South Africa News 2009


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Improving Survival of HIV+ Babies. 5/12/09


Phakamile Magamdela

HIV-positive babies will have an improved chance of survival following the implementation of government’s revised anti-retroviral (ARV) policy. All children living with HIV under one year of age will receive treatment as soon as they are diagnosed.

Announcing the changed guidelines in Pretoria at the main event marking World AIDS Day, President Jacob Zuma said: “This decision will contribute significantly towards the reduction of infant mortality”. 

“All children under one year of age will get treatment if they test HIV-positive. Initiating treatment, will, therefore not be determined by the level of CD cells”, he said.

The new guidelines will be effective as from April next year.

Up until now government’s policy has been to enrol people, including children, on to treatment when their CD 4 count reaches 200 or is lower, by which stage some are already ill and have severely compromised immune systems.

The revised guidelines will benefit many children to live even healthier lives. Take Thabo, for instance. Like all healthy children his age, he is a bouncy, cuddly and healthy baby who chuckles a lot and loves playing.

Little Thabo tested HIV-positive late last year.

“He was three weeks old when he started getting sick. He was then admitted to Chris Hani Baragwanath Hospital because he was vomiting and had diarrhoea. Doctors tested him for HIV and he tested positive”, says his mother, Neo.

“My baby was always sick. He presented with different symptoms every day. He had no appetite. He was never this big”, she continues.

But with antiretroviral therapy, Thabo’s health has improved.

Dr Lee Fairlie, a paediatrician at the Enhancing Children’s HIV Outcomes (ECHO) clinic at Chris Hani Baragwanath Hospital, welcomed the revised guidelines, saying they will go a long way in protecting babies.

“Our main concern is that the HIV really damages children’s organs, particularly the brain. We are extremely excited about Jacob Zuma’s announcement, because the sooner we start treatment, the more children’s brains we protect and all the other systems”, she says optimistically.

“We are going to create a healthy generation of children, rather than a generation of children that are going to have endless problems later on”, she adds.

This story was covered in collaboration with Panos, a network of institutes fostering development.



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Resources Needed To Effect Policy Change. 3/12/09

President Zuma finally ended any ambiguity in the government’s response to AIDS when he announced changes to improve AIDS treatment this week. But for these policy changes to be real, the new-found political commitment must be accompanied by the commitment of resources.

Living with AIDS # 415
03.12.2009 Khopotso Bodibe

World AIDS Day 2009 will be remembered as the day that the AIDS denialism that has hampered the country’s response to AIDS was officially declared dead. Breaking away from the past, President Jacob Zuma led the commemoration of World AIDS Day and reassured the nation that government was earnest in its approach to dealing with the epidemic. Addressing a packed auditorium at the Pretoria Show-grounds, the president made four significant announcements.  

From now on all children under one year of age will get treatment if they test positive. All patients with both TB and HIV will get treatment with antiretrovirals if their CD4 count is 350 or less. TB and HIV/AIDS will now be treated under one roof. All pregnant HIV-positive women with CD4 counts of 350 or with symptoms, regardless of the CD 4 count, will have access to treatment. All other pregnant women not falling into this category, but who are HIV-positive, will be put on the treatment at 14 weeks of pregnancy to protect the baby.       

These policy changes will be implemented from April 2010.

The revised criteria for ARV treatment means that the country’s target of treating two million people with ARVS by 2011 will actually increase. But South Africa’s health care system is already under strain from a variety of diseases, not just AIDS. So, how will the country’s already struggling health system cope with the increasing AIDS demand?

“We don’t have any option. We just have to build that capacity because the alternative is too ghastly to contemplate,” states Health Minister, Dr Aaron Motsoaledi.

 “Yes, I know, in terms of the SANAC Strategic Plan we need to cut the rate of infection by 50% by 2011 and 80% of people who need ARVs need to be covered. That is like climbing Mount Everest. We have got no option, but to climb. I know that there are people who climb Mount Everest for recreation, but in our case in South Africa, we are going to have to climb it for survival because if we don’t do so, the country won’t survive” he continues.   

Added to insufficient institutional capacity to provide services is the problem of finances. Recently, the country’s ARV programme almost collapsed because of a R1.2 billion shortfall to purchase drugs. Now the new treatment protocol obviously means that more patients will need treatment, which in turn means that the budget allocation for ARVs will also balloon. Asked where the money will come from for this project, the Minister said: 

“I’ll repeat… It’s not as if we have any choice or any option where we’ll say we’ve got no money. If we don’t do anything, then it means we have chosen to succumb - and we can’t allow the nation to succumb. So, we are going to do everything in our power”.

Senior policy advisor for UNAIDS’s eastern and southern Africa regions, Dr Mbulawa Mugabe, says South Africa can afford to put more people onto ARVs. However, he says, in the current economic climate, the country might not meet its obligations. Thus, the need for donor support is more crucial at this stage.

“In fact, if there’s a time that you need the donor community and everybody else to come to the party, it’s today”, Mugabe says.

He called on foreign donors to honour their commitment to less developed countries to fund efforts towards reaching universal access to AIDS treatment. A number of key rich nations and donor agencies such as the Global Fund to fight AIDS, TB and Malaria and the American President’s Emergency Plan for AIDS Relief (PEPFAR) have either reduced or not increased their funding for AIDS services in the developing world.

In a twist of good fortune, however, the United States government, through PEPFAR, announced this week that it will give South Africa R900 million over the next two years for its treatment programme for AIDS.


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Address By President Jacob Zuma On The Occasion Of World AIDS Day Pretoria Showgrounds. 1/12/09

“Let there be no more shame, no more blame, no more discrimination and no more stigma.”

1 December 2009

Deputy President Kgalema Motlanthe, The Minister of Health Dr Aaron Motsoaledi and all Ministers and Deputy Ministers present, Premier of Gauteng Nomvula Mokonyane and MECs present, Executive Mayor of Tshwane Dr Gwen Ramokgopa, Deputy Chairperson of the SA National Aids Council, Mark Heywood, Members of the diplomatic corps, UN Aids Executive Director Michel Sedibe and all representatives of international agencies, Fellow South Africans,

Today we join millions of people across the globe to mark World Aids Day.

We join multitudes who have determined that this epidemic cannot be overcome without a concerted and coordinated effort.

We join millions who understand that the epidemic is not merely a health challenge. It is a challenge with profound social, cultural and economic consequences.

It is an epidemic that affects entire nations. Yet it touches on matters that are intensely personal and private.

Unlike many others, HIV and AIDS cannot be overcome simply by improving the quality of drinking water, or eradicating mosquitoes, or mass immunisation.

It can only be overcome by individuals taking responsibility for their own lives and the lives of those around them.

Fellow South Africans,
As a country, we have done much to tackle HIV and AIDS.

In every sector of society, there are individuals and groups who have worked tirelessly to educate, advocate, care, treat, prevent and to break the stigma that still surrounds the epidemic.

Today, we wish to acknowledge their dedicated efforts.

As government we are ready to play our role of leadership, building on the foundation that has been laid over the past 15 years.

Under the leadership of Presidents Nelson Mandela, Thabo Mbeki and Kgalema Motlanthe, the democratic government has put in place various strategies to comprehensively deal with HIV and Aids, tuberculosis and sexually transmitted infections.

Working with other sectors through the South African National Aids Council, we have managed to harness unity in confronting this scourge.

The amount of resources dedicated to prevention, treatment and care has increased with each successive year.

But it is not enough. Much more needs to be done.

We need extraordinary measures to reverse the trends we are seeing in the health profile of our people.

We know that the situation is serious. We have seen the statistics.

We know that the average life expectancy of South Africans has been falling, and that South Africans are dying at a young age.

We have seen the child-headed and granny-headed households, and have witnessed the pain and displacement of orphans and vulnerable children.

These facts are undeniable. We should not be tempted to downplay the statistics and impact or to deny the reality that we face.

At the same time, the epidemic is not about statistics. It is about people, about families, and communities.

It is about our loved ones.

For many families, it is a burden that they have to bear alone, fearful of discrimination and stigma.

Dear Compatriots,
Now is not the time to lament. It is the time to act decisively, and to act together.

Our message is simple. We have to stop the spread of HIV. We must reduce the rate of new infections. Prevention is our most powerful weapon against the epidemic.

All South Africans should take steps to ensure that they do not become infected, that they do not infect others and that they know their status.

Each individual must take responsibility for protection against HIV. To the youth, the future belongs to you.

Be responsible and do not expose yourself to risks.

Parents and heads of households, let us be open with our children and educate them about HIV and how to prevent it.

Ladies and gentlemen,
We are still marking the 16 days of activism against violence on women and children. During this period, it is important that we also remember to uphold the rights of women and children, including their right to protection from infection with HIV.

Many women are unable to negotiate for protection due to unequal power relations in relationships.

As we mark the International Day of Persons with Disabilities on Thursday, the 3rd of December, let us remember the impact of HIV on persons with disability.

We have to tailor government programmes and messages to also speak to the needs of this sector.

Fellow South Africans,
To take our response a step forward, we are launching a massive campaign to mobilise all South Africans to get tested for HIV.

Every South African should know his or her HIV status. To prepare for a continuous voluntary testing campaign, we would like to announce a few new measures, to expand our response.

All children under one year of age will get treatment if they test positive. Initiating treatment will therefore not be determined by the level of CD cells.

This decision will contribute significantly towards the reduction of infant mortality over time.

All patients with both TB and HIV will get treatment with anti-retrovirals if their CD4 count is 350 or less. At present treatment is available when the CD4 count is less than 200. TB and HIV/Aids will now be treated under one roof.

This policy change will address early reported deaths arising from undetected TB infection among those who are infected with HIV.

We have taken this step, particularly on learning that approximately 1% of our population has TB and that the co-infection between TB and HIV is 73%.

All pregnant HIV positive women with a CD4 count of 350 or with symptoms regardless of CD4 count will have access to treatment. At present HIV positive pregnant women are eligible for treatment if their CD4 count is less than 200.

All other pregnant women not falling into this category, but who are HIV positive, will be put on treatment at fourteen weeks of pregnancy to protect the baby. In the past this was only started during the last term of pregnancy.

In order to meet the need for testing and treatment, we will work to ensure that all the health institutions in the country are ready to receive and assist patients and not just a few accredited ARV centres. Any citizen should be able to move into any health centre and ask for counselling, testing and even treatment if needed.

The implementation of all these announcements is effective from April 2010. Institutions are hard at work to ensure that systems are in place by the 31st of March.

What does this all mean? It means that we will be treating significantly larger numbers of HIV positive patients. It means that people will live longer and more fulfilling lives.

What does it NOT mean? It does not mean that we should be irresponsible in our sexual practices.

It does not mean that people do not have to practice safer sex. It does not mean that people should not use condoms consistently and correctly during every sexual encounter.

We can eliminate the scourge of HIV if all South Africans take responsibility for their actions.

I need to re-emphasise at this point that we must intensify our prevention efforts if we are to turn off the tap of new HIV and TB infections. Prevention is our most powerful and effective weapon.

We have to overcome HIV the same way that it spreads - one individual at a time. We have to really show that all of us are responsible.

The HIV tests are voluntary and they are confidential. We know that it is not easy. It is a difficult decision to take.

But it is a decision that must be taken by people from all walks of life, of all races, all social classes, all positions in society. HIV does not discriminate.

I am making arrangements for my own test. I have taken HIV tests before, and I know my status. I will do another test soon as part of this new campaign. I urge you to start planning for your own tests.

Ladies and gentlemen,
We are also mindful of the social impact of the epidemic, and continue to provide psycho-social support and home based care, through the Home Community Based Care and child care programmes of government.

Let me use this opportunity to salute all our caregivers including those neighbours who assist and support families in distress.

We also thank our international partners, who continue to provide material support to our campaign against AIDS.

On this day, our hearts go out to all South Africans who are in distress as a result of this epidemic. To families looking after sick relatives, we wish you strength. We understand what you are going through.

To those who have lost their loved ones to the epidemic we share your pain, and extend our deepest condolences.

Fellow South Africans,
At another moment in our history, in another context, the liberation movement observed that the time comes in the life of any nation when there remain only two choices: submit or fight.

That time has now come in our struggle to overcome AIDS.

Let us declare now, as we declared then, that we shall not submit.

We have no choice but to deploy every effort, mobilise every resource, and utilise every skill that our nation possesses, to ensure that we prevail in this struggle for the health and prosperity of our nation.

History has demonstrated the strength of a nation united and determined. We are a capable, innovative and motivated people.

Together we fought and defeated a system so corrupt and reviled that it was described as a crime against humanity.

Together we can overcome this challenge.

Let today be the dawn of a new era.

Let there be no more shame, no more blame, no more discrimination and no more stigma.

Let the politicisation and endless debates about HIV and AIDS stop.

Let this be the start of an era of openness, of taking personal responsibility, and of working together in unity to prevent HIV infections and to deal with its impact.

Working together, we can achieve these goals!

I thank you.


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TAC Commends President Zuma For His Leadership On HIV And Welcomes The Death Of AIDS Denialism.3/12/09

TAC Press Statement

3 December 2009

Following on other important speeches in recent months, President Zuma’s World AIDS Day address reaffirmed government’s new-found commitment to fighting HIV/AIDS in an open, serious, and evidence-based manner. TAC welcomes the president’s call for people to get tested and his public admission of having taken HIV tests himself.

Some key changes announced by the president include:

1) Providing ART to all people co-infected with TB/HIV at a CD4-count of 350.

While we welcome the decision to initiate treatment for all people co-infected with HIV and TB with a CD4 count of 350 cells/mm3 or lower, TAC will continue to campaign for the provision of treatment to all HIV-positive people with a CD4 count of 350 cells/mm3 or lower irrespective of their TB status. This is in accordance with World Health Organisation recommendations.

2) Providing all infants under 12 months with antiretroviral treatment (ART)

TAC welcomes the changes made to the paediatric treatment guidelines. Following the compelling findings of the Children with HIV Early Treatment study, TAC has been campaigning for the provision of antiretroviral treatment for all infants under one year of age.

3) Providing pregnant women with CD4 counts above 350 with prevention
of mother-to-child treatment from 14 weeks.

The changes to the PMTCT regimen indicate government's commitment to eradicating new paediatric infections. However, in addition to improving the prenatal regimen, policy improvements are also needed for postpartum vertical transmission. Various options are possible here which TAC will address in more detail in a PMTCT briefing that we will release early in 2010.

 While we welcome the new guidelines, they do not address the urgent need to update the current first-line treatment regimen. TAC will continue to campaign to have tenofovir-based three-in-one once-daily pills introduced as part of the standard first-line regimen by July 2010.

 As the new guidelines are implemented in facilities across the country it is critical to improve the monitoring and evaluation of both the HAART and PMTCT programmes. At a minimum we must aim for complete quarterly district-level information on the numbers of people initiated on these programmes, median baseline CD4 count, median change in CD4 count, number of people lost-to-follow-up, number of deaths and number of children born to HIV-positive women who have been tested.

President Zuma will face challenges ahead to ensure that these are not just changes to policy but are implemented in all facilities across the country. We call on government to strengthen health systems to implement the improved treatment guidelines.

TAC is committed to working with government to address capacity constraints to improve the response to HIV. TAC further supports government’s call for all South Africans to take responsibility for their own health and get tested and access treatment for HIV. Knowing your status will allow you to make informed decisions to protect your own health, the health of your sexual partner and the health of your baby.


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Improvements In HIV Policy, At Last. 2/12/09

JOHANNESBURG, 2 December (PLUSNEWS) - AIDS researchers, scientists and activists have welcomed the changes to South Africa's HIV/AIDS treatment policy, announced by President Jacob Zuma on World AIDS Day.

 The changes will mean antiretroviral (ARV) treatment can begin earlier for certain vulnerable groups, but stop short of raising the treatment threshold for all HIV-positive patients, as recommended by the World Health Organisation (WHO) in their revised guidelines, released on 30 November.

 Zuma said that from April 2010, all HIV-positive children under the age of one would be eligible for treatment, regardless of their CD4 count (a measure of immune system strength).

 Pregnant women living with HIV, and patients co-infected with tuberculosis (TB), will qualify for ARVs if their CD4 count falls to 350 or less. Pregnant HIV-positive women with higher CD4 counts will be given treatment from the 14th week of pregnancy to prevent mother-to-child transmission; currently, treatment is only given in the final trimester.

 Zuma also committed the government to ensuring that all health facilities in the country are equipped to offer HIV counselling, testing and treatment. At present only health facilities accredited as ARV sites by the health department can administer ARVs, which has created bottlenecks and long waiting lists at some hospitals.

 However, for most HIV-positive patients, a CD4 count of 200 or less will remain the starting point of treatment. The new WHO guidelines suggest starting patients on ARV medication when their CD4 count drops to 350 or less, in line with several studies that have shown earlier initiation improves survival rates.

 Mark Heywood, executive director of the AIDS Law Project, told journalists at the Social Aspects of HIV/AIDS Research Alliance Conference taking place in Johannesburg this week that the South African government should aspire to eventually adopt the WHO's new guidelines, but that the improvements announced by Zuma targeted some of the most vulnerable groups.

 Heywood, who is also Deputy Chairperson of South Africa's National AIDS Council (SANAC), pointed out that many patients delayed seeking treatment until their CD4 counts were well below 200. "We need to scale up the promotion of treatment," he said.

