HIV/Aids in South Africa
The high prevalence of HIV/Aids in South Africa poses major challenges for both government and civil society groups, who are doing their utmost to curb the spread of the disease and help those affected by it.
An estimated six million South Africans are expected to die from Aids-related diseases over the next 10 years. Based on the Department of Health’s national ante-natal survey, involving anonymous testing of pregnant women at state health facilities, an estimated 4.5-million South Africans were living with HIV in the year 2000.
Much of the reporting on Aids in South Africa has centred around the the fact that President Thabo Mbeki has in the past questioned the link between HIV and Aids.
Far less has been said about the tremendous efforts being mounted year after year around the country by local, provincial and national government agencies, as well as myriad non-governmental organisations, to combat Aids by creating awareness around the disease, promoting
behaviour change and providing medical, social and economic assistance to those affected and/or infected by the epidemic.
HIV causes Aids
The government has always been unequivocal about the fact that its Aids policy stems from a belief that HIV causes Aids. A recent Cabinet statement announcing a substantial increase in state spending on HIV/Aids emphasised that “government’s starting point is based on the premise that HIV causes Aids”.
The statement concludes that “as government focuses its efforts and resources ever more intensively on the public policy challenges of HIV/Aids, it will draw whatever it can from science to use in this fight. As in all areas of science, research and debate will continue, but government is not a protagonist in those debates.”
Strategy, budget
The government has massively increased the budget for its HIV/Aids and Sexually Transmitted Infections Strategic Plan for
2000–2005, a five-year plan in line with international trends in fighting the disease, that has been lauded as among the best strategies in the world.
The plan has four priority areas: preventing further HIV infection; providing treatment, care and support for those infected and affected by HIV; researching an AIDS vaccine and conducting other research and monitoring; asserting the human and legal rights of all affected by the disease.
The amount of R350-million budgeted for spending by the Departments of Health, Social Development and Education for the 2001/2 financial year has been increased to R1-billion this financial year and will be increased to R1.8-billion for 2004/05.
- For more information on the government's HIV/Aids strategy and programmes, visit AidsInfo
A partnership approach
Since 1998, when then Deputy President Thabo Mbeki launched the
Partnership Against Aids, the government has adopted a broad-based, multi-sectoral approach towards fighting the disease. Given that HIV/Aids affects every sector of our society, all initiatives – awareness campaigns, care for the affected and research – are strengthened by a partnership approach.
In January 2000 the Partnership Against Aids was formalised by the formation of the South African National Aids Council under Deputy President Jacob Zuma. The government is strengthening its own contribution to the partnership with the establishment of a Presidential Task Team on Aids, consisting of Cabinet ministers and headed up by Zuma.
Education & awareness campaigns
Given that there is no cure for Aids, the government’s strategy focuses on prevention by promoting public awareness and delivering life skills and HIV/Aids education.
The many Aids awareness campaigns run by government and NGO partners such as LoveLife and Soul City are
now bearing fruit. There is now a high level of awareness among youth on HIV/Aids – around 90% – but the pressing challenge is to ensure that this awareness translates into behaviour change.
Life skills education which incorporates HIV/Aids education is now a compulsory part of the school curriculum and is to be fully implemented by the end of 2003.
LoveLife. LoveLife is a nationwide campaign which aims to promote healthy sexual behaviour among adolescents, reduce the incidence of HIV/Aids, sexually transmitted diseases and teenage pregnancies. LoveLife uses a widespread media campaign targeting adolescents, and offers educational, recreational and sexual health services in under-resourced areas.
Soul City. Soul City uses the mass media to promote awareness around health issues. Soul City has won international awards for its success in
integrating education and entertainment using popular radio and television drama.
Treating sexually transmitted diseases
The government’s primary health care programme to treat sexually transmitted diseases (STDs), which increase the risk of HIV transmission, is being extended. Currently,80% of all public clinics are staffed by health care workers trained in this field.
The good news is that there has been a steady decline in the incidence of syphilis among pregnant women attending public health sector clinics. Also, antenatal surveys show that the rate of HIV infection in pregnant women is levelling off.
Reproductive
Health Research Unit. A joint project of the Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital and the University of the Witwatersrand, and the City of Johannesburg. The unit conducts research into sexual and reproductive health, including effective treatment of sexually transmitted diseases.
