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

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

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

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

5. Estimated number of AIDS deaths in South Africa per year

6. 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 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

7. 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
new HIV infections daily

8. 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:
AIDS cases and AIDS deaths in 1999
Large number of adults and children with HIV/AIDS seen by health services

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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

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

18. 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

19. 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

20. 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

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

22. 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

23. 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

24. 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

25. 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)

26. 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

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

28. 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

29. 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

30. 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

31. 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

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

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

34. 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

35. 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

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

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

38. 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

39. 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)

40. 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

41. 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)