 Dr Olive Shisana, CEO of South Africa's Human Sciences Research Council, predicted that earlier ARV treatment for pregnant women, babies and people with TB would "help tremendously in reducing deaths". In the last decade, death rates in South Africa have increased dramatically, largely as a result of HIV/AIDS.

 Shisana said the recent controversy over conflicting estimates of death rates from different sources should not obscure the widely accepted fact that "AIDS is the number one cause of death in South Africa ... If you live in any township, you know Saturdays are for funerals."

 Responding to concerns about how the government will fund an expanded treatment programme, particularly in view of the global economic crisis, Dr Stella Anyangwe, WHO country representative in South Africa, said the initial costs might seem large, but "in the long run, the country will be saving itself money" with lower rates of hospitalization and opportunistic infections.

 In his World AIDS Day speech, broadcast on national television, Zuma appeared determined to usher in a new era of government openness and commitment to combating South Africa's devastating HIV/AIDS epidemic. He also announced a countrywide HIV testing campaign and encouraged all South Africans to participate. "I am making arrangements for my own test," he told viewers.

 In the struggle to overcome AIDS, he said, "We have no choice but to deploy every effort, mobilise every resource, and utilise every skill that our nation possesses."

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President Zuma And UNAIDS Executive Director Call For Mass Prevention Movement At World AIDS Day Commemoration In Pretoria. 1/12/09

To mark World AIDS Day, UNAIDS Executive Director Mr Michel Sidibé joined President Jacob Zuma and South Africans in their national commemoration in Pretoria where he called for the forging of a mass prevention movement.

1 December 2010

Mr Sidibé was in the company of the President of the Republic of South Africa Mr Jacob Zuma and Minster of Health Dr Aaron Motsoaledi at the Tshwane Events Centre in Pretoria for an event attended by thousands of participants. At the event, President Zuma made a commitment to take an HIV test, personifying the theme of the South African celebrations–I am Responsible. 

Mr Sidibé, in his World AIDS Day address referred to South African President Mr Zuma’s landmark speech in October to the National Council of Provinces in Parliament. That speech, praised by UN Secretary-General Ban Ki-Moon, marked a fundamental break from the past outlining bold and ambitious goals to turn the tide on AIDS epidemic.  

“I am here today to stand in solidarity with your commitment and vision—you are giving hope to so many millions who have been waiting for South Africa to join the front line in the global response,” said Mr Sidibé.

In South Africa an estimated 5.7 million were people living with HIV in 2007; the world’s largest population of people living with HIV. Sub-Saharan Africa remains the region most heavily affected by HIV worldwide, accounting for over two thirds of all people living with HIV and for nearly three quarters of AIDS-related deaths in 2008. message is simple, we have to stop the spread of HIV. We must reduce the rate of new infections. Prevention is our most powerful weapon against the epidemic.

President Jacob Zuma of South Africa

“Our message is simple,” President Zuma said, “we have to stop the spread of HIV. We must reduce the rate of new infections. Prevention is our most powerful weapon against the epidemic.”

President Zuma announced the provision of HIV treatment to all children under one year of age if they test positive.

He also spoke of South Africa’s goal of universal voluntary HIV testing: “To take our response a step forward, we are launching a massive campaign to mobilise all South Africans to get tested for HIV. Every South African should know his or her HIV status.”

South Africa’s renewal of commitment for an evidence-informed AIDS response, calling its citizens to know their status, reduce risk and seek treatment, is pivotal to the success of the AIDS response regionally, on the African continent, and beyond.

There is hope for universal access; in 2008, 44% of adults and children in the region in need of antiretroviral therapy had access to treatment. Five years earlier, the regional treatment coverage was only 2%. 

However, Mr Sidibé noted, “with 7400 new infections across the world every day, to change the trajectory of the epidemic there is need to forge a mass prevention revolution movement.”

Also speaking at the event, was Prudence Mabele who has been living openly with HIV since 1992. “As a person living with HIV I welcome the leadership of the Government in the new fight against HIV,” Ms Mabele said, imploring the South African people “Let us all know our own status so we can all live positive.”
Ms Mabele featured on the cover of UNAIDS Outlook 2010

Earlier in the day, Mr Sidibé attended a European Union (EU) World AIDS Day commemoration hosted by the Ambassador of Sweden Mr Peter Tejler, local representative of the Swedish EU Presidency at the Swedish Embassy in Pretoria.

During this event the UNAIDS head stressed the importance of an AIDS response based in Human Rights, noting that there is an urgent need to refocus on HIV prevention.

“Universal obstacles to human rights are getting in the way of universal access,” said Mr Sidibé. 

Ms Gunilla Carlsson, Swedish Minister of International Development Cooperation called for increased gender equality in the AIDS response, “Women and girl’s rights must be secured including the right to sexual and reproductive health. All forms of gender based violence must come to an end.”

Mr Mark Heywood, deputy chair of the South African National AIDS Council,and Judge Edwin Cameron, Constitutional Court of South Africa were also in attendance.

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Govt Steps up Aids Fight. 1/12/09

President Jacob Zuma announces new measures to expand South Africa's response.
Pretoria - President Jacob Zuma on Tuesday announced new measures to expand South Africa's response to HIV/Aids.

"All patients with both TB [tuberculosis] and HIV will get treatment with antiretrovirals if their CD4 count is 350 or less," Zuma said at a World Aids Day commemoration in Pretoria. The announcement was welcomed with loud cheers and applause.

At present, treatment was available for those whose CD4 count was under 200.

"TB and HIV/Aids will now be treated under one roof."

The president said "extraordinary measures" were needed to reverse the current trend of the disease in the country.

"This policy change will address early reported deaths arising from undetected TB infections among those who are infected with HIV."

Zuma said the steps came after it emerged that approximately one percent of the population had TB, and that co-infection between TB and HIV was 73%.

All pregnant HIV-positive women with a CD4 count of 350 would have access to treatment. At present HIV positive pregnant women are only eligible for treatment if their CD4 count is less that 200.

"All other pregnant women falling into this category... will be put on treatment at 14 weeks of pregnancy to protect the baby. In the past this was only done in the last term of the pregnancy."

In order to meet the need for testing and treatment, all health institutions would need to be ready to receive and assist patients, not just ARV-accredited centres. Anyone should be able to go into any health centre and ask for counselling, testing and even treatment if needed, he said. This would be effective from April 2010. Zuma said all institutions were "hard at work" to ensure systems were in place by March 31.

"What does all this mean? It means that we will be treating significantly larger numbers of HIV positive patients. It means that people will live longer and more fulfilling lives.

"What does it not mean? It does not mean that we should be irresponsible in our sexual practices," Zuma said to roaring applause.

Health Minister Aaron Motsoaledi last month released "shocking" statistics on HIV/Aids, blaming the previous administration's tardy response to the disease for these.
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Driepunt-Plan In Stryd Teen MIV/Vigs. 1/12/09

2009-12-01 08:10

Elsabé Brits
Kaapstad - Die stryd teen MIV/vigs in die Wes-Kaap word na ’n hoër vlak geneem met die aankondiging van drie nuwe inisiatiewe om mense met die siekte gouer op te spoor en te behandel.

Dié aankondiging is gister, voor Wêreld-vigsdag vandag, deur Theuns Botha, Wes-Kaapse minister van gesondheid, gedoen.

Hy het op ’n nuuskonferensie gesê mense in die Wes-Kaap sal voort­aan antiretrovirale middels (ARM’s) ontvang wanneer hul CD4-telling laer as 350 is, en nie meer 200 nie. Alle MIV-positiewe babas jonger as een jaar sal ARM’s kry, ongeag wat hul CD4-telling is.

Na raming sal 50 000 bykomende pasiënte eenmalig op dié behandeling geplaas moet word en daarna sowat 20 000 per jaar.

Hoewel nie alle pasiënte altyd die behandeling vra nie, word daar voorspel dat tussen 6 000 en 20 000 bykomende mense in die Wes-Kaap ARM’s sal benodig. Dit sal sowat R16 miljoen kos.

“Ek sou nie die aankondiging gedoen het as ek nie baie seker was dat ons die geld sal kry nie,” het Botha gesê. Hy het die nasionale regering en die private sektor genader vir geld.

Tans kry 70% tot 80% van die mense in die Wes-Kaap wat die medisyne benodig dit. Elke maand kom daar tussen 1 500 en 1 800 nuwe pasiënte by wat ARM’s kry.

Roetine-toetsing vir MIV sal as standaardsorg beskikbaar wees by alle openbare gesondheidsinstellings in die Wes-Kaap. Tans word toetse net vrywillig gedoen en mense moet daarvoor vra; dit word nie aangebied nie.

“Daar is geen plan om MIV-toetse verpligtend te maak nie, maar die klem het verskuif van konvensionele, vrywillige MIV-berading en toetsing na ’n roetine-aanbod. Die pasiënt kan nee sê.”

Prof. Keith Househam, Wes-Kaapse hoof van gesondheid, het gesê dit beteken die sowat 5 miljoen mense wat jaarliks die provinsie se gesondheidsinstellings besoek, gaan nie meer net deur die stelsel vloei “sonder om die opsie van ’n toets gegee te word” nie.

Pasiënte sal steeds ná die toets berading kry, ongeag of hulle positief of negatief toets.

Die oordrag van MIV tussen ma en baba in die Wes-Kaap is 4%, die laagste in die land, en die provinsie wil dit heeltemal uitwis.

Gedurende die ma se swangerskap en geboorte ontvang die ma en baba tans twee ARM’s. Die provinsiale gesondheidsdepartement gaan dit verhoog na drie.

Al drie inisiatiewe sal binne die volgende jaar deurgevoer word. Botha het gesê hy hoop dit sal teen die begin van 2011 ten volle in werking wees. Volgens hom is die inisiatiewe nodig sodat daar binne vyf tot tien jaar werklik ’n verskil gemaak kan word in die stryd teen MIV/vigs.


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'New Morning' for AIDS Response. 01/12/2008

new spirit of unity in South Africa's AIDS response
Kerry Cullinan

Outgoing UNAIDS director Dr Peter Piot praises new spirit of unity in South Africa's AIDS response, as health minister says ARV waiting lists must be shortened.

The new unity between government and civil society to fight HIV/AIDS marks “a new morning for the AIDS response in Africa”, according to the head of the United Nations AIDS programme.

UNAIDS director Dr Peter Piot was addressing a World AIDS Day rally in Durban yesterday, the first time that he had been invited by the South African government to speak at one of its events in a decade.

In the past, relations between UNAIDS and the government has been strained because Piot was seen to be critical of the AIDS stance of former president Thabo Mbeki.

However, at Sahara Stadium in Durban yesterday, Piot said he was now “encouraged” by the leadership of the SA National AIDS Council (SANAC) and how civil society and government were working together.

“The recent past has shown what we can do when we work together,” said Piot. “This is a new morning for the AIDS response in South Africa and Africa.”

However, Piot said that we all needed to do more especially to prevent new infections.

“Some 5.7 million people are living with HIV in South Africa, and eventually they will all need treatment. At the same time, new infections are spreading at a faster rate than we are able to put people on treatment.”

Piot said that the last time he had been in the stadium, he had listened to Nkosi Johnson speak about how he wished all mothers with HIV could get treatment to prevent their babies from getting HIV. Johnson had been infected at birth by his mother and died when he was 13 years of age.

Dr Zweli Mkhize, MEC for Economic Affairs and head of the ANC’s health desk, thanked Piot, who is retiring from his position in the next few weeks, for his “many years of friendship to the South African HIV/AIDS campaign”. This is one of Piot’s last public appearances.

Deputy President Baleka Mbete declared that HIV, AIDS and TB “are national priorities requiring urgent action by all sectors of society”.

Mbete, who is chairperson of SANAC, said “significant gains” had been made to implement the national strategic plan. These included the fact that “many partners” had joined the HIV/AIDS fight, there were prevention programmes in schools and South Africa has “the largest ARV programme in the world”.

Health Minister Barbara Hogan said there was both “sorrow and optimism” in the commemoration of AIDS Day.

“There is sorrow because of all the illness and suffering. We mourn those lives that were not saved and recognise the pain HIV/AIDS has caused in our country,” said Hogan.

She then paid tribute to eight-year-old Thando, who recently died of TB meningitis in the Eastern Cape.

“Thando was on the waiting list for ARVs. We could have given Thando and his mother ARVs. We could have given nurses and healthworkers the tools to treat Thando and his mother. We need to scale up the programme to prevent mothers from infecting their children with HIV. We urgently need to reduce the waiting lists for ARVs. We need to reach out to the marginalised, including gay men, women, children and sex workers,” said Hogan. – health-e news.


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Letter in Response to Dr Zuma's Speech

Friend and Colleague, Ricardo Walters highlighted key points from Pres. Zuma's speech:


 I trust this finds you well on this important World AIDS Day.

 I’m not sure whether you were able to tune into the Pretoria-meeting today, but I thought it would be of interest to share some comments made by President Jacob Zuma.  I thought these would have bearing on our efforts towards AIDS Competence in the country, particularly as it affirms the socio-economic, cultural, personal lives of people at family and community level, and issues the challenge towards the extraordinary.

* Not just a health issue:  social-economic, cultural consequences
* Affects whole countries, but touches on matters that are intensely personal and private.
*  HIV/AIDS cannot be overcome simply through mass-immunization, improving quality of water, etc.  It can only be overcome by individuals taking responsibility for their own lives and the lives of those around them.
*  We need extraordinary measures to reverse the trends we are seeing in the health profile of our people.
*  The epidemic is not about statistics:  it is about people, about families and about communities.

 We have to stop the spread of HIV.

o        We must reduce the number of new infections.  Prevention is our most powerful and effective strategy.  Each individual must take responsibility for their protection from infection.  Each individual must know their status.
o        Parents and heads of households:  let us be open with our children, and educate them about HIV and how to prevent it.
o        We must uphold the rights of women and children, including their rights to protection.
o        Let us remember the impact of HIV on persons living with disabilities.  We have to tailor government services and messages to further speak to the needs of this sector.

We are mobilising a massive campaign to get every South African to test in order to know their status.  We should like to announce a few new measures, effective April 2010.

o        All children under 1 year of age will receive treatment if they test positive.  Initiating treatment will therefore not be determined by the level of CD-cells.
o        All patients with both TB and HIV will get treatment with ARVs if their CD4 count is 350 or less. (as opposed to present treatment commencing at <200).
o        TB and HIV/AIDS will now be treated under one roof. 
o        All pregnant HIV+ women with CD4 count of 350, or with symptoms regardless of CD4 count, will have access to treatment.  All others will be put on treatment at 14 weeks of pregnancy to protect the baby. 
o        All health institutions will be ready to receive and assist patients, and not just a few accredited ARV-centres.  Any citizen should be able to move into any health centre and receive counselling, testing and treatment.
o        We must continue to provide psychosocial support and home-based community care.  

What does this mean?

•         We will be treating significantly larger numbers of HIV patients.
•         People will live longer and more fulfilling lives.

What does it not mean?

•         That we should be irresponsible in our sexual practises.
•         That people do not have to practise safer sex.
•         That people should not use condoms consistently and correctly during every sexual encounter.

“I’m making arrangements for my own test.  I have taken HIV-tests before, and I know my status.  But I will do another test soon as part of this campaign.  I urge you to make arrangements for your own test.” – President Zuma. 

Seems like a good time for us – the HIV Competent Church movement – to stake our claim in this response.



Ricardo Walters
Facilitation | Consulting | Support Services:
HIV/AIDS ž Health ž Community & Organisational Development
Cape Town, South Africa  ŸSKYPE: ricardowalters
Cell: +27 (0)82 495 5440 Ÿ Fax: +27 (0)21 557 2824


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SA Secures Funding To Fight HIV. 26/11/09

South Africa has secured an additional $108 million from the Global Fund to finance its HIV prevention projects over the next five years.
Compiled by the Government Communication and Information System

Date: 26 Nov 2009
Pretoria - South Africa has secured an additional $108 million from the Global Fund to finance its HIV prevention projects over the next five years.

Deputy President Kgalema Motlanthe, who is Chairperson of the South African National Aids Council (SANAC), said the funding had come at the right time given the current fiscal environment.

The funding was made available after South Africa's application to the Global Fund under the Round 9 submission entitled "Leveraging partnerships to achieve the objectives of the National Strategic Plan".

Motlanthe said a SANAC Plenary, held on Wednesday, also noted that a regional meeting of the Global Fund would be held in Malawi next month. SANAC will be sending delegates to this meeting aimed at giving stakeholders better understanding of how the Global Fund operates.

"This is very important for us as we try to mobilise additional resources for our response to the epidemic," said Motlanthe.

The plenary was also briefed on the preliminary findings of the midterm review of the National Strategic Plan (NSP).

"This review took place alongside a United Nations led review of the health sector's HIV programme as well as an analysis of our state of readiness to conduct mass counseling and testing".

Motlanthe said the review focused on progress towards achieving the key objectives of the NSP as well as the institutional arrangements at national, provincial and local levels to implement the NSP. "We acknowledge that the review team had a short timeframe to conduct the review and that a bit more work needs to be done to finalise the report," he said.

It found that while levels of knowledge about HIV are high, behavior change remained a challenge. "Condom use has increased but we need to increase the consistent use of condoms significantly".

Regarding treatment, Motlanthe said more than 700 000 patients were receiving treatment but that the figure represented only 50 percent of those who need to be treated.

The review found that the health system needs to be strengthened to ensure increased access to care and for services to be integrated with within the public health sector and between the public and private health sectors.

"We really need to ensure that we mobilize and align all our resources to meet our targets. There are also challenges with regard to information about the epidemic. We collect lots of data but do not use the information intelligently to monitor progress," added Motlanthe.

Meanwhile, it is all system ahead of the annual commemoration of World Aids Day on 1 December. The main event is expected to be held at the Pretoria Show Grounds under the theme 'iBambeni - Take Responsibility'. -BuaNews


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Radical Shift In HIV-AIDS Thinking. 15/11/09

President Zuma plans to be tested in public for HIV as government calls for urgent battle against disease decimating country
Geoffrey York

Nov. 15, 2009

In a sharp break from the days when South Africa's government was suggesting garlic and beet root as AIDS remedies, President Jacob Zuma is planning to be tested in public for HIV next month.

The test will be part of a dramatic expansion of HIV testing in South Africa, including tests for all of Mr. Zuma's cabinet ministers and a national campaign to encourage tests for citizens across the entire country, according to a South African newspaper report.

South Africa has more AIDS deaths than any other country in the world, but until recently it was notorious for the ignorance and denials of its top politicians.

Former president Thabo Mbeki, who was ousted in a power struggle last year, became infamous for questioning the value of AIDS drugs and suggesting that the disease might not be caused by the HIV virus.

The Mbeki government's hostility to standard AIDS treatment led to 365,000 premature deaths in South Africa from 2000 to 2005 alone, Harvard University researchers estimated in a recent study.

Mr. Mbeki had always refused to take an HIV test, dismissing it as a “publicity stunt,” despite evidence that testing could help prevent thousands of deaths.

His health minister, Manto Tshabalala-Msimang, proposed that AIDS could be treated with traditional African remedies such as garlic, lemon juice and beet root. Even as thousands of South Africans were dying without access to AIDS drugs, the minister was complaining that anti-retroviral drugs were “toxic.”

Mr. Zuma himself had displayed his own ignorance on AIDS issues during his trial on rape charges in 2006 when he testified that he had taken a shower after sex with an HIV-positive woman to protect himself from the virus.

But now the government is making a radical shift on the issue. In a series of speeches in the past three weeks, Mr. Zuma and his new health minister have called for an urgent battle against AIDS and HIV. They have warned that a rapidly escalating death rate from AIDS is decimating the country, killing especially those below the age of 50.

“Wherever you go across the country, you hear people lament the frequency with which they have to bury family members and friends,” Mr. Zuma said. “At this rate, there is a real danger that the number of deaths will soon overtake the number of births.”

The government has made it clear that it is determined to reverse the ignorance of the past, which one official called “the lost years.”

In a presentation on the latest AIDS numbers last week, Health Minister Aaron Motsoaledi put the blame squarely on the government of the past 10 years. “Our attitude toward HIV/AIDS put us where we are,” he told reporters. “In the past, we were not really fighting HIV/AIDS, we were fighting against each other.”

Mr. Zuma's public HIV test, and the ambitious new campaign for widespread testing, is expected to be announced on Dec. 1, World AIDS Day. Under the plan, doctors and nurses would routinely offer HIV tests to all of their patients, and celebrities would urge everyone to be tested. The tests would be voluntary, but the new availability of tests would produce a dramatic rise in the number of people tested across the country.

It would be a “massive mobilization campaign,” Mr. Zuma said in his speech. “All South Africans need to know their HIV status, and be informed of the treatment options available to them.”

Of the estimated 5.3 million South Africans who are infected with HIV, only a minority know their status.

Last year, according to a government research council, only a quarter of South Africans had taken an HIV test within the previous 12 months.

A leading activist group, Treatment Action Campaign, said the speech by Mr. Zuma was one of the most important in the history of AIDS in the country. “With this speech, state-supported AIDS denialism has been banished,” the group said.

Mr. Zuma has pledged to cut the rate of new HIV infections by half and provide anti-retroviral drugs to 80 per cent of those who need them by 2011.



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Health Minister Calls For Ramped Up Fight Against HIV/AIDS In South Africa 12/11/09

South African health minister Aaron Motsoaledi on calls for a reinvigorated effort in the country's fight against HIV/AIDS.

Kaiser Daily Global Health Policy Report
Thursday, November 12, 2009
South African health minister Aaron Motsoaledi on Tuesday called for a reinvigorated effort in the country's fight against HIV/AIDS, echoing comments recently made by South African President Jacob Zuma, Agence France-Presse reports. Motsoaledi said to reporters, "In 11 years – from 1997 to 2008 – the rate of death has doubled in South Africa" (11/10).
According to SAPA/Times LIVE, "Researchers attribute the sharp rise in the total number of registered deaths to the AIDS pandemic." Motsoaledi "said the figures called for a 'massive change in behaviour and attitude' toward AIDS among South Africans," the news service reports (11/10).
According to Bloomberg, the South African government hopes to "reduce new HIV infections by half and provide treatment to 80 percent of those who need it by 2011." Motsoaledi called for "the biggest voluntary counseling and testing program ever seen in the world" to improve patient access to treatment, Bloomberg writes.
Additionally, authorities are exploring ways to reduce the cost of drugs and increase access to condoms. "Prevention is still the mainstay of dealing with each and every disease," Motsoaledi said (Cohen, 11/10).
Business Day examines Motsoaledi's proposal for voluntary HIV tests to be integrated into routine care. Additionally, Motsoaledi is "leading a government charge to get more people to take voluntary tests," the newspaper notes, adding that the "measures are meant to increase acceptance of testing and raise the proportion of HIV-positive people who know their status, in the hope that they will take precautions to protect others from infection and seek help if they fall ill" (Kahn, 11/11).
PlusNews examines a television ad running in South Africa in November that "aims to reach deaf people with vital information about how to protect themselves from HIV." Brothers for Life, the group behind the ad, has also started reaching out to the country's blind population with brochures about HIV prevention in Braille, PlusNews reports (11/10).
The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. © 2009 Henry J. Kaiser Family Foundation. All rights reserved.
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SA Plans Biggest HIV Campaign. 11/11/09

South Africa is to stage the world's largest HIV and Aids counselling and testing campaign as the government embarks on a huge drive to contain the disease that is decimating the population.
Xolani Mbanjwa
November 11 2009
Health Minister Aaron Motsoaledi told journalists in Parliament yesterday that the campaign marked the "dawn of a new era" for South Africa.
He said he would ask President Jacob Zuma to take the lead in testing for the virus and said he was mobilising every sector of society including labour unions, religious leaders, schools, traditional leaders, celebrities and sports stars to provide leadership in encouraging people to know their status.
The drive - to be launched on World Aids Day on December 1 - comes against a backdrop of shocking statistics that reveal the damage done by the denialism of the previous administration under former president Thabo Mbeki and ex-health minister Manto Tshabalala-Msimang.
They show that young women of child-bearing age are bearing the brunt of a pandemic that has cut life expectancy from around 75 to 51 years in just 10 years, and is causing people to die in numbers that threaten to overtake the birth rate.
Motsoaledi said an SA National Aids Council (Sanac) task team was auditing the country's health facilities to gauge the state of readiness for a massive HIV and Aids testing campaign. It would report back before World Aids Day on December 1.
He said he would not expect Zuma to resist a public examination as part of encouraging people to get tested for the disease.
Motsoaledi said it was Zuma who had recently spearheaded the government's massive mobilisation campaign against the disease to spur South Africans into action to change their behaviour and safeguard their health. He urged South Africans to stand together by declaring war on HIV and Aids.
"We are going to go out to the nation and say 'here we are, we want you to get tested. We've got treatment and we've got everything'. This doesn't mean you force them, but you come and say 'here I am, I want to offer you to know your (HIV and Aids) status'. We need mass mobilisation," he said.
"We need to change our behaviour. It means there must be a massive change in behaviour and attitude by South Africans. We need to undertake a massive and unprecedented VCT (voluntary counselling and testing). That means we need to plan the biggest voluntary counselling system seen anywhere in the world and South Africans have to agree to do that because they need to know their status," he said.
The Sanac task team had found there were 10 000 trained counsellors in the public sector. While the campaign had yet to be costed, Motsoaledi said the private sector was prepared to help fund it.
"I must emphasise that when we test you, we will not know your status. You will know it personally. We will use numbers and codes like when you mark a script during exams," the minister said.
He said this year's commemoration of World Aids Day would be "extraordinary" in order for government to be able to reduce the rate of infection by 50 percent by 2011.
The department was reviewing guidelines on anti-retroviral treatment and its drugs policy because "we are not happy that people are being treated when the CD4 count is 200".
Motsoaledi said HIV/Aids was "weighing heavily" on everyone, as it was clear that the rate of death would soon surpass the birth rate.
He provided alarming figures of how the disease had ravaged the country.
According to Motsoaledi, the number of deaths had "doubled" from 300 000 in 1997 to 756 000, while the birth rate dropped from 1,5 million to 1,2 million.
He said it was "extremely disturbing" that the pandemic was the main contributor to the child mortality rate. Figures showed that 57 percent of children under the age of five were dying from the disease in 2007.
"The rate of death in the first six months increases 15 times when the baby is born HIV-positive," Motsoaledi said.
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Cutting The Cost Of HIV Treatment. 31/10/09

WITH hundreds of thousands of new AIDS patients expected to sign up for treatment in the next three years, the government is intent on finding ways to slash the cost of providing care.

Business Day


 SA has one of the world’s worst HIV/AIDS epidemics, with 5,4- million people infected with the virus. Based on current demand, the government expects to be providing AIDS drugs to 900000 people by the end of March .

The Department of H ealth is finalising new guidelines that will see patients starting treatment earlier. It is also considering whether to provide more patients with an expensive drug, tenofovir, which has fewer side effects than the much cheaper and more commonly prescribed stavudine.
The price tags for personnel, laboratory tests and drugs are all under the microscope.
Finance Minister Pravin Gordhan hinted at the potential savings to be made earlier this week, when he released his midterm budget. “If we use a different approach … we can get the drugs at one sixth of the cost, which frees up money for other priorities,” he said.
Industry sources and analysts are sceptical that costs could be reduced so much, but it is clear SA could be getting its AIDS drugs much cheaper than it does through the R3,6bn tender it awarded last June.
A rough calculation based on the Clinton Foundation AIDS Initiative’s August price list, making allowances for VAT, transport costs, warehousing and distribution, shows SA is paying 27% more for efavirenz than it could be, and double its rate for tenofovir .
These are the two most expensive drugs provided at state facilities. Efavirenz is prescribed to most adults as first-line therapy, along with stavudine and lamivudine. Patients who get dangerous side-effects from stavudine are switched to tenofovir.
“D4T (stavudine) is one of the biggest obstacles to providing ARVs at primary level. It has a host of common, disfiguring and dangerous side-effects ,” president of the Southern African HIV/AIDS Clinicians Society Dr Francois Venter says .
“If we could replace it with tenofovir, it would be a huge step forward, and the only obstacle appears to be cost.”
Aspen Pharmacare, which won 60% of the AIDS drug tender, says its prices are higher than the Clinton Foundation’s because of the high cost of imported active pharmaceutical ingredients, and because it did not have the licence to produce generic tenofovir or efavirenz when the tender was issued. Aspen is waiting for its application to the Medicines Control Council to register generic tenofovir , without which it cannot distribute the drug in SA.
The H ealth D epartment’s Yogan Pillay says the government is looking at ways to reduce the cost of its HIV/AIDS programmes.
Officials are exploring “task- shifting” — training nurses to provide services traditionally performed by doctors — and talking to the National Health Laboratory Services about cutting the cost of the regular blood tests required to monitor AIDS patients’ progress.
But most significantly for the industry, the department is also talking to its suppliers about how to cut medicine prices, including those in the current contract, which expires in May. “One of the biggest challenges facing our (local) drug companies is that 70% of their prices come from the active pharmaceutical ingredient , which is imported,” says Pillay. “The g overnment could look at buying them in bulk, or SA could produce them in the country in the state or private sector or in a public-private partnership.”
The D epartment of T rade and I ndustry has set up a task team to investigate the feasibility of establishing a local active pharmaceutical ingredient industry.
“Alongside that, we’ve started discussions with the Clinton Foundation. We’ve compared prices and found that in some areas we could make savings … and we’ve started to think about how we could do the next tender (differently),” says Pillay.
The AIDS Law Project’s Jonathan Berger says the government is not legally obliged to use the tender system and could procure drugs via the Clinton Foundation if it chose to.
“The constitution requires processes that are fair, equitable, transparent, competitive and cost- effective. The legal framework to give effect to this does not necessarily require a tender process,” he says. “But you’d probably want to give local companies a chance to at least match or better them (the Clinton Foundation).”
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SANAC Invigorated by Political Changes. 30/10/08

27.10.2008 Anso Thom

The SA National AIDS Council plans dynamic AIDS Day including possible 15-minute work stoppages, and the Development Bank of SA takes over secretariat to improve efficiency.

Under the new political dispensation there was for the first time consensus and common purpose in tackling HIV and AIDS, South African National AIDS Council (SANAC) deputy chairperson Mark Heywood told business leaders in Cape Town this week.

Speaking on the first stop of the “Work the Future” road show, organised by Business Unity South Africa, Metropolitan and the SA Business Coalition on HIV and AIDS, Heywood there was a stated committed from Health Minister Barbara Hogan and Deputy President and SANAC chair Baleka Mbete to make HIV and AIDS a priority.

Heywood said these commitments had been backed up by an extra R932-million over the next three years, structures to strengthen SANAC and plans to send out a strong message on World AIDS Day.

“We have been struggling to get SANAC to operate efficiently because of the secretariat’s location within the Health Department, but it has now been moved to the Development Bank of South Africa, which will make a massive change,” Heywood said.

Heywood said Hogan had “instructed” SANAC to come up with an operational plan for a prevention social mobilisation event around World AIDS Day on December 1. He said there were already moves to urgently improve the Prevention of Mother to Child Transmission Programme which has seen reductions in transmission levels to around 3% in parts of the Western Cape, but transmission rates as high as 40% in parts of Limpopo.

Heywood said that SANAC was hoping for President Kgalema Motlanthe to address the nation on World AIDS Day, joined by outgoing UNAIDS Executive Director Dr Peter Piot, who will be in South Africa.

SANAC was exploring the suggestion of a 15 minute “stoppage” around the country on World AIDS Day when businesses and trade unions will speak to employees and members about HIV and AIDS.

Heywood said there was a critical need to make an impact on preventing infections. He said the National Strategic Plan, which has a stated goal of halving new infections by 2011, was not making progress.

“Our prevention campaigns are too unfocussed and need to be broken down. We need to be speaking to people’s real lives. It is intolerable that we have about 1 000 new infections every day,” said Heywood.

He said that there was a lot of ignorance and that campaigns needed to speak to those people. However, he said that others knew everything, but still became infected. “You need campaigns that speak to a poor 16-year-old girl who knows the facts, but lives in a rural area and is powerless against predatory men. Then we have also ignored another group, pretending that their type of sex doesn’t exist. We have ignored the very serious epidemic among men who have sex with men. Anyone trying to get information on how to protect themselves will find it very hard,” said Heywood.

“We have got to take HIV away from the national and place it in the local circumstances in which people work,” said Heywood.

Professor Wiseman Nkuhlu, former Chief Executive of the New Partnership of Africa’s Development (Nepad) and chair of the Metropolitan Board, told the gathering that HIV/AIDS was the biggest socio-economic challenge facing South Africa.

While attending the recent International AIDS Conference in Mexico, Nkuhlu said “I kept asking myself where is South Africa on this thing? Other sub-Saharan African countries seem to be more successful in tackling the epidemic and we need to ask why we are not showing the same progress as Uganda and Botswana which took it seriously and is showing progress”.

Nkuhlu said HIV and AIDS demanded visionary and courageous business leadership similar to the response that turned the tide against apartheid.

“The threat is HIV/AIDS kills 370 00 young South Africans per year and this is a real crisis,” said Nkuhlu.

Nkuhlu said it would require leadership by captains of industry and implementation of company specific plans if South Africa wanted to achieve universal access to HIV/AIDS prevention, treatment, care and support by 2010.

“The CEO must take the leadership role, stand up and champion and engage stakeholders. It is not enough to simply make resources available, leaders need to speak openly about the challenge facing us,” Nkuhlu said.

Heywood responded that as an activist it was exciting listening to Nkuhlu: “I have waited for a long time for business to step forward and lead in addressing this epidemic. We are indeed facing a scenario where we need to dig ourselves out of another mess.”

The ‘Work the Future’ road show is a pragmatic platform that will outline scenarios ranging from devastating to inspiring, based on a range of possible responses by civil society, business and government.

Its chief aim is to engage business leaders on their role in the HIV/ AIDS Strategic Plan for South Africa, 2007 - 2011 (NSP), promote business collaboration and highlight what business is currently doing (or failing to do) in addressing prevention of HIV infections and in providing treatment, care and support. – health-e news service.


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Address by the President of the Republic of South Africa. 29/10/09

Address by the President of  the Republic of South Africa, Mr Jacob Zuma, to the National Council Of Provinces (NCOP)
29 OCTOBER 2009
The Chairperson of the National Council of Provinces, Honourable Mninawa Mahlangu;
Deputy Chairperson of the National Council of Provinces, Honourable Thandi Memela;
Provincial Premiers;
Members of Parliament;
Representatives of the South African Local Government Association,
Distinguished guests;
Ladies and gentlemen;
The National Council of Provinces occupies a unique and a special place in our democracy.
The Constitution charges the NCOP to represent the provinces in order to “ensure that provincial interests are taken into account in the national sphere of government”.
This chamber has to perform this important function by mainly participating in the national legislative process and by providing a national forum for public consideration of issues affecting the provinces.
The Constitution says that representatives of local government may also participate in the proceedings of the NCOP when the need arises.
The NCOP therefore is the meeting point of the three spheres of government.
It is a forum where the elected representatives of our people should jointly discuss the major issues facing our republic and its citizens.
Chairperson, Honourable Members,
Our young democracy faces significant challenges.
Though we have achieved much, there is much more that we need to do.
Just as we cannot allow ourselves to be overwhelmed by these challenges, we dare not underestimate them.
If we are to build the thriving nation for which we have worked so hard, and for which so many have sacrificed so much, we need to appreciate the extent and nature of these challenges.
I would like to highlight two critical challenges, both of which, in different ways, have the potential to undermine our efforts to achieve a better life for our people.
The first of these challenges relates to our economy.
The global economy is going through a major economic crisis.
The impact of this crisis has been felt by every section of our society.
Businesses, both big and small, have been closed.
Thousands of workers have lost their jobs.
As more families lose their livelihoods and businesses risk collapse, they look to government for assistance.
And yet government’s ability to assist has been weakened.
As the Minister of Finance indicated in his address to the National Assembly on Tuesday, government revenues are down and the budget deficit is up.
Our ability to assist those in need has been placed under strain.
With fewer funds available, we nevertheless need to provide health care to the sick, education to our youth, and social grants to the most vulnerable in our society.
Our challenges compel us to do more with less.
We have to ensure that limited public resources are spent on those things that serve a greater public good.
The Medium Term Budget Policy Statement that Minister Gordhan presented this week underscores this imperative.
It presents a spending programme that places the interests of ordinary South Africans – particularly the poor and vulnerable – at the centre of government’s work.
It recognises that we will need to borrow more to meet our needs.
We are determined, however, to contain our borrowing requirement within sustainable limits, to ensure that we do not burden future generations with our debt.
Chairperson, Honourable Members,
We are facing arguably our greatest economic challenge since the advent of democracy.
We do so against the backdrop of a global recession not of our making, and in an economic and social environment still dominated by the distortions of our apartheid past.
South Africa has long been plagued by structural unemployment, with the result that a sizable portion of our population has been without work for many years.
Many of our people do not have the skills needed to find employment.
Though it absorbs a significant amount of our budget, our education system does not produce the outcomes we require.
Apartheid planning continues to have a significant impact on poor people living in both rural and urban areas.
The lack of basic infrastructure in these areas, and their location far from economic centres, severely limits opportunities for millions of our people.
These are among the challenges we face.
We need to recognise them and properly understand them.
For only then, can we ensure that we respond appropriately.
Chairperson, Honourable Members,
It is our firm belief that indeed this government is responding appropriately to these challenges.
The steps we need to take to respond to the recession cannot be separated from the longer term task of transforming our economy and society.
That is why we borrow not to bail out banks and failing businesses, but to invest in economic infrastructure, education, health care, rural development and the fight against crime.
That is why we see in this recession an opportunity to improve the operation of government and ensure that it better utilises scarce resources.
That is a task in which we would like to see this National Council playing a prominent role.
We have created new departments and reformed others in order to focus on the important priorities on which our people expect us to deliver.
I would mention in particular the establishment of the new Department of Cooperative Governance and Traditional Affairs, which replaced the former Department of Provincial and Local Government.
The change in the name is more than cosmetic.
It draws attention to the role that we think this new department should play.
Chapter 3 of the Constitution of the Republic enjoins all spheres of government to cooperate with one another in mutual trust and good faith by fostering friendly relations; assisting and supporting one another; consulting one another on matters of common interest; and coordinating their actions and legislation with one another.
The experience of the last fifteen years of our democracy has taught us that the three spheres of government have not always lived up to these constitutional injunctions.
More often than not, the three spheres of government pull in different directions.
Their actions are not coordinated.
We have therefore established this new department to assist us to ensure that government works in a cooperative and coordinated fashion.
I ask for your support and assistance to make sure that this department and all other departments meet their mandates.
In that way, we can use this crisis to ensure that our three spheres of government work better together to improve people’s lives.
Though we may be buffeted by the uncertain winds of the global economy, we are not helpless.
Working together, determined that our common national programme should succeed, we can and will weather this particular storm.
Chairperson, Honourable Members,
The second challenge that I wish to highlight is no less grave.
Indeed, if we do not respond with urgency and resolve, we may well find our vision of a thriving nation slipping from our grasp.
Recent statistics from the Department of Health, Human Sciences Research Council, Medical Research Council, Statistics SA and other sources paint a disturbing picture of the health of our nation.
They show that nearly 6 out 10 deaths in our country in 2006 were deaths of people younger than 50 years.
If we consider mortality trends over the last decade, we see that the age at which people die has been changing dramatically.
More and more people are dying young, threatening even to outnumber in proportional terms those who die in old age.
Honourable Members, South Africans are dying at an increasing rate.
The number of deaths registered in 2008 jumped to 756,000, up from 573,000 the year before.
At this rate, there is a real danger that the number of deaths will soon overtake the number of births. The births registered during this period were one million two hundred and five thousand one hundred and eleven (1, 205, 111).
The Independent Electoral Commission had to remove 396 336 deceased voters from the Voters Roll during September last year and August this year.
What is even more disturbing is the number of young women who are dying in the prime of their life, in their child-bearing years.
In 2006, life expectancy at birth for South African men was estimated to be 51 years.
By contrast, life expectancy in Algeria was 70 years and 60 years in Senegal.
These are some of the chilling statistics that demonstrate the devastating impact that HIV and AIDS is having on our nation.
Not even the youngest are spared.
Some studies suggest that 57% of the deaths of children under the age of five during 2007 were as a result of HIV.
This situation is aggravated by the high tuberculosis prevalence. 
The co-infection rate between HIV and TB has now reached a staggering 73%.
Statistics indicate that the numbers of citizens with TB number at 481 584.
These statistics do not, however, fully reveal the human toll of the disease.
It is necessary to go into the hospitals, clinics and hospices of our country to see the effects of HIV and AIDS on those who should be in the prime of their lives.
It is necessary to go into people’s homes to see how families struggle with the triple burden of poverty, disease and stigma.
Wherever you go across the country, you hear people lament the apparent frequency with which they have to bury family members and friends.
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TAC Statement on Landmark speech by President Zuma. 30/10/09

Yesterday President Jacob Zuma made one of the most important speeches in the history of AIDS in South Africa. In front of the National Council of Provinces (NCOP), he unequivocally acknowledged the devastation of AIDS on our country. With this speech state-supported AIDS denialism has been banished. The Treatment Action Campaign welcomes the ushering in of this new era, almost exactly ten years since former President Mbeki made a speech that began the era of state-supported denial in front of the NCOP.
President Zuma acknowledged that government’s efforts so far have been insufficient to curb the devastation of the epidemic. The reality of this has been declining health outcomes and increasing mortality. We have a crippled health system and a ballooning epidemic from the years of AIDS denialism and inaction by former President Thabo Mbeki and former Health Minister Manto Tshablala-Msimang. However, today’s speech puts that behind us and provides hope that President Zuma will urgently tackle the epidemic with renewed commitment to meet the treatment and prevention targets of the HIV & AIDS and STIs National Strategic Plan 2007-2011 (NSP).
In his speech, President Zuma acknowledged that the fear and shame that have surrounded the epidemic must be overcome. The spread of the epidemic is intimately connected to government’s ability to safeguard our human rights. All South Africans must feel secure to know their status and access and adhere to treatment without fear of discrimination.
President Zuma emphasized the need for behaviour change to reduce new infections by 50% from 2007 to 2011, the NSP prevention target. Changing behaviour must be facilitated by increased access to prevention services and by reducing the vulnerabilities to HIV infection in our society. Converting knowledge to behaviour change will be directly linked to these interventions.
A theme of the speech was that to turn the tide of the epidemic political will is needed not only by government but also by the citizens of South Africa. TAC and other civil societies have developed an active cadre of HIV activists in South Africa but this commitment to tackling the epidemic needs to be adopted throughout our society. As South African citizens we must actively engage with our own health and the health of each other. As active citizens we can overcome the stigma and discrimination that have driven the epidemic.
Key challenges remain to meeting the ambitious targets of the National Strategic Plan (2007 - 2011) for the treatment and prevention of HIV. But with the renewed political demonstrated by President Zuma and the leadership of Minister of Health, Aaron Motsoaledi, we believe these targets are achievable.
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Time for New Aids Attack: Zuma. 29/10/09

News 24

Cape Town - President Jacob Zuma on Thursday called for a change of behaviour and a renewed onslaught against HIV/Aids.

South Africa had very impressive awareness levels about HIV/Aids, well over 95%, he told the National Council of Provinces.

"We should now seriously work to convert that knowledge into a change of behaviour."

"Knowledge will help us to confront denialism and the stigma attached to the epidemic," he said.

Prevention remained a critical part of the strategy.

"We need a massive change in behaviour and attitude especially among the youth. We must all work together to achieve this goal," Zuma said.

Massive campaign

World Aids Day, on December 1, should mark the beginning of a massive mobilisation campaign that reaches all South Africans, and spurs them into action to safeguard their health and the health of the nation.

"Though a considerable undertaking, it is well within our means, and we should start now, today, to prepare ourselves for this renewed onslaught against this epidemic."

"I have instructed the minister of health, as we prepare for World Aids Day, to provide further detail to the nation on the impact of HIV and Aids on our people. He will do so next week."

It was also expected that the SA National Aids Council, under Deputy President Kgalema Motlanthe's leadership, would develop a set of measures to strengthen the programmes already in place, he said.

Despite the comprehensive strategy to tackle HIV and Aids, acknowledged internationally, and the largest antiretroviral programme in the world, "we are not yet winning this battle".

Come to terms

"We must come to terms with this reality as South Africans.

"We must accept that we need to work harder, and with renewed focus, to implement the strategy that we have developed together. We need to do more, and we need to do better, together."

"If we are to stop the progress of this disease through our society, we will need to pursue extraordinary measures," he said.

It would be necessary to mobilise all South Africans to take responsibility for their health and well-being and that of their partners, their families and their communities.

Though it posed a grave threat to the well-being of the nation, HIV and Aids should be treated like any other disease.

There should be no shame, no discrimination, no recriminations. The stigma surrounding Aids has to be broken.

Sight should not be lost of the key targets in the national strategic plan, including reducing the rate of new infections by 50%, and extending the antiretroviral programme to 80% of those who needed it, both by 2011, Zuma said.

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Mid Term Budget Policy for 2009 brings Good News for HIV Treatment

South African Minister of Finance, Mr Pravin Gordhan presented the Mid Term Budget Policy for 2009 on the 27th of October.  You can read the full speech here.

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ARV Programme Could Be Enlarged. 30/10/09

Oct 30, 2009 1:14 PM

Times Live  By Sapa
The health ministry is doing cost studies on extending its antiretroviral therapy programme to HIV carriers with a higher CD4 count, deputy director general Kamy Chetty said.
Chetty confirmed to Sapa that this was possibly linked to a policy announcement President Jacob Zuma has said Health Minister Aaron Motsoaledi would make next week.
At the moment, the state provides medication to HIV sufferers once their CD4 count - the number of lymphocytes per cubic millimetre of blood -drops below 200.
This is in line with early World Health Organisation guidelines for poorer nations. The recommendations have been revised because of the benefits of starting therapy before immune suppression reaches that level.
Chetty told Parliament's health portfolio committee that the department was studying the cost implications of extending the treatment programme to patients whose CD4 counts are below 300.
"Giving ARTs [antiretroviral therapy] to people with a CD4 count of 150 costs a lot less than giving it to people with a CD4 count of 300... These exercises are being done right now," she said.
"If the policy changes the (expenditure) estimates will go up," she told the committee.
She said the health department was determined to intensify its programme to prevent mother-to-child transmission and was also doing cost studies in this regard.
"The government and the department would like to see a situation where no child is born with HIV."
The Treatment Action Campaign has called for the programme to be extended, citing the example of neighbouring Botswana where the drugs are given to HIV carriers by the state once their CD4 count hits 350.
Zuma this week said South Africa must step up the fight against HIV/Aids and called for a behaviour change among the population to stem the tide of infection.
He said high levels of awareness of the disease and the world's biggest antiretroviral (ARV) campaign were not sufficient to stop the pandemic.
"We should now seriously work to convert that knowledge into a change of behaviour."
Zuma said the SA National Aids Council, under Deputy President Kgalema Motlanthe's leadership, would develop a set of measures to strengthen the programmes already in place.
The Democratic Alliance on Friday called for the roll-out of ARV medication to be increased.
It welcomed Zuma's appeal to make fighting Aids a top priority but questioned whether the state had the ability to put this into action.
DA spokesman Mike Waters pointed out that Motsoaledi had to concede earlier this year that South Africa would not meet its target of providing ARVs to 80 percent of people living with HIV/Aids by 2011 because of logistical problems and a lack of personnel.
"In other words, as is increasingly becoming the case with Jacob Zuma's administration, a very public and critically important undertaking on behalf of the government proved to be misguided and poorly thought through, with the consequence that it had to be downscaled."


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Significant Increases For HIV/AIDS Treatment. 28/10/09

Business Day

CAPE TOWN — The Treasury has made significant additions to the government’s budget for HIV/ AIDS programmes in anticipation of meeting its target of providing treatment to 80% of those in need by 2011.
Finance Minister Pravin Gordhan yesterday announced an extra R900m for providing AIDS drugs in state health facilities for the rest of this fiscal year. The money will help meet the R1bn shortfall acknowledged last month by Health Minister Aaron Motsoaledi.
The Treasury declined to comment yesterday on progress in securing more donor funding for AIDS drugs. “We think the R900m is a very substantial allocation which will go a long way to addressing this (shortfall),” said the Treasury’s director for health policy, Mark Bletcher.
The Treasury has also added R5,4bn to the HIV/AIDS conditional grant over the medium term, given an expected rise in demand for AIDS drugs. An extra R1,2bn is allocated in 2010-11, R1,8bn in 2011-12 and R2,4bn in 2012-13, taking the total allocations to R5,5bn, R6,4bn and R7,3bn respectively.
The Treasury said “treatment uptake will soon exceed more than 300000 entrants per year. By the end of March 2010 more than 900000 people will be receiving antiretroviral treatment.”
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Age Raised For Child Grants. 22/10/09


Cape Town - The state child support grant of R240 a month will be extended to children older than 14 years with effect from January 1 next year, government announced on Thursday.
Briefing the media following Cabinet's regular Wednesday fortnightly meeting, government spokesperson Themba Maseko said the meeting approved the extension of the grant to eligible children up to their 18th birthday.
Currently, children turning 15 are removed from the system.
Maseko said the decision applied only to children from "poor households". Caregivers of the beneficiaries would have the responsibility to ensure that the beneficiaries remained in school.
The extended grant would be phased in, starting with 15-year-olds on January 1 2010.
The extended grants would benefit about two million children from poor households.
The total cost to the state would be R1.3bn, R2.6bn, and R3.5bn respectively over the next three years, Maseko said.



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South Africa Needs An HIV/AIDS Truth Commission. 15/10/09


A truth commission can account for South Africa's past HIV/AIDS denialist policies and rebuild trust, says AIDS expert, Salim S. Abdool Karim.
15 October 2009
The HIV/AIDS epidemic is one of the greatest challenges facing post-democracy South Africa. In 2007, the country, which is home to less than one per cent of the world's population, carried 17 per cent of the global burden of HIV infection — and the virus continues to spread relentlessly.

The government's response to the epidemic during the last decade has contributed to this disproportionate burden. It not only questioned the reliability of HIV testing, the safety and efficacy of antiretroviral drugs and the accuracy of statistics on AIDS-related morbidity and mortality, but also the very premise that HIV causes AIDS.

Deliberate attempts were made to undermine scientific evidence as the basis for action and to place politics at odds with science. President Thabo Mbeki's AIDS Advisory Panel, set up in 2000, marked a low point in the government's relationship with scientists when he asked AIDS scientists to engage AIDS 'denialists' in a debate for political adjudication.

Preventable deaths
The impact of these policies was very damaging. The government delayed the implementation of nevirapine — an antiretroviral drug proven to prevent mother-to-child transmission of HIV — which resulted in hundreds of thousands of newborns becoming infected unnecessarily. Researchers at Harvard University estimate that between 2000 and 2005, 330,000 lives were lost to HIV/AIDS and 35,000 babies were born with the virus because of government inaction and failure to provide lifesaving drugs.

AIDS activists have repeatedly had to challenge health service providers, government and pharmaceutical companies. Through petitions, marches, mobilising communities and legal action they have sought to bring more treatment to poor people.

