HIV/AIDS in South Africa Dr. Nono Simelela Chief Director: HIV/AIDS and STDs

HIV Prevalence in women attending public antenatal clinics, 1991 - 2000, South Africa

HIV prevalence in women attending antenatal clinics by age, South Africa, 2000

HIV prevalence in women attending antenatal clinics, by province, 2000

Estimated number of AIDS deaths in South Africa per year

HIV Antenatal Surveys - Summary Nationally 24.5% of women attending antenatal clinics are HIV positive HIV prevalence in provinces ranges from 8 to 36% 26% of pregnant women aged 20-30 are HIV positive 17% of pregnant women aged <20 are HIV positive Most women who are HIV positive acquired the infection when they were <20

HIV Antenatal Surveys Extrapolation to the South African Population 4.7 million South Africans were HIV positive in 2000 compared to 4.2 million in 1999 and 3.6 million in 1998 1 out of every 8 adults are HIV positive 1600 - 1700 new HIV infections daily

South Africa’s AIDS Epidemic Some of the AIDS epidemic is hidden because: The rise in AIDS cases occurs after the rise in HIV prevalence Many HV infections are never diagnosed Many people do not reveal their diagnosis It is estimated that there were: 200 000 AIDS cases and 180 000 AIDS deaths in 1999 Large number of adults and children with HIV/AIDS seen by health services

HIV and TB in Developing Countries HIV increases the risk of developing active TB for those who have been infected with TB earlier in life. Risk increases from 10% lifetime to 10% per year If newly infected, persons with HIV more likely to progress to active disease Leading cause of death among HIV infected persons

Reducing Impacts: Priority Issues Socio-economic development Prevention Programmes Information on epidemic Intersectoral collaboration Improve status of women Priority Issues Strategic choices Support affected people & orphans Workplace programmes Health sector responses Reduce HIV/AIDS stigma

HIV/AIDS Strategic Plan Priority Areas Prevention Treatment, care and support Human and legal rights Monitoring, research and surveillance Youth - both as a specific target population and cross-cutting through all priority areas

HIV/AIDS Strategic Plan Prevention Goals Improve the management and control of sexually transmitted diseases Promote safe and healthy sexual behaviour Reduce mother to child HIV transmission Promote voluntary HIV counselling and testing Maintain blood safety Provide HIV post-exposure services

HIV/AIDS Strategic Plan Treatment, Care & Support Goals Provide treatment, care and support services in health services Provide treatment, care and support in communities Develop and expand the provision of care to children and orphans

HIV/AIDS Strategic Plan Human and Legal Rights Goals Create a supportive social environment Develop an appropriate legal and policy environment

HIV/AIDS Strategic Plan Research, Monitoring and Surveillance Goals Promote vaccine development Investigate research and care methods Conduct policy research Conduct regular research and surveillance

Selected HIV/AIDS Management and Co-ordinating Structures Cabinet South African National AIDS Council Interdepartmental Committee on AIDS MinMEC PHRC Directors-General Forum National HIV/AIDS Programme

Partnership Support Assist sectors to develop and implement HIV/AIDS plans Document best practices Mobilise resources Address human rights and legal issues

STDs, Barrier Methods & TB Improve STD treatment in the public and private sector Increase condom use Conduct HIV/AIDS/STD related research Establish pilot districts to integrate HIV/AIDS/STD and TB care Interact with traditional healers

Care, Counselling & Support Implement home-based care Collaborate to render care for children infected and affected by HIV/AIDS Investigate options for caring for the carers Ensuring training and capacity building Coordination of programmes for PWAs Development of guidelines & manuals Reducing stigma and increasing community responsibility

Youth Programme Assist youth organisations to develop and implement HIV/AIDS plans Promote, co-ordinate and support the implementation of life skills in primary and secondary schools

IDC and NGO Funding Develop minimum HIV/AIDS programmes for government departments Conduct HIV/AIDS impact studies Fund and monitor NGOs

Major Policy Drives MTCT Programme Integrated Plan Life Skills in primary and secondary schools Home-based care (HBC) Voluntary HIV counselling and testing (VCT) Community mobilisation Participants: Health, Education, Social Welfare R125 million in 2001/02

Care and Support Programme Identified 2 empowerment projects – 3 more to follow Assisted NAPWA to strengthen its organisation Established a database of PWA Support Groups in all nine provinces Appointment of Care and Support focal persons in all provinces Provision of basic home-based care drugs and supplies for 4 project, using WHO funding

Care and Support Programme Completed guidelines: adult & paediatric palliative care, curriculum for caregivers, HBC training manual, HBC Guidelines, Nutritional Guidelines for PWAs Models developed for HBC developed Workshops for home carers and religious leaders

Counselling Programme VCT strategy and business plans completed Tender for rapid test kits awarded Rapid test quality assurance protocols developed VCT sites selected in all provinces Counsellor training in all provinces (2219 trained to date)

Youth Programme Workshops with youth formations – targeted and lobbied 36 to date Launched the SA AIDS Youth Programme (SAAYP) Assisted in the launch of the Tertiary HIV/AIDS Media Project

Life Skills Programme Audit of life skills programme (LSP) Development of support materials for teachers, also a parent guide

Partnership Support 8 PWAs employed by government Sectoral links established: Traditional leaders, SALGA, Hospitality industry, Transport, Business, FBOs, Women, CMA, Trade Unions Capacity building workshops in these sectors Funding the national antenatal survey

STDs, Barrier Methods, Research & TB Syndromic Management established in PHC facilities Materials on STDs available STD training mandatory CPD requirement for private GPs Support for projects, including Lesedi & Lechabile (Welkom), Mothusimpilo & WRAP (Carletonville), National STI Initiative, Trucking Project

STDs, Barrier Methods, Research & TB Stratified surveillance piloted in Gauteng – national implementation to follow Collaborate on the SA Microbicide imitative National Male Condom Policy Female condom introductory strategy Traditional Healer training

Government AIDS Action Plan Mass media advertising Provision of communication resources Major Projects: AIDS memorial quilt Tertiary Institutions Media Workers Living Openly Training of celebrity AIDS ambassadors

Government AIDS Action Plan PR campaigns Provincial GAAP personnel appointed Partnership Support AIDS Helpline – increase in call rates

Up to the end of the financial year Planned Activities Up to the end of the financial year

Care and Support HBC Train-the-Trainer workshops Capacity building workshop for men living with HIV/AIDS Project and Financial Management training for HBC focal persons PWA capacity building workshops Develop guidelines for the care of children orphaned by HA

Care and Support Marketing care and support services through Soul City Workshops for religious leaders and home carers National drug literacy campaign Training workshops for HCWs on the Clinical Management Guidelines Implementation of economic empowerment programmes for PWAs

Counselling Programme Provincial Train-the-Trainer workshops Training of HIV/AIDS counsellors Develop and launch monitoring and evaluation tools for VCT VCT promotional campaign

Youth Programme Develop strategic and operational plans for youth formations targeted Lobby additional formations

Life Skills Programme Teacher guide and learner activity book for grades 8 and 9 Adolescent Reproductive Health Care Flip Chart for all secondary schools Develop peer education norms and standards Youth Risk Behaviour Survey Develop age-appropriate IEC materials for primary school learners

STDs, Barrier Methods, Research & TB Audit of HIV/AIDS research Establish a comprehensive surveillance system Increase support to targeted STD interventions Prevalence studies in specific populations (gay men and drug users)

STDs, Barrier Methods, Research & TB Revise and reprint materials National summit on sex work Increase condom social marketing Expand female condom introduction Implement a Logistics Management Information System for condoms Review traditional healer training manuals

MTCT Programme Implement MTCT in at least 25 sites in all provinces Providing Nevirapine and formula feeding Cost = R25 million Appointing provincial MTCT coordinators (2 per province)