South African Aids Vaccine Initiative
Government is giving funding and other support to scientists attempting to develop a vaccine to give people immunity to HIV infection. Vaccine trials are being conducted in South Africa by the South African Aids Vaccine Initiative, part of the International Aids Vaccine Initiative.
A vaccine, if developed, will be of no help to those already infected with the virus and will also only be available several years after its creation.
Furthermore, a vaccination for HIV poses many
challenges: because the HI virus incorporates its own genetic material into the host’s immune system, it is difficult to destroy the virus without destroying the immune system too. It also mutates very fast, with sub-types that vary from one geographical region to the next, from person to person and even in the same person, over time.
More information on the Aids vaccine initiative:
Preventing mother-to-child transmission
This programme is being run in 18 research sites around the country, and more than 38 000 mothers have passed through it. A universal roll-out plan that
will offer all HIV-positive pregnant mothers the antiretroviral Nevirapine is likely to start by early 2003.
In the meantime, the government is upholding the temporary ruling of the Constitutional Court that it remove any restrictions to the providing of HIV-positive pregnant women with Nevirapine in public health institutions and that it do its utmost to speed up and expand the delivery process.
The government has been hesitant to do so given that there is still uncertainty around the drug’s toxicity. However, guidelines on administering the drug and providing the backup services required have been given to all hospitals. A special task team set up by Health Minister Manto Tshabalala-Msimang and assisted by the nine provincial health ministers is facilitating this process.
At the 18 sites, pregnant women are offered voluntary HIV testing. Those who are HIV-positive are offered Nevirapine They are given vitamins, treatment for infections and milk formula if they
decide not to breastfeed. Babies are also given multivitamins and prophylaxis for opportunistic infections.
For more information on mother-to-child transmission, visit:
Dealing with rape cases
The incidence of violence against women in South Africa is high and contributes to the spread of HIV. The government is endeavouring to provide antiretrovirals to survivors of sexual assault and those with needle stick injuries, as well as counselling and testing for HIV, STDs and pregnancy.
Treating people with HIV/Aids
In 2000 the government set up a programme to provide voluntary HIV testing and counselling. Out of 495 sites identified by the provinces, 359 are so far operational. At these sites treatment for opportunistic infections is
available for both HIV-positive and HIV-negative patients.
The government is working with pharmaceutical companies to lower the costs of drugs to treat these infections. In December 2000 an agreement was signed with pharmaceutical company Pfizer to provide Fluconazole (Diflucan) to public hospitals and clinics for two years.
Funding was provided for the training of healthcare workers in diagnosing and managing oral thrush and cryptococcal meningitis. So far, about 20 000 patients have benefited from this programme.
Although antiretrovirals are not generally available in the public health sector, the government recognises that they can improve the quality of life of people living with Aids, if administered correctly – in other words, at particular stages during the progression of AIDS and in line with international guidelines.
In the belief that antiretrovirals can cause harm if not administered correctly or if health services are inadequate, the government
will intensify its campaign to make sure that patients infected with HIV, TB, thrush and meningitis follow the correct treatment advice.
The government will continue to lobby drug companies to lower the cost of anti-retrovirals and investigate the production of generic equivalents. In the knowledge that poverty increases vulnerability to illness, It will also work towards poverty alleviation and provision of nutrition for those lacking it; as well as encourage investigation into alternative treatments, particularly those that boost the body’s immune system.
For more information on access to antiretrovirals, visit:
Care & support of families affected by HIV/Aids
The government supports
home-based care for people with Aids and HIV, partly because hospitals cannot cope with the number of people needing care and partly because this form of care - where the terminally ill are looked after by their families – is considered more appropriate in that it offers the sick a loving, familiar environment.
Families affected by the epidemic are being helped with foster care grants, assistance to child-headed households, food parcels and other interventions. The government has increased its budget for home-based and community-based care for people suffering with AIDS from R94.5-million in fiscal year 2002/03 to R138-million in 2004/5.
Several NGOS, some supported by government, have set up home-based care projects to help those families in need, including:
Discrimination against people affected by HIV/Aids
The government will continue to intensify its HIV/Aids awareness campaign to combat discrimination against people affected by the epidemic.
For more information on Aids and the law, contact:
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