But the change in government leadership last year has created new hope that the country will rise to the challenges posed by HIV/AIDS. President Jacob Zuma's 2009 State of the Nation Address boldly stated: "We must work together to improve the implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and AIDS so as to reduce the rate of new HIV infections by 50 per cent by the year 2011. We want to reach 80 per cent of those in need of ARV [antiretroviral] treatment also by 2011."

Yet, while these statements are welcome, should we simply forget the past and accept that it was unfortunate — but there is nothing we can do about it now? To simply ignore the actions that led to hundreds of thousands of avoidable deaths would be to condone them and lay South Africa open to history repeating itself.

Call for a commission
South Africa needs an HIV/AIDS truth commission as a vital step towards establishing what happened and why, including detailed estimates of how many people died.

It is particularly important to hear directly from the decision-makers and to gather personal testimonies from all parties involved on how the damaging policies took hold in a democracy, where government should be accountable to the public for its actions.

The commission would also help us understand how to prevent the situation from happening again and would give the many people who lost loved ones to AIDS an explanation for why they died unnecessarily.

It is also needed to rebuild trust among people working against HIV/AIDS in South Africa, including those in research, government, health and local communities.

Simply establishing the truth is an important step. But for real reconciliation, the truth must also be made public and open to scrutiny before we can move on.

As South Africa starts building a new era in its response to the HIV/AIDS epidemic, we must work together — government, scientists, civil society and community organisations. It will take all our efforts — unimpaired by any ill-feeling or hurt from the past — to build a constructive foundation for tackling this devastating enemy.

Salim S. Abdool Karim is director of the Centre for the AIDS Programme of Research in South Africa at the University of KwaZulu-Natal. He was a member of Thabo Mbeki's AIDS Advisory Panel.



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Free State Controversies Continue. 02/10/09

 The troubles in the Free State Department of Health in the news:

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Free State ARV Fiasco. 2/10/09

Xolile Ntutu
A "damning" government report leaked to the Mail & Guardian reveals that the Health Department cannot say with any certainty how many HIV-infected patients in the Free State are receiving antiretroviral (ARV) therapy. This is because of inefficient computer software that has regularly broken down since 2001.
The document, written in April this year, also says that "reports are centralised so that individual ARV treatment sites have no indication of what is going on in the management of their programme".

The chaos in the Free State Meditech software monitoring system has serious implications for the province's already crisis-ridden response to HIV.

According to the Treatment Action Campaign (TAC), the Free State is again running out of ARVs, as it did earlier this year. Interruption of treatment leads to drug resistance.

The M&G has established that the problem is much wider than a single province. The Budget and Expenditure Monitoring Forum (BEMF), which monitors the provision of public sector ARVs, said this week that only the Western Cape, Northern Cape and North West were sure of avoiding treatment interruptions because of budget constraints and mismanagement in the near future.

Nationally, there is a R1-billion funding shortfall for ARVs.

Health Minister Aaron Motsoaledi recently announced that the government could not meet its target of providing life-prolonging antiretroviral treatment to 80% of HIV-infected people suffering from advanced infections by 2011.

The Free State document was written by the Integrated Support Task Team, which was formed by the government to investigate ARV shortages in the province.

According to the BEMF's Mark Heywood, the "damning report" is being withheld, and "there is no evidence yet that it is being acted on". BELOW

Heywood said Free State Health Minister Sisi Mabe recently said on national radio that there was "no shortage" of medicine, but TAC representative Sello Mokolepi visited several clinics this week and found them without drugs.

"At the Welkom Clinic I found ARV patients lining up for three days, only to be told that the drugs never arrived," he said. "The government also distributes waiting list numbers that are significantly lower than the real need."

Health Department spokesperson Fidel Hadebe said this week that 850 000 people are on ARVs in the public sector. But activists and health experts say government figures are unreliable, as there is little consistency in the methods used to collect them. If the health department does not know how many people are on ARVs and how many need it, they said, addressing the problem becomes increasingly complex.

Hadebe said "differences in treatment figures have to do with some ARV patients having died since they started treatment".

He said the government has applied for additional funding from treasury and international donors, and has received "very positive feedback".

Hadebe conceded, however, that treasury funding on average "takes at least two months to arrive in our bank account due to all the processes that have to be followed". This could lead to several provinces not receiving interventions in time. One international donor has given strong indications that it will procure ARVs on behalf of the government as a matter of urgency, but Hadebe was unwilling to reveal its identity.

The two largest foreign donors are the United States government's President's Emergency Fund for Aids Relief (Pepfar) and the Global Fund to Fight Aids, TB and Malaria. Pepfar's policy is to procure drugs on behalf of governments, rather than fund them directly.

South African HIV Clinicians Society president Francois Venter said Motsoaledi would have to do "considerably more" than apply for more funding if he wanted to prevent "thousands of unnecessary deaths".

Venter said the drug supply was a "hangover from the [former health minister] Manto Tshabalala-Msimang's era", and that Motsoaledi will have to "get rid of far more people in the Health Department than director general Thami Mseleku, whom he has courageously dismissed. There's a lot of dead wood."

In a recent article, Heywood said the funding shortfall was "only half the story … As the national treasury is well aware, what money is available is misused … Corruption is rife." The M&G has seen a letter from pharmacists at Shongwe Hospital, near Komatipoort in Mpumalanga, to the provincial department complaining that they have been repeatedly told there is "short stock", active ingredients have been stolen or the government has not paid its bills.

The hospital has been out of stock of HIV-related drugs such as antibiotics for eight months, whereas sources said the number of patients needing ARVs had increased, with more than 1 000 turning up at the hospital since the beginning of the year.




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FS New Budget Allocation Uninspiring. 28/03/09

Khopotso Bodibe

Patients in the Free State were recently denied AIDS treatment because of a lack of funds. But the National Treasury’s new allocation towards the province’s HIV and AIDS expenditure for the 2009 – 2010 financial year, which begins in April, is R83 million short. Now the province’s head of health is already talking about restricting access to antiretrovirals.

“Maybe this time, in order to avoid the challenges we’ve had, we must just work out what the quotas are in terms of numbers and stick to those numbers. If you come and we’ve said only 20 and you are number 21 in April, we tell you to wait for next month”, says Prof. Pax Ramela, head of the Free State Health Department.

He added that “the lack of quotas on treatment access in the financial year ending this March, is the reason there was over-subscription of the ARV programme, which led to last November’s moratorium to not allow new patients to access treatment”.

“We should actually have staggered the intake of patients from the beginning of the year, so that we can come out to March with 27 000 patients. The ones who seem to be saying to us ‘no, but you did not manage this thing properly’, managing it properly means we should actually have turned back the patients from the beginning and agreed on quotas for the month from April and said, ‘we will only take so many patients so that by the time we get to March we would have had 27 000 patients’. That way we would have had a continuous supply of drugs. We’ve got to think about it if there’s no additional help coming and our business plan says, ‘you can only take so many people’. The needs by far exceed the budgets that are available”, explained Ramela.

The Free State Health Department requested national Treasury to fund it for a total of R319 million for its HIV and AIDS programme for the financial year 2009 – 2010, which begins in April. But Treasury has given the department only R235 million, which is R83.9 million less. The bulk of the shortfall will hit the province’s antiretroviral treatment programme the hardest. It’s been under-funded to the tune of R63 million this new financial year.

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Boost for FS Health Dept. 19/03/09

The Free State health department has received an advance of R110m on its 2009/10 budget for medicines and services.

19/03/2009  - (SA)  

Bloemfontein - The Free State health department has received an advance of R110m on its 2009/10 budget for medicines and services.

Provincial health spokesperson Elke de Witt said on Thursday that the department received the money from the provincial treasury.

"This will enable the department to address the challenges in our facilities."

The cash-strapped department announced in November last year that it had financial problems and that cost-containing measures would be implemented.

The measures were applicable in 31 hospitals, clinics and administrative offices in the province.

One of the services stopped was that no new patients would be put on antiretroviral medication in the Free State until the provincial health department's financial woes were sorted out.

Nevertheless, this moratorium was lifted in February this year.

Earlier this month Health Minister Barbara Hogan said the Free State health department was a victim of it own success for running out of antiretroviral (ARV) medicine.

"Free State health was a pace-setter in the ARV field as far as the rollout of the programme, together with the Western Cape [was concerned]," she said in Bloemfontein during the visit.

Hogan said of the 28 ARV clinics in the province, seven had not taken in new patients, after the moratorium was lifted, due to lack of medicine.

However, some 500 new patients had been taken up in the ARV programme since February.

Hogan also warned that medicine orders placed by the state were based on money available and not the number of patients.

She said the Free State's situation was due to "pressures on resources" and not bad management.

On Thursday, De Witt said only routine non-emergency surgical cases at hospitals were affected by the cost-containing measures announced earlier.

"The theatres at Pelonomi regional hospital in Bloemfontein yesterday [Wednesday] handled 16 emergency operations. This included seven Caesarean sections, three emergency cases, four operations on children, one adult skin graph and another."

De Witt said non-emergency cases would remain a low priority until the situation was normalised.

"The theatres are continuing to operate normally for priority cases," she said.

The Free State health department has received an advance of R110m on its 2009/10 budget for medicines and services.

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FS health workers made to Abandon Patients to do ANC Electioneering. 18/03/09

Khopotso Bodibe


Despite a health crisis in the Free State caused by a funding shortage, the provincial health department has granted 160 health workers who are members of the ANC-aligned National Education Health and Allied Workers’ Union (NEHAWU) paid leave for six months to do election campaigning for the ANC.

Free State head of health Prof Pax Ramela approved the leave after it was requested by the National Education and Health Workers’ Union (Nehawu) in early February.

Ramela, head of the Free State Health Department, now denies that the 160 shop stewards were released to do election work for the ANC. Instead, he said that they were doing “union work” but has failed to explain what “union work” they were doing. 

However, the Nehawu memorandum addressed to MEC Sakhiwo Belot asking for leave for its members is explicit in its request, saying: “The Congress of South African Trade Unions and its affiliates, NEHAWU included, took a decision to actively and practically participate in the 2009 election campaigns for a decisive victory of our glorious movement, the African National Congress.

“To achieve this, NEHAWU in particular, is tasked to facilitate and secure political release of shop-stewards to be deployed in various strategic workplaces and towns for the same purpose. It is on this basis that NEHAWU requests your office to facilitate the release of attached comrades to perform the above-mentioned task until Election Day.”

Attached to the memo, which is in Health-e’s possession, are names of 160 employees from health facilities across the province – from the Motheo district to Clocolan. 

Ramela approved NEHAWU’s request on 16 February  “on condition that the release is for six months whilst we evaluate the impact of service delivery; that at any given point and time 50 percent of shop-stewards are available to provide contractual obligations for the institutions; and activities must as far as possible be within the institutions”.

Meanwhile, the Democratic Alliance in the province has condemned the release of the 160 personnel and said it would be seeking legal advice on the matter.

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Crisis As Free State ARV Programme Collapses. 12/03/09

Anso Thom

12 March 2009

Opinion All Africa

The AIDS epidemic in our country over more than 10 years has had sadly many more downs than ups.

The small victories, sometimes in the courts, sometimes in a hopeful utterance by a politician, became straws we clung onto believing that a better day would come.

We were all slightly shell-shocked when President Kgalema Motlanthe announced without warning in September last year that the then Health Minister Manto Tshabalala-Msimang would be redeployed to his office while ANC backbencher Barbara Hogan would be handed a task that many feel is impossible.

For many years the then President Thabo Mbeki, his health minister Tshabalala-Msimang and some of their allies in government had resisted attempts to introduce anti-retroviral (ARV) drugs for the millions of South Africans in need of it despite International research that showed beyond a reasonable doubt that an ARV treatment programme was the best hope for those already infected.

For years we would travel to the far-flung corners of our country interviewing caregivers, families, those living with HIV, children and many others who shared their stories of grief, fear, panic, hopelessness, anger and despair at being denied access to a handful of pills that would save their lives or those of their patients or loved ones.

Our first real glimmer of hope came in 2003 when Cabinet unexpectedly released a statement endorsing the introduction of ARVs in the public health service.

But the health minister and her supporters continued to obstruct, delay and deny treatment on many levels.

The release of the National Strategic Plan at the end of 2007 provided another injection for South Africa's treatment plan which was increasingly and eagerly wheeled out by politicians as one of the "largest in the world". Of course they failed to mention that many people first had to pay with their lives and the limited success of the programme was despite their hindrances.

Hogan's elevation and the final removal of Tshabalala-Msimang left everyone with a sense that finally things would gather momentum and there was the real prospect of a better life for those relying on the public health sector.

For a while we all basked in the "honeymoon" phase relieved that there was a Health Minister who was prepared to unequivocally state that HIV causes AIDS and make sure those needing ARV treatment are able to access it.

However, the euphoria, ended last November when e-mails leaked from the Free State health department revealed that the province had run out of ARVs and it had stopped admitting any new patients onto ARVs. Hogan reacted immediately and sent a task team to the province, managing to gather emergency funds which would tide the province over until the next financial year.

The impression was created that a return to the Mbeki-Manto nightmare days had been averted and people went off on their Christmas breaks. However, unbeknown to many the situation deteriorated rapidly. Doctors, nurses and caregivers sent increasingly desperate reports of hospitals and clinics turning new patients away or patients already on treatment being told there were no drugs and they would have to return on another day.

The collapse of the Free State's ARV treatment programme was soon to be followed by pretty much its entire health system as the health department announced far reaching cutbacks. Provincial health authorities have made very little or no effort to communicate with their staff who are desperately trying to keep people alive or comfort those facing death. In the meantime, a waiting list of 15 000 people is growing by the day while the province shows little sense of urgency to solve the problem.

Perhaps this is because many of these people are poor and have no way in which to make their voices heard. The damaged caused by the decision to impose a moratorium will for many years play itself out in the mining province.

In the four months since the story broke, not much has changed. While the national government has gone the extra mile in trying to clean up the mess left by the province, the limits of its power to compel the province to put its house in order are all too clear.

Many lives have been lost and many more will pay the price for incompetence and provincial politicking and those who make these life and death decisions. A visit by the AIDS Law Project to the province in February revealed that nothing had changed since November. If anything, the situation had deteriorated with the waiting list growing longer, people on treatment being forced to default because of a shortage of ARVs and doctors pulling their hair out as they were forced to stand by and watch young patients die.

Patients' immune systems have dropped to dangerous levels as they wait for their medication causing long term damage and increasing the likelihood of them contracting fatal infections. This who have had their treatment interrupted will develop resistance to their current drugs and if they survive will have to be placed on very expensive second-line drugs often with more side-effects.

There is speculation that the breakdown was not purely the fault of the provincial health department, but also the provincial bean counters who appear to have used political motivations for withholding money, with some citing a power struggle between the Mbeki-supporting health MEC and a Zuma-supporting finance officer as one of the reasons why the money tap was simply turned off once the health department had reached the end of its budget.

One also has to ask where has Premier Beatrice Marshoff, the ultimate custodian of her province, been in all of this? Has the former nurse and member of Parliament's health portfolio committee not heard the cries of her residents?

Marshoff failed to mention the ARV crisis in her State of the Province address. She reportedly later denied assertions that the province's health care system was in tatters and told journalists that the provincial government could assure its citizens there was no crisis in health care and that the government would provide adequate health care.

But surely 30 AIDS-related deaths every day and 20 babies unnecessarily infected every month (according to HIV Clinicians Society figures based on solid research papers) constitutes a crisis?

HIV Clinicians paint a clear picture of the price this province's residents will pay for many years to come - whether through the imminent deaths of loved ones, children being orphaned or those infected battling to recover from debilitating opportunistic infections as their immune systems have become very weak from the delay in getting medicine.

"At worst these people will die," says Dr Francois Venter, President of the HIV Clinicians Society which has been trying to support doctors battling to cope with the overwhelming numbers of very sick patients presenting to the treatment sites.

"If they are lucky enough to survive they are at great risk and almost certain to contract unnecessary illnesses such as TB, pneumonia and meningitis. It's the long-term consequences were going to face because of this decision which really quite simply involves terrible illness," says Venter.

Venter said he found the "casualness" with which the decision was taken to implement the moratorium in the Free State alarming.

"The consequences for the poor are profound and they will become the quiet victims in all of this. This is a dumb way to deal with illness. People are going to end up in hospital needing intensive treatment and care, they are going to become resistant to the first line drug regimen and will have to put onto second line treatment which is expensive and comes with all kinds of other side-effects, " says Venter.

Top HIV paediatrician Dr Ashraf Coovadia explains that children's immune systems are not as fully developed as those of adults which means they have to get onto treatment as soon as they are diagnosed HIV positive. Not accessing treatment or delaying it equals death or the prospect of painful and horrendous opportunistic infections.

Treating them once they have fallen ill is complex involving hospitalisation and intensive care.

Coovadia said it was also very difficult to retain the trust of the patient and their caregiver if the treatment is constantly interrupted, more often than not with fatal consequences.

He adds that another worrying factor was that reports were indicating that women were not accessing the Prevention-of-Mother-to-Child transmission programme which means many children will end up being infected and ultimately dying if they are not diagnosed and treated in time. "The fact that they are being infected in the first place is disastrous," says Coovadia.

