing?
The department alone cannot address this epidemic and as such we have
engaged the traditional healers in all the aspects of the implementation of the
plan. This is because the majority of our communities consult traditional
healers for all afflictions.
I am here to report on the progress made by this province in the
implementation of the comprehensive HIV and AIDS Care, Management and Treatment
Plan.
Prevention
The multi-pronged approach toward prevention highlighted in the five year
strategic plan for HIV and AIDS includes Information, Education, and
Communication (IEC), Voluntary Counselling and Testing (VCT), treatment-related
preventions e.g. treatment of sexually transmitted infections (STIs), the use
of barrier methods and interventions to reduce the risk of prevention of mother
to child transmission (PMTCT).
In the context of the plan, prevention activities have been significantly
strengthened. The key elements of the IEC strategy are:
* living positively
* circles of support (increasing support for orphans and other vulnerable
children)
* youth campaign (Our time, our choice, our future)
* prevention campaigns.
IEC interventions in the context of High Transmission Areas (HTAs) have been
intensified for truck drivers and commercial sex workers. Working with our
partners in the Transport sector, we have established four truck stop wellness
centres in the strategic areas of our province (viz., Tugela, Mooi River,
Kokstad and Port Shepstone).
Our focus in these wellness centres is the management of sexually
transmitted infections among long distance truck drivers and commercial sex
workers. The KwaZulu-Natal Department of Health is distributing 150 000 male
condoms, 2 600 female condoms and treating 4 900 new cases of Sexually
Transmitted Infections at their four HTA sites per annum.
Honourable speaker, we also have Occupational and Non-Occupational Post
exposure Prophylaxis (NOPEP) programmes that focus on the prevention of HIV
infection due to accidental exposure either through sexual assault or needle
stick injuries, and body fluid splashes in the workplace. Here we advise the
victims of sexual assault to visit our facilities within 72 hours of the
incident to access these services.
VCT is also one of the key prevention strategies used to slow down the
spread of HIV and AIDS, and mitigate the impact of HIV and AIDS. The VCT
programme is seen as the entry point for prevention, treatment and care
interventions. The department's 1 787 lay counsellors have targeted a total of
480 900 clients for HIV at 740 VCT sites (55 Hospitals, 14 Community Health
Centres (CHCs), 501 Primary Health Care (PHCs), 100 mobile clinics and 70
non-medical sites) for 2006/07.
PMTCT programme aims to reduce HIV transmission from mother to child by
encouraging HIV anti-body testing, providing antiretrovirals to mother and
child, and offer safer feeding options. This province has the largest PMTCT
programme in the world, and it is anticipated that in addition to the 192 000
antenatal clients tested for HIV, 26 000 infants will be DNA PCR tested and 648
000 tins of infant formula will be distributed throughout the 53 hospitals and
580 clinics offering this service in the province this year.
All public health facilities are providing syndromic management of STIs. In
addition, greater effort is being placed on partner notification (which is
critical to the prevention of transmission of STIs). This year alone, 645 000
new cases of STIs will be treated and the same number of partner notification
slips will be issued.
Currently, the KwaZulu-Natal Department of Health distributes 32 million
male condoms and 245 000 female condoms throughout this province per annum.
Treatment
The Antiretroviral Therapy (ART) programme, which commenced in 2004 in this
province is compliant with National protocols and guidelines. Fifty five
hospitals and six CHCs have been accredited as ART service points. Recently the
rollout has been extended to the accreditation of three correctional service
facilities (Pietermaritzburg, Westville and Empangeni) as well as one
non-government organisation (NGO).
The uptake of ART has exceeded expectations, and the annual target of 55 160
patients on treatment has already been exceeded. At the end of August there
were 57 100 patients on treatment, which represents roughly half of patients
eligible for treatment. It is expected that more than 171 806 CD4 tests and 95
728 viral loads will be done this year. The anticipated 549 270 scheduled doses
of antiretrovirals will also be exceeded.
Care and support
The Home and Community Based Care (HCBC) programme [which is housed within
the greater Community Health Worker (CHW) programme] as well as the Step Down
Care (SDC) programme are the vehicles used by the department for the care and
support strategy.
There are currently 5 728 active Home and Community Based Carers conducting
weekly visits to 85 920 patients. The department currently contributes
financially to 44 Community Care centres, which enables them to provide at
least one balanced meal per day to orphans and vulnerable children. This is in
partnership with the other Social Sector departments.
The department has access to a total of 482 step-down beds in this province,
and will have 3 302 admissions to these facilities by the end of the financial
year. Currently three NGOs are contracted to assist with the provision of step
down beds due to capacity and space constraints at Department of Health
facilities.
As our outgoing United Nations Secretary General once said, "AIDS is far
more than a medical problem. AIDS is far more than a national problem. AIDS is
a threat to an entire generation, indeed a threat to human civilisation as a
whole. From now on let us resolve that failure is not an option." Our Minister
echoed the same sentiments when she said: "Let us get together wherever we
live, work, learn, study, pray or play and reflect on the impact of HIV and
AIDS on our families and communities, our nation and our continent. It is a
challenge that demands our active participation. We cannot be audiences in
matters of health and illness, life and death."
Honourable members we need to agree on one message for our people. We need
to tell them that:
* if you are still young refrain from sex
* if you are sexually active ,stay faithful to one partner who should also be
faithful to you
* use a condom properly each time you have sex.
I thank you
Issued by: Department of Health, KwaZulu-Natal Provincial Government
19 October 2006
Source: KwaZulu-Natal Department of Health (http://www.kznhealth.gov.za)