On paper the moratorium has been lifted in the Free State, but on the ground the picture is very different. What is happening in the Free State is a crime against the people of that province and we need to ensure that their deaths are not simply swept under the carpet, but that we shine a very bright light on those responsible and hold them accountable. This can never happen again.

Copyright © 2009 Health-e. All rights reserved. Distributed by AllAfrica Global Media (

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Heywood likens Free State Situation to Death Sentence 12/03/09

Somewhere around 1 November 2008 the death penalty was reintroduced in the Free State. Quietly, with the stroke of a pen, an official in the Department of Health in Bloemfontein signed a memorandum introducing a moratorium declaring that no new patients should be put on anti-retroviral (ARV) treatment. This was to be for the next five months – until the new financial year, April 1 2009 -- when the funds would return.
Who was this official? Did he or she have a God complex, or was he an AIDS denialist who didn’t believe that ARV treatment keeps people alive? Certainly a few of them still lurk within the corridors of the Free State Health department. In fact at  the same time that ARV treatment was stopped an official provincial government publication was promoting garlic and the remedies of Tine van Der Maas.
Or did the official just not understand the law, the Constitution, the meaning of the right to health, or the huge life and death implications of the piece of paper that he signed that day?
Did the official think that the moratorium would save our government money and that he was doing his duty in terms of the Public Finance Management Act? Why did he not understand that the denial of ARV medicine is cost-creating, not cost-saving. It creates the added costs of managing TB, and other opportunistic infections. It puts sick people in hospital beds. For families it is the cost of a coffin, a burial, the loss of income. For a child it is the cost of a deceased parent.
Whatever, the explanation, it seems that he did not even inform the national Health Minister of his rueful decision.
In the days ahead, the effect of the moratorium began to be felt by those unfortunate citizens of the Free State who needed ARV treatment. Some had been prepared for starting treatment for weeks, a process known as ‘adherence counselling’ – psychologically preparing themselves for the day that they would commence life-long treatment. At the back or the front of their minds was the prospect of recovering health, recovering strength, recovering hope. The life-restoring effect of taking ARVs is best described by Justice Edwin Cameron in his book ‘Witness to AIDS’. He talks about feeling ‘a miraculous new energy’ and ‘illness .. yielding to a nearly novel feeling – renewed and joyful wellbeing.’
However, for people with AIDS in the Free State this hope was rudely interrupted when they crossed that arbitrary line marked ‘1 November’ – the day ARV treatment dried up. In the months ahead, more and more people came to clinics seeking ARVs, only to be sent away, told to come back some time in the future, that time unknown.
For overworked doctors and nurses this was an equally stressful period, even more so than usual. They were instructed to send sick people away from their health facilities knowing that they would not return. The probability of a person with a CD4 count of 10, coming back in a month, is small. The hope that health workers had developed, arising from their ability to use medicine to save lives, was suddenly dashed, bringing back memories of medicine in the time of AIDS that existed under the former Health Minister, Manto Tshabalala-Msimang.
Their feelings cannot be described. Neither can the agony or anxiety of people needing medicines, knowing that they needed them, and being denied them. These were slow deaths and, as they laboured through the Xmas holidays, those condemned must have wondered why there was no outcry.
And there were a lot of deaths. In cold statistics, the SA HIV Clinicians Society has calculated that at least 30 people died a day as a result of the moratorium.
These facts are galling. They make it hard to understand how the Minister of Health, Barbara Hogan, could have gone to the killing fields last week and declared that the Free State Health Department was ‘a victim of its own success’ and that the crisis (an understatement) was not the result of bad management.
The idea that the Free State is a victim of its own success is no more immediately believable than the claim that Schabir Shaik qualifies for medical parole. If we are to believe it the public is entitled to an independent enquiry to establish the facts of what happened.
It is strange comparing the public outcry over Schabir Shaik with the few lonely voices calling for accountability and an explanation of what happened in the Free State. Is it because the dead are poor and usually hidden? Are officials in the health department and the ANC resisting an enquiry because in the final stages of an election campaign inconvenient truths are less than welcome? 
Arbitrarily stopping an essential health service must be an unlawful act. The illegality is compounded by the fact that it was not only ARV treatment that was suspended. Many other essential health services were cut back. The constitutional provision on the right of access to health care services and the jurisprudence that has built up around it must mean something in this context. If we allow tens of thousands of lives to be brushed under the carpet, it will be a dark day for democracy, a failure of the Constitution, and a harbinger of future moratoriums on life saving health services.
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Hogan: FS Victim of Own Success. 08/03/09

05/03/2009 News 24

Bloemfontein - The Free State health department was a victim of its own success when it ran into shortages of antiretroviral (ARV) medicine, Health Minister Barbara Hogan said on Thursday.

"Free State health was a pace-setter in the ARV field as far as the rollout of the programme, together with the Western Cape [was concerned]," she said in Bloemfontein during a visit to the province.

Hogan said more people had needed ARV medicine than could be budgeted for.

The minister, accompanied by a large national department delegation, indicated they were "just visiting" to talk to healthcare workers and patients.

"This is not a fact-finding mission, but also not a 'hi and goodbye', because we met senior management, health workers, civil society and stakeholders."

Stopped taking in new patients in November 2008 In November 2008 the Free State stopped taking in new ARV patients, saying there was no money or medicine. The moratorium was lifted in February this year.

Hogan said of the 28 ARV clinics in the Free State only seven had not taken in new patients due to lack of medicine, while one type of medicine was still not available in the province.

However, some 500 patients had been taken up in the ARV programme since the moratorium was lifted.

Hogan warned that medicine orders placed by the state were based on money available and not the number of patients.

She said it should be made clear that the Free State's situation was due to "pressures on resources" and not bad management.

Hogan also admitted that Free State health MEC Sakhiwe Belot warned about the pending situation in September last year. "He had been upfront."

Turning to overseas donors

She said South Africa would, during future crises, turn to overseas donors.

"I do believe in a crisis situation you must get donor money," she said, adding that a special unit had been set up in her department to co-ordinate this.

Hogan said with the international economic crisis affecting the national economy "not much extra money" would come to health.

The minister visited staff and patients at the Pelonomi Regional Hospital in Bloemfontein and the Mangaung clinic.


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Lives Lost As State Coffers Run Dry. 22/02/09


Last week, regulars at the HIV treatment clinic at Pelonomi hospital, in Bloemfontein, capital of South Africa's Free State Province, would have told you that the clinic has never been this quiet.

Ever since the provincial government stopped initiating new patients on antiretroviral (ARV) drugs, the buzzing treatment literacy classes for people about to start taking ARVs had shrunk in size, while some existing patients stopped coming to check whether their drugs were in stock.

A provincial moratorium barring new patients from getting ARV medicine has been in place since November 2008, after massive overspending and a failure to apply for emergency funding in time became apparent. According to the AIDS Law Project, about 15,000 people in Free State are waiting to start ARV treatment.

The province has also discontinued CD4 monitoring [which measures the strength of the immune system], health workers have stopped referring patients in need of ARVs, there has been a fatal interruption in the treatment of hundreds who have been on ARVs for years, and the province is failing to meet the treatment needs of many children.

The HIV Clinicians Society conservatively estimates that about 30 people per day have died in the province due to their inability to access treatment.

AIDS lobby group Treatment Action Campaign (TAC) said this week it was receiving complaints from doctors and activists in Free State who said they still did not have access to drugs, despite assurances from the government on 13 February that the moratorium had been lifted.

"People think that they are going to die"

A small group of pregnant women sit in the waiting area at Pelonomi, taking a break from their treatment literacy class on a Wednesday morning; conversation is muted, and there are hardly any staff about. Although the moratorium was lifted the previous week, the drugs have not yet arrived at the clinic, one of the largest ARV treatment sites in the province.

Sello Mokhalipi works for the Treatment Action Campaign in Free State and conducts drug-readiness training for new patients at Pelonomi hospital, but since the moratorium his classes have virtually stopped; people who completed drug readiness training in August last year are still on the waiting list for medication.

"It makes me feel bad when people come here and find that there are no drugs; they come back to me and say, 'What are we supposed to do with no drugs? Should we wait and develop resistance?'"

In January, Mokhalipi, who gets his own medication from Pelonomi, was forced to buy a month's supply of Lamivudine (also known as 3TC) - a component of all first-line ARV regimens - from a pharmacy because the clinic had run out of stock.

"Most people think that they are going to die if this goes on. People are frustrated, depressed and confused; they don't know who to turn to when they are told there are no drugs and have to go home empty-handed."

Stella Mothata thought her six-year old nephew, Thapelo, was going to die. When she went to Pelonomi clinic on 10 February to collect his next batch of ARVs, she was told to come three days later; but three days later, the drugs were still not there and she was told to come back the following week.

Thapelo had already gone for a week without medicine and Mothata was becoming frantic. "I asked them if they could give him something for the weekend, but they said, 'There is nothing we can do'," she told IRIN/PlusNews.

A desperate Mothata then called Trudie Harrison, director of the Anglican Church's Mosamaria AIDS Ministry, and asked for help. Harrison arranged for her to purchase the drugs at a local pharmacy, but when Thapelo started taking the ARVs he became sick. "He can't eat, when he eats he vomits and this morning he woke up with a rash on his face," she said.

"They say it's pneumonia, but he woke up feeling better today, so I took him to school. But the teacher sent him back because the rash has become too bad - they say he can't open his eyes."

Mothata, who receives her own treatment from a donor-funded private organization in Bloemfontein, is finding out whether they will also treat Thapelo, as she has lost faith in the government.

But health officials insist that by March the treatment programme will be replenished and will have "bounced back".

According to Portia Shai-Mhatu, senior manager in the Free State's HIV/AIDS directorate, medical depots have been told to speed up deliveries of drugs, while drug manufacturers have agreed to fast-track the province's orders.

What went wrong?

As the health department tries to pick up the pieces, questions about how this could have happened remain unanswered. The TAC has accused the Free State's health department of "gross financial mismanagement" but national health officials have put the crisis down to "severe financial pressures" in the province.

"We can't prove that it was mismanagement, but I do ask myself what has gone wrong?" wondered Trudie Harrison at the Mosamaria AIDS Ministry.

The official answer is that a funding shortfall of R63 million (US$6,300,000), higher numbers of patients on treatment, and the introduction of more expensive dual therapy for prevention of mother-to-child transmission, led to the shortages.

The health department budgeted for an anticipated 27,000 people on treatment by the end of March 2009, but has now estimated that 35,000 people will be accessing treatment by then.

"By September [2008] already, we realised that we were in a crisis ... we thought the most sensible thing was to give existing patients treatment. It would be very wrong and very fatal to initiate treatment one month, and then the next month there are no drugs," said Sylvia Khokho, executive manager of strategic health programmes in the province.

"All this time we were hoping for money, but the crisis was worsening. We were looking everywhere and taking money [from other programmes] and pushing it to ARVs," she added. Shai-Mhatu commented: "Without being defensive, it's clear that the Free State health budget is too low."

With the exception of essential health services, the financial crisis has also affected healthcare in other ways - hospital beds have been slashed by more than 50 percent, according to the AIDS Law Project.

Health budgets around the country have been pushed to the limit by massive overspending, poor budgetary controls and the implementation of a new salary structure for nurses.

KwaZulu-Natal Province has overspent its health budget by over a billion rand (US$100 million) and media reports earlier in February said doctors in the port city of Durban were complaining that basic surgical supplies were unavailable at some of KwaZulu-Natal's biggest hospitals.

National Health Minister Barbara Hogan has appointed a team of experts to visit provinces and assess the over-expenditures and the state of health services.

Although Finance Minister Trevor Manuel allocated additional funding in his budget speech to roll out the new dual therapy programme and expand ARV treatment, he also announced that new systems were being designed to improve the national health department's ability to monitor provincial expenditure.

"There is a broad consensus that public health services have been insufficiently funded, but the problem is not simply inadequate financial and human resources, it is also one of inefficient use of resources," noted Adila Hassim, head of litigation and legal services at the AIDS Law Project.

In an editorial in a local newspaper, Business Day, Hassim called for parliamentary scrutiny of budget allocations and spending, as well as for a way of ensuring that funds allocated to the provinces would be spent on nationally determined priorities.

Whether it was mismanagement or inadequate funding, Harrison told IRIN/PlusNews that the provincial health department had to take responsibility for the lives lost.

"Where does the buck stop? It's people's lives we are talking about, but there's no sense of accountability, they are just blaming everyone else," she commented. "That is not good enough."

© IRIN. All rights reserved. HIV/AIDS news and analysis:

[This item comes to you from PlusNews, part of IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States. Reposting or reproduction, with attribution, for non-commercial purposes is permitted. Terms and conditions:

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Drugs Trickle Into the Free State. 19/02/09

Health-e News

19.02.2009 Anso Thom and Lungi Langa

Most hospital and clinics in the Free State have still not started treating the more than 15 000 people waiting for their anti-retroviral (ARV) drugs, however the national health department has given the assurance that drugs will now start arriving at all 28 sites.

It is unknown how many people were simply turned away during a four-month moratorium which saw people with HIV in need of ARVs sent home and others who had been on the drugs for years being told that the clinic had run out of stock. Dr Yogan Pillay, Deputy Director General of Health in the national health department admitted that the province had “severe financial pressures”.

“The Chief Financial Officer in the province oversees the medicine depot and has a close hand on ensuring that drugs get to the sites,” said Pillay, who visited the province on Monday.

He gave the assurance that the extra funds coupled with the current provincial budget was enough to sustain patients currently on ARVs and initiate all those in need of the drugs.

ARVs are expected to start trickling into the smaller treatment sites, especially clinics, by today (Thursday)while some hospitals have started putting patients on treatment.

Rebecca Hodes of the Treatment Action Campaign (TAC) said contradictory responses were coming from Pelonomi Hospital, a large HIV treatment site in Bloemfontein, where government officials said the moratorium had been lifted, but patients were still complaining that access to treatment was denied.

However, Bongani Hospital in Welkom this week started initiating 50 patients every day.

All but one clinic in the province’s Motheo district which includes Bloemfontein still did not have drugs at the time of going to press.

Hodes that it was clear that provincial officials had not fulfilled their duties and had likely not followed due process in pursuing emergency allocations for ARVs and other critical healthcare services which were cut during the moratorium which was instituted in November, or for adequately considering the dire consequences of these measures.

“Whoever is responsible must be held accountable and must lose his or her position to someone else who is committed to fulfilling their role as an enabling figure in progressively granting sustained access to medicines in the Free State and South Africa at large,” said Hodes.  Dr Francois Venter, President of the HIV Clinicians Society said the moratorium had translated into a death sentence for many.

“People die without ARVs and we know a large number of people would have died. Who is going to be held responsible and accountable? This has done massive damage to the public health system and we need to know how it managed to spiral out of control within four months,” said Venter.

Pillay also confirmed that the cutbacks in among others surgery, outpatient services and hospital beds were still in place in the province and that the drug supply crisis was not only contained to ARVs, but to many other essential drugs.

In terms of the waiting list, Pillay said the province had been tasked with developing a plan reflecting clearly how it was going to reduce it.

Pillay said he had also linked the province with the private sector hospital body which committed itself to providing ARVs for emergency cases, transport to get the drugs to sites and additional doctors, nurses and pharmacists where needed.

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FS Thrown A Desperate Lifeline. 12/02/09

Anso Thom: AIDS Law Project Report

Thousands of desperate HIV positive patients in the Free State have been thrown a lifeline with news that millions has been secured to procure anti-retroviral (ARV) drugs needed to keep them alive.

A staggering 15 000 HIV-positive people have been placed on waiting lists in the Free State where a moratorium implemented in November barred them from accessing ARVs at hospitals and clinics. Others, who failed to be placed on the ever expanding waiting list, were simply sent home to die.

According to an investigative report compiled by the AIDS Law Project and sent to health minister Barbara Hogan this week, the treatment of more than 15 000 people had been stopped in the province. The province had also discontinued CD4 monitoring, health workers had ceased referring patients in need of ARVs, there had been a fatal interruption in the treatment of hundreds who have been on ARVs for years and the province was failing to meet the treatment needs of many children.

Deputy Director General for Strategic Health Services in the national health department Dr Yogan Pillay revealed last night (THURSDAY) that he had personally been in contact with all drug manufacturer CEOs securing promises that they would fast track all the Free State drug orders, including those received last month.

“These orders (to the Free State) will be filled by tomorrow,” Pillay confirmed last night.
He said the province had made R10-million available from its own funds, the national health department had shifted R5,5-million from a conditional grant and the United States Agency for International Development (USAID) had confirmed that it would make a further R11,2-million worth of drugs available to the Free State.

“This means that 2000 people on waiting lists will start their treatment as soon as the drugs are available which will be within days,” said Pillay.

He said a letter had been sent to all facilities in the Free State ordering the lifting of the moratorium and that the HIV Clinicians Society and Treatment Task Team at the SA National AIDS Council would be assisting the province with the protocol on how to prioritise patients who are not on treatment and helping to shrink the waiting list.

“I am personally overseeing the entire process and I am happy that everything is on track,” said an exhausted Pillay.

He added that health minister Barbara Hogan had appointed a task team to look at not just what had gone wrong with the supply of ARVs, but what was going wrong or presenting as challenges in many of the provinces.

“The task team will start their work in the Free State,” Pillay said.

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National Watch Over Provinces Is ‘A Priority’ to Stop ‘Anarchy’. 12/02/09

12.02.2009 Kerry Cullinan

Government needs to prioritise improving national oversight over provincial health services to address the “anarchy” and “scope for corruption” in provinces, according to the AIDS Law Project (ALP).

The ALP was reacting to Finance Minister Trevor Manual’s announcement this week that systems were being designed to improve the national health department’s ability to monitor provincial expenditure.

In the past few months, the HIV/AIDS treatment programme in the Free State virtually collapsed due to massive overspending in the province.

The province was unable to buy adequate supplies of antiretroviral medication, potentially affecting the 33 000 people already on treatment. Treatment for some 15 000 people who urgently needed ARVs was delayed.

KwaZulu-Natal has also overspent its health budget by over a billion rand, while most other provinces’ health departments are also in the red.

Health Minister Barbara Hogan has appointed a team of health and finance experts to visit provinces and assess the overexpenditures, as well as to assess the health services.
Hogan is well aware of the structural problems that hamper implementation of health services in provinces.

“The ANC identified both health and education as priorities at its Polokwane conference, as neither have been great performers since 1994,” said Hogan in an interview with Health-e.
“With both, there are concurrent powers [in the Constitution] and the provinces responsible for implementation,” said Hogan.

“I can’t, as national Minister, instruct an MEC in a province to do something. I don’t want to tinker with the Constitution. But there are a number of misfits. We need to find smarter ways to deal with the lack of an integrated health system.

“The relationship between the Minister and the MECs is critical. We have to see ourselves working together as Team Health.”

The ALP has said that by giving bigger health allocations to provinces, Manual has “reinforced the need for effective synergy and oversight of the provincial implementation of nationally determined priorities”.

Meanwhile, the Institute for Democracy (Idasa) notes that expenditure on health “constitutes more than one-fifth of all consolidated government expenditure on social services in 2009/10”.
The 2009 Budget allocates R17.1 billion to the national Department of Health, of which R15.6 billion goes to grants for provinces.

However, Idasa notes that the budget “is set to increase by 10.3% on average annually over the medium Term”, which is “lower than that projected between 2007/08 – 2010/11, which was 14.1% on average”.  Idasa also notes that the health department “appears to be struggling to spend its capital budget”.

By the end of November 2008, when at least 75% of the budget should be spent, the health department had only spent 58 % of its capital budget and 63% of its current budget.
“This trend is suggestive of “fiscal dumping”, in which the bulk of expenditure takes place in the fourth quarter of the financial year, sometimes on wasteful and/or non-productive expenditure,” said Idasa.

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Thousands Of FS Patients Sent Home to Die. 11/02/09

Anso Thom and Lungi Langa

A staggering 15 000 HIV-positive people have been placed on waiting lists in the Free State where a moratorium is barring them from accessing anti-retroviral (ARV) drugs at hospitals and clinics. Others, who fail to be placed on the ever expanding waiting list, are simply sent home to die.

According to an investigative report compiled by the AIDS Law Project and sent to health minister Barbara Hogan yesterday (SUBS: WEDNESDAY), the treatment of more than 15 000 people has been stopped in the province. The province has also discontinued CD4 monitoring, health workers have ceased referring patients in need of ARVs, there has been a fatal interruption in the treatment of hundreds who have been on ARVs for years and the province is failing to meet the treatment needs of many children.

A provincial moratorium barring new patients from getting antiretroviral (ARV) medicine has been in place since last November, following massive overspending and a failure to apply for emergency funding when alarm bells were ringing.

Many of the 33 000 patients who were on ARV treatment before the moratorium report drug shortages. Some patients have been told to share medication or are simply transferred from three ARVs to a two-drug regimen, increasing the danger of resistance.

“At Pelonomi HospitaI (Bloemfontein) I was told that they have no drugs and that I should come back next week and try again,” said a woman last week who has been on triple therapy of AZT, efavirenz and 3TC since 2007.

All but essential health services have also been affected by the financial crisis, and hospital beds have been slashed by more than 50%.

The Free State has blamed the crisis on an over-expenditure on personnel costs, an increase in patient numbers and the increasing cost of goods and services.

Treatment Action Campaign (TAC) supporters picketed outside Parliament’s gates yesterday (SUBS: WED) calling for an end to the waiting lists in the Free State.

TAC General Secretary Vuyiseka Dubula claimed that health minister Barbara Hogan “informed us that the ban on ARV treatment in Free State has been lifted and that HIV patients are going to be able to access the drugs by Friday and we as TAC are going to monitoring that situation to see that this does happen”. Hogan said in a statement released on Monday that she was urgently addressing the situation.

Joining the picket COSATU Western Cape organizer Mike Louw slammed the situation in the Free State as criminal calling for those responsible to be held accountable.

Finance Minister Trevor Manuel yesterday announced a sizeable increase in the ARV treatment budget.

His budget papers also revealed that the national health department’s oversight capacity over provincial health services would be strengthened.

Reverend Teboho Klaas of the South African Council of Churches (SACC) visited Bloemfontein last week and said it made him “very scared that the department is putting people on death row”.   “If they are aware that they are inadequately funded they should have systems in place to cater for these people rather than say people should go home and die,” said Klaas, who is also deputy chairperson of the Treatment Action Campaign (TAC).

Earlier this week Hogan stated her commitment to urgently address the crisis in the Free State.
She said that additional funding was being sought through donors, and that she was also in discussion with National Treasury in this regard.

Meanwhile, desperate Free State patients are being turned away from donor funded treatment sites who have also reached their capacity.

Some patients have turned to private doctors but are unable to consistently afford the R350 per month needed to buy their drugs privately.

Many government doctors spoke to Health-e last week, detailing the collapse of the province’s primary and secondary health care system, especially the treatment of people living with HIV, but asked to remain anonymous for fear of losing their jobs.

“At one Bloemfontein clinic alone, they had to turn away more than 100 patients who had been referred for treatment,” said a frustrated doctor said, adding that he knew of a number of patients who had died.

“At National Hospital (Bloemfontein) there is a three-page list of drugs that are currently out of stock.  At Universitas Hospital they are admitting no new patients for any treatment. There is no elective surgery, so this means anaethetists and surgeons are sitting around doing nothing,” he added.

He claimed that the manager of a regional hospital had also suggested they stop treating tuberculosis as part of a cost cutting measure.

The doctor confirmed that many clinics were struggling to continue treating those currently on ARVs. “At one clinic today they had three boxes of 3TC and 50 patients waiting. The problem is that many of the patients who qualify for treatment now may be relatively healthy, but by the time province get their act together these patients will be fatally ill. We have gone back to that nightmare of not being able to give people ARVs,” he said. “We have around 130 patients who test positive every month and we now have nowhere to refer them anymore,” said Trudie Harrison who runs the Anglican Church’s Mosamaria AIDS Ministry in Bloemfontein.

A doctor working at a northern Free State hospital which used to start around 200 patients a week on ARVs said he had been told earlier last year already to “slow down and take it easy”.

“The clinics have stopped referring patients to us, they are going elsewhere to die,” he said
Another doctor said that although the moratorium excluded children and pregnant women, the supply of paediatric ARVs in the province was sporadic and unreliable.
“The pharmacies often run out of medication and it’s really impossible to try and put a small baby on adult medication.  Today for example we have no ARV stock whatsoever for children,” the doctor said.

Dr Petro Basson who runs the United States-funded Bana-Pele project in Bloemfontein said they were increasingly seeing children being put on treatment, but their desperately ill mothers were denied ARVs in accordance with the moratorium.

“The mothers are too ill to work and therefore unable to afford the transport money to get the children to hospital which means the children default,” said Basson.

“It’s a grim picture from my side. You lose the mother and it creates so much trouble. Everywhere the posters and TV tell them to get tested and then what?”

An internal one-page memorandum faxed to health facilities on Monday from the province’s head of health Professor Pax Ramela states that “orders for ARVs have been placed and are expected to be received in 2 to 3 weeks from today”.

Activists have questioned the continuous delay stating that drug companies have stated their ability to distribute the required drugs within days.

At the time of going to press the Free State Health Department had failed to respond to a list of questions.

For more details on the crisis in the Free State go to

3 November 2008

Head of the province’s HIV programme Dr Mvula Tshabalala sends an email via the province’s Chief ARV Pharmacist Palesa Santho to a group of health care workers, mainly facility managers, informing them that the province was experience an acute shortage of ARVs. She states that “the remaining ARVs are for the exclusive use of those on treatment already with the exception of clients on the PMTCT program (pregnant women).”

 4 November 2008

Tshabalala replies to questions from staff saying she is unable to say when the ARVs will again become available. She recommends the suspension of drug readiness training as it will “raise false hopes”. She also recommends the suspension of baseline blood tests.

 10 November 2008

The Treatment Action Campaign releases the e-mail correspondence and says it has been inundated with calls from concerned healthcare workers. The TAC demanded an immediate end to the stoppages and requests a detailed investigation into the shortages and stoppages which it said “allegedly stem from gross financial mismanagement within the Free State Health Department”.

 12 November 2008

Health minister Barbara Hogan acts swiftly and orders the immediate transfer of R9.5 million for purposes of procuring essential drugs for patients on the programme. She approaches the donor community to assist in ensuring the continuity of the programme in the province. The US Centres for Disease Control grants permission for PEPFAR funds to be used by two NGOs that work in the province to purchase drugs that are in short supply.
A team of senior officials from the Department of Health is immediately dispatched to the Free State to work with their counterparts in the provincial health and Treasury departments to find ways of resolving their financial/budgetary problems.

 14 November 2008

Head of the Free State Health Department Professor Pax Ramela releases a statement blaming the stoppages on underfunding from National Treasury, the addition of AZT to the Prevention of Mother to Child HIV transmission (PMTCT) programme regimen and an increase in patients needing treatment.
He confirmed that the “entry of new patients” had been “delayed” since the beginning of November.

 25 November 2008

The Free State Health Department Communications directorate releases a statement conceding that the financial situation in the department is “reaching dire proportions”. It announces radical cost containment measures including the cancellation of all routine non-emergency surgical cases until the end of January 2009, the discharge of all patients other than those needing “high acuity care”, directing all private patients to private hospitals, accepting only emergency referrals, placing staff on mandatory leave, redeploying personnel and stopping all non-critical appointments.

 27 November 2008

The TAC warns that there will be huge increases in mortality and morbidity if ARV treatment is delayed for even a few weeks.

 19 December 2008

The TAC writes a letter to the Free State Health MEC Sakhiwo Belot asking for clarity on a range of issues.

 21 January 2009

The TAC sends another letter after Belot fails to respond.

27 January 2009

The TAC releases a statement revealing Belot’s failure to respond.

 28 January 2009

Belot and Free State Premier Beatrice Marshoff send replies to the TAC and Aids Law Project head Mark Heywood. Belot states that a donation of drugs to the value of R17,8-million would hopefully be enough to only sustain patients currently on treatment until the end of January 2009. He said funds had been shifted from the other programs in the conditional grant to the ARV programme in the hope of initiating new patients, but that the delivery of drugs to the province was a challenge. He also confirmed that “almost all services” had been scaled down because of budgetary constraints.

 3 February 2009

The Free State Health Department says in the statement that due to financial constraints it was not in a position of admit new patients on the ARV program and “the status quo thus remains”.

 4 February 2009

The South African Council of Churches sends a letter on behalf of civil society organizations to Belot and Marshoff warning that the poor and vulnerable were being most severely affected. It calls on the Free State Aids Council to give a written explanation at its meeting on 11 February as to why it had failed to take strong leadership in preventing the moratorium.

 5 February 2009

The Programme Implementation Committee of the SA National AIDS Council proposes that the moratorium be lifted by February 9. The Director General for Health undertakes to provide a plan on how the situation can be addressed by Monday, February 9.

 6 February 2009

The TAC states that the moratorium has caused avoidable death and illness.

 9 February 2009

Health Minister Barbara Hogan releases a statement giving an undertaking to urgently address the situation whereby no new patients are initiated on treatment in the Free State.

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SA Wins Plaudits For AIDS Approach. 1/10/09


CAPE TOWN — Once internationally condemned for its handling of the AIDS crisis, SA is now being lauded by the world’s leading organisation for combat ing the disease.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) regional director, Mark Stirling, yesterday gave the thumbs-up to President Jacob Zuma ’s administration’s approach to the HIV epidemic, saying: “What I see in SA is very responsible leadership and governance.”
Former president Thabo Mbeki was slated by 82 of the world’s leading scientists for his contrarian approach to HIV/AIDS, and a Harvard study estimated that 330000 lives would have been saved if the government had not delayed providing AIDS treatment until 2005.
Last week, Zuma told CNN that Mbeki’s unorthodox views were his own and not government policy.
Stirling said the government’s openness about the funding problems facing provincial health departments had boosted the international donor community’s confidence in SA. “They have been absolutely transparent in working with the provinces to try and understand the reasons, and initiated important work on future costs (of providing AIDS treatment),” Stirling said.
SA is one of a handful of hard-hit countries able to put sizable resources of its own into the fight against the disease, but it nevertheless requires substantial support. Last month, Health Minister Aaron Motsoaledi confirmed AIDS activists’ fears that SA faced a R1bn funding shortfall for its AIDS treatment programme and said he had been meeting international funders to try to secure more resources.
Activists had warned that six provinces were likely to run short of AIDS drugs due to the shortfall.
Stirling made his remarks as Unaids released a report showing that less than half of the 9,5-million HIV patients needing treatment in low- and middle-income countries last year were able to get the drugs they needed. This was despite huge strides in mobilising donor support and significant reductions in the cost of drugs since 2006.
The report says 700500 people were taking AIDS drugs in SA by the end of last year — 17% of the world’s 4-million HIV patients who were able to get treatment.
The UNAIDS estimate for SA includes public and private sector patients, and makes important allowances for attrition from the government programme. It draws on the government’s public sector figure of 678550 for end-December , a cumulative total that does not take account of deaths or people who have stopped taking their pills since the programme began in 2004, and a private sector figure of 130500 based on research published in the South African Medical Journal.
The report shows there has been a significant increase in the number of HIV-positive patients on treatment since 2007 (458951), equivalent to about 16000 new patients starting treatment each month.
More attention should be paid to “turning off the tap” and preventing new infections, Stirling said. Last year, about 900000 HIV patients started taking AIDS drugs in Africa, but 1,7-million became infected.


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Lack Of Funds Threatens ARV Programmes 26/9/09

Six provinces may run out of anti-retroviral (ARV) drugs as a result of a financial shortfall experienced by the Department of Health totalling one billion rand.

26.09.2009 Phakamile Magamdela
“Health Minister, Dr Aaron Motsoaledi told us that there is an ‘emergency fund’ of five million rand. But we know that five million rand is a drop in the ocean for six provinces that have the HIV and TB problem. There is a shortfall of one billion rand”, said Vuyiseka Dubula, Secretary-General of the Treatment Action Campaign (TAC). She was speaking at a media briefing of the recently-launched Budget and Expenditure Monitoring Forum (BEMF).
According to the BEMF, only three provinces do not expect treatment interruptions. These are the North West, Northern Cape and Western Cape.
Executive Director of the AIDS Law Project and member of the BEMF, Mark Heywood, said the shortfall is a major concern both for new and enrolled patients.
“It’s estimated that probably 40 percent of people who need treatment are receiving treatment, which means there are still more people dying of AIDS than people receiving treatment. We’re concerned that even for those people who’ve managed to get onto treatment up to this point, sustained access to treatment is now under threat”, said Heywood. 
According to a report compiled by the department’s Integrated Support Task Team (ISTT), which was given to Health Minister Dr Aaron Motsoaledi, mismanagement is one of the reasons for this looming crisis.  
“He (Minister Motsoaledi) confirmed our suspicions in terms of mismanagement, lack of planning and proper budgeting on health. As a result, in the Free State, one of the findings is that for three weeks in one hospital there haven’t been ARVs. Is what’s happening in Free State unique? No, it’s not unique”, said Dubula.
The BEMF is now calling for a unified approach that will include the private health sector to avert the situation.
“The private health sector is escaping the burden of responsibility for the AIDS epidemic. We are saying to Minister Motsoaledi, ‘don’t just talk about this NHI thing sometime in the future’. If you want to build a unified health service, start building it around the response to the AIDS epidemic and demonstrate through the response to the AIDS epidemic that something can be done that can be applied to other aspects of the provision of healthcare”, suggested Heywood.
“We say to the Minister of Health and to (President) Jacob Zuma, ‘it’s not a choice, it’s a duty that faces you’, he said.
The BEMF was launched by various non-governmental organisations (NGOs) after the ISTT’s report was “leaked” to Heywood. The ISTT was formed by government to probe ARV shortages in the Free State, which led to the imposition of a controversial moratorium that stopped the provision of ARVs to new AIDS patients late last year.


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Towards A Lively, Accountable AIDS Council. 17/9/09

Dr Nono Simelela, newly-appointed Chief Executive Officer of the South African National AIDS Council, promises to improve the way in which SANAC will function in the future.

Living with AIDS # 405
Khopotso Bodibe; Health - e
Dr Nono Simelela left South Africa six years ago after resigning as Chief Director of the HIV/AIDS, TB, STI’s cluster under former Health Minister Dr Manto Tshabalala-Msimang. At the time, Dr Simelela said that she had left the Department “for personal reasons”.  But she confirms that she was frustrated by working in a department that seemed unable to respond adequately to the AIDS epidemic. But, she says, this has changed.
“Ever since I’ve been here there has been an amazing level of positive energy. There is a new dialogue between civil society and government. Somebody was making a joke, actually, that ‘all the people who had abandoned the Department of Health are coming back’,” she said.
Siemelela, herself, is now back as Chief Executive Officer of the South African National AIDS Council (SANAC) on a five-year contract.
The role of SANAC includes the co-ordination of all AIDS programmes, monitoring the implementation of the National Strategic Plan on HIV and AIDS, collecting information to inform policy and advising Cabinet on the best possible action on HIV/AIDS. In the few weeks that she has occupied her modest office at the Development Bank of South Africa in Midrand, Simelela has identified the first major challenge that needs attention within this scope of work.    
“I think the biggest challenge we’re facing now is the absence of a robust monitoring and evaluation framework. That, as far as I can see, is the most critical aspect and my priority as I start here because we can only really invest properly if we know where we are and where the gaps are”, she says.
“At the moment we know the number of patients who have been initiated on treatment, but I don’t know that we can confidently say where all those people are, whether they are still taking medication. And then the rest of the interventions by civil society and other government departments… there isn’t a common frame-work where you can put all of those efforts in, document what is happening so we can measure how far we are from the targets that we’ve set”, she continued.
Is South Africa likely to meet the targets it set itself in the National Strategic Plan on HIV and AIDS, I asked.
“Honest people will tell you, ‘no’, and I would tend to agree with that. We’ve made progress, but we set very ambitious targets in that NSP”, was Simelela’s reply. 
She lamented the fact that there is nothing much that SANAC can do to ensure accountability that targets made are met. In its current form as an advisory body to Cabinet, the SANAC does not have a legal status. That means that no policy can be enforced through the SANAC, which was not the vision that inspired the inception of the body, in the first place. But as the response to the AIDS epidemic grows and more players come on board, says Simelela, there is a need to review SANAC’s status to give it more power as opposed to simply being an advisory body so as to ensure accountability.
“We’re using information from other sub-Saharan countries that have got National AIDS Commissions – some of them established through an Act of Parliament, others established in different ways - and then we’ll investigate which is the best option for South Africa. I think the key thing is, really, to ensure that SANAC is able to discharge its mandate in line with what the response requires and that does need some areas where you can tie things and make people accountable because at the end of the day we have to be able to account on the things that we have done and government has to also demonstrate how many policies were presented to Cabinet as recommendations; how many of those policies or recommendations were adopted by Cabinet; if not, what were the reasons for doing that; what have the implications been. None of that has been happening, actually. And that is what SANAC should be doing”, Simelela said.            


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Long Way From Treatment Target. 16/9/09

South Africa is not on track to meet its target of reaching 80 percent of people in need of antiretroviral (ARV) treatment by 2011, Health Minister Aaron Motsoaledi told reporters.

JOHANNESBURG, 16 September (PLUSNEWS) - South Africa is not on track to meet its target of reaching 80 percent of people in need of antiretroviral (ARV) treatment by 2011, Health Minister Aaron Motsoaledi told reporters on 15 September.

 A five-year National Strategic Plan (NSP), adopted in 2007, set ambitious targets for the HIV/AIDS programme and was viewed as the beginning of a new era of greater government commitment after a decade of official foot-dragging and denial about the extent of the epidemic.

 But Motsoaledi, who took office in May 2009, said a R1-billion (US$123 million) funding shortfall, combined with a shortage of skilled healthcare workers and an ailing and overburdened public health sector, was hampering efforts to roll out ARV treatment, and the programme was still only covering 700,000 people - about 50 percent of the target set in the NSP.

 Mark Heywood, director of the AIDS Law Project and deputy chair of South Africa's National AIDS Council (SANAC), said 700,000 was likely an overestimate, as it reflected the number of people who had started taking ARVs since the programme began in 2004, rather than the number currently on treatment. "It's generally accepted you can lop 20 percent off that figure," he told IRIN/PlusNews.

 Heywood welcomed the health minister's honesty, but cautioned against giving up on the NSP targets. "It's easy enough to just say we're not going to meet the targets, but it means we're effectively writing off quite a number of people's lives," he said.

 "The challenge for him is to convene stakeholders and try to develop a plan that includes finance, ensuring the medicines are there, and ensuring the health systems are in place."

 National health department spokesperson Fidel Hadebe said Motsoaledi was in discussion with provincial health departments and had instructed his deputy minister to meet with the health minister of Free State Province, where the delivery of ARV treatment has been particularly erratic.

 Runaway overspending by the Free State health department in 2008 led to a four-month moratorium on new patients starting ARV treatment, and another crisis is looming - HIV/AIDS activists are warning that understaffed clinics and long waiting lists are preventing many patients from accessing ARVs.

 "We need to jack up our implementation," said Hadebe. "If you keep having other Free States then that is going to limit your prospect of reaching the target."

 Civil society groups have been talking about the R1-billion (US$123 million) shortfall in the ARV programme for several months, but Motsoaledi's comments were the first official confirmation of the situation.

 The health department has requested additional money from the Treasury, but has also appealed to international donors for assistance. Hadebe declined to name the possible donors but said sustainability of the treatment programme would also depend on finding government funding sources.

 Francois Venter, director of the Southern African HIV Clinicians Society, pointed out that the health sector had been underfunded for many years. "It will require massive resources to get back confidence in the [public] health system, and the people who are hurt the most are the poor who can't move to the private [health] sector," he told IRIN/PlusNews.

 "Motsoaledi is a man of integrity and I think he's being realistic, but the previous cabinet must hang their heads in shame for allowing [former President Thabo] Mbeki and [former Health Minister Manto] Tshabalala-Msimang to continue their mismanagement of the health system for the last 10 years."

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SA Lags Behind Africa With AIDS Campaigns 11/9/09

Too much talk and too little action, says minister.

September 11 2009, IOL

South Africa is lagging behind the rest of Africa with its HIV and Aids campaigns because it talks too much and acts too slowly, Health Minister Aaron Motsoaledi said on Friday.

"It's not a secret that we didn't do well," he told a South African National Aids Council (Sanac) meeting in Johannesburg.

"If the scourge of HIV and TB [Tuberculosis] is a snake, the head is South Africa. If you want to kill a snake, you start with the head and it will die."

Motsoaledi said South Africa's slow response to the pandemic was raised at a meeting in New York in June.

UNAIDS executive director Michel Sidibe called him in for a meeting to discuss this, said Motsoaledi.

"He said: 'Look, I've got a message for you. I've met several leaders on Africa and they say that if South Africa doesn't wake up to fight this epidemic, the whole continent will go down.'"

He received a similar message from former Botswana president Festus Mogae at a summit of African health ministers in Kigali last week, said Motsoaledi.

"Festus Mogae said: 'We can understand the poor statistics in the rest of the region, but how do we explain South Africa, a highly industrialised country?'."

The minister said South Africa wasted too much time "debating" the pandemic.

"Many African countries are implementing; South Africa is still debating."

South Africa wanted to reach 80 percent of people who need treatment with anti-retroviral drugs by 2011, he said.

"That will mean 2,3 million people. At the moment we have 700 000 [people on ARVs] and the country is already feeling the weight.

"If we were to increase that number to 2.3 million? I mean, that is scary, that is like climbing Mount Everest without oxygen," said Motsoaledi. - Sapa

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SOUTH AFRICA: Who's Who on the National AIDS Council. 8/9/09


JOHANNESBURG, 8 September 2009 ( PlusNews) - The South African National AIDS Council (SANAC), long inactive, is showing signs of life. The revived secretariat moved out of the Department of Health and acquired a new CEO on 1 September, and recently flexed some of its new-found muscle when it recommended that government change outdated treatment guidelines.
IRIN/PlusNews introduces some of the faces behind what could soon be one of the country's most influential HIV/AIDS bodies.
Chairperson: Kgalema Motlanthe, South Africa's Deputy President
Motlanthe assumed the post of SANAC chairperson, always held by the country's deputy president, after national elections in May 2009. He earned praise from AIDS activist for replacing controversial health minister Manto Tshabalala-Msimang with the popular and efficient Barbara Hogan during his brief tenure as South Africa's President from September 2008 to May 2009.
Chief Executive Officer: Dr Nono Simelela
After becoming the first black South African woman to qualify as a specialist obstetrician and gynaecologist, Simelela spent 20 years working for the Department of Health before becoming head of the National HIV/AIDS/TB Programme in 1998 under Tshabalala-Msimang.
She stayed in the post until 2004, when she left for Britain to lead the International Planned Parenthood Federation's technical knowledge and support division in London. She outlined some of SANAC's future priorities in an August interview with IRIN/PlusNews.
Deputy Chairperson and Law and Human Rights Sector: Mark Heywood
Heywood was active with the local AIDS lobby group, Treatment Action Campaign, and spent years lobbying to revive SANAC before being elected its Deputy Chairperson in 2007. He also represents the Law and Human Rights Sector in SANAC, which works to safeguard the rights of people affected by HIV and AIDS.
He currently serves as executive director of the AIDS Law Project, which uses the law to protect the human rights of those with HIV/AIDS.
Children's Sector: Dr Ashraf Coovadia
One of the country's best-known HIV paediatricians, Coovadia was an obvious choice to represent the sector charged with ensuring that children's HIV care, treatment, support and prevention receive adequate attention.
Coovadia heads paediatric HIV services at the Rahima Moosa Mother and Child Hospital in Johannesburg, and has been a vocal advocate for scaling up prevention of mother-to-child HIV transmission services (PMTCT). He argues that improving these services is one of the sector's biggest challenges, along with reducing delays in diagnosing and treating HIV-positive children.
Women's Sector: Dr Samukeliso "Samu" Dube
A public health physician, researcher and activist, Dube says women need their own sector, with its own specific agenda, because of their greater biological and socio-economic vulnerability to HIV. "It's not a case of one size fits all; what works for men does not necessarily work for women."
The sector's priorities include increasing access to the female condom and ensuring that research addressing HIV prevention among women remains a priority.
Dube is the Africa programme leader for the Global Campaign for Microbicides, and a committee member of Physicians for Human Rights in her native Zimbabwe. She was co-investigator on several HIV-prevention trials at the University of Limpopo in South Africa.
Deborah Baron, coordinator of the Microbicides Media and Communication Initiative, noted that Dube's scientific background and passionate advocacy for women are critical to the sector.
Business Sector: Brad Mears
Before becoming CEO of the South African Business Coalition on HIV and AIDS (SABCOHA) in 2005, Mears worked as an industrial relations consultant and was head of the HIV and AIDS programme of the Chamber of Commerce and Industry in the east-coast port of Durban.
"He understands the business environment very well," Paul Davies, chairman of The Aurum Institute, a health NGO that has helped several large companies implement HIV policies in the workplace, told IRIN/PlusNews. "He brings a different perspective to SANAC in representing a sector that is quite capable and willing to participate in the management of HIV."
People Living with HIV/AIDS Sector: Vuyiseka Dubula
Dubula is the secretary-general of the Treatment Action Campaign (TAC), a well-known AIDS lobby group that won a court case against the government in 2002, forcing it to begin providing prevention of mother-to-child HIV transmission (PMTCT) services.
She was diagnosed HIV positive in 2001, joined the TAC months later and worked her way up from local organizing in and around Cape Town to her current position, which she took up in 2008.
The sector advocates for the needs, rights and concerns of people living with HIV (PLHIV), but Dubula has her work cut out trying to unite the representatives of TAC and the National Association of People Living with HIV/AIDS (NAPWA), which each have their own PLHIV sector in SANAC and have yet to join forces.
Denise Hunt, executive director of the AIDS Consortium, a membership organization for local NGOs working in HIV and AIDS, said: "She's been at all the different levels of activism and ... is able to apply [that understanding] at a strategic level."
Research Sector: Dr Olive Shisana
As head of SANAC's research sector, Shisana will help formulate a research agenda that provides scientific support to national HIV/AIDS policies. In 2005, Shisana became the first black woman to be appointed president and CEO of South Africa's Human Sciences Research Council (HSRC).
In her almost 20 years in public health she has overseen the World Health Organization's Family and Community Health Cluster, served as director-general of South Africa's Health Department, and worked as principal investigator on a number of large studies, including the third National HIV Prevalence, Incidence, Behaviour and Communication Survey, released in June.
Shisana cites lack of funding for the sector's work as the main challenge to achieving top priorities such as further research into male circumcision and re-examining prevention approaches.
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Minister Vows To Address Maternal And Child Deaths 4/9/09


Health Minister Dr Aaron Motsoaledi declared war on maternal and child deaths at a summit held recently in Johannesburg.
“It’s definitely not acceptable that mothers should die from what could be avoidable causes. It is actually primitive to allow mothers to die when they are supposed to be celebrating the bringing of life on earth. We can’t allow it”, said Dr Motsoaledi.
Maternal mortality is defined as deaths of women during pregnancy, child-birth or shortly after giving birth.
Motsoaledi told healthcare practitioners attending the summit that, “having just one woman dying has adverse effects”.
“It brings poverty. It brings social disruption. It brings psychological disruption”, he said.  
Three different committees working under the Department of Health have been investigating maternal, infant and child deaths. They present their findings and make recommendations every two years.
Dr Motsoaledi said he was “shocked” when he was presented with the findings.
Professor Jack Moodley, chairperson of the maternal deaths committee, told the summit that:
“We get about 140 maternal deaths per 100 000 live births, annually. KwaZulu Natal has the largest percentage of deaths and that’s because KZN is the most populous and it’s probably the most rural of provinces”.
“We should provide training for all professionals working in maternity units on all practical obstetric and surgical skills – and skills in anaesthesia. One of the things we are not very good at is post-natal care and we must, in fact, strengthen that”, said Prof. Moodley.
The second committee tasked with investigating the deaths of children under the age of five, also painted a gloomy picture.
Its Chairperson, Prof Neil McKerrow, said that, “there are huge inter-provincial variations in infant mortality, ranging from as low as 25 to as high as 71 young babies in the first year of life dying for every 1 000 babies born.
If you look at the under five mortality, exactly the same discrepancies across the provinces, ranging from lows in the low 30’s right up to mortality figures well over 100 per 1 000 children dying before they reach the age of five”, he said.
The Chairperson of the third committee focusing on infant deaths, Prof. Sthembiso Velaphi, said, “46% of neonatal deaths are due to prematurity and 29% are due to asphyxia”.
Asphyxia is a condition resulting from the short supply of oxygen to the body that arises from being unable to breathe normally and may lead to suffocation.
Prof Velaphi pointed out that something can be done to avoid these deaths.
“We can focus our attention in giving the best care in looking after premature babies and managing babies with asphyxia or preventing asphyxia”.
He emphasised that “two thousand deaths could be prevented every year”.
Health Minister, Dr Aaron Motsoaledi, said that government has good policies, but questioned the challenge in implementation of the programmes.
“Many countries that are poorer than us have much better health outcomes. I want to know: What are the bottle-necks to implementing our policies?”, he asked.
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The Lancet Reviews Healthcare in SA. 29/8/09

Lyn’s Comment: A series was published by UK-based medical journal, The Lancet, written by some of the country's leading researchers, doctors and public health specialists. These articles are critical of the South African health situation. It seems as if the South African government’s reaction to this criticism has changed quite a bit. New South African Health minister, Aaron Motsoaledi, admitted that this often harsh criticism may be accurate.

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Health System Failing Mothers And Babies. 26/08/09

JOHANNESBURG, 26 August (PLUSNEWS) - Each year in South Africa, an estimated 76,600 women, newborns and children die from preventable and treatable causes, putting the country among only a dozen in the world that have backtracked on the Millennium Development Goal (MDG) of reducing child mortality by 2015.

Although HIV/AIDS has played a major role in the high rates of maternal and child mortality, between a quarter and a half of maternal and child deaths are the result of health-system failures, according to a report in "Health in South Africa", a new six-part series published in the UK-based medical journal, The Lancet.

Despite steadily rising investment in maternal and child health since 1994, health outcomes have failed to improve. The authors identify bottlenecks at regional and tertiary hospitals as part of the problem, suggesting that with more training and support, a higher proportion of care could be provided by district hospitals.

Over-stretched and demotivated health workers are expected to deliver an increasing number of services with little supervision or monitoring. "Reports and observations of rude and sometimes abusive behaviour by health workers, especially in the maternal setting, are widespread," the authors noted.

A recent report on maternal mortality in South Africa said 38 percent of the maternal deaths at health facilities between 2005 and 2007 were avoidable, and included a failure to properly diagnose or manage post-delivery bleeding, hypertension and sepsis.

Prioritise HIV interventions

The Lancet authors said a strategy that "re-energizes and motivates" health workers was a priority, but scaling up HIV interventions for women and children had the potential to save the greatest number of lives. Non-pregnancy related infections, primarily HIV, account for 44 percent of maternal deaths, while 57 percent of deaths in children under five are believed to be HIV-related.

South Africa's prevention of mother-to-child HIV transmission (PMTCT) programme was belatedly launched in 2002 after a protracted legal battle between the government and Treatment Action Campaign, an AIDS lobby group.

However, the prevention effort has been dogged by poor leadership and a lack of integration into other maternal and child health interventions. "The legacy of a vertical response has created many conflicts that will be difficult to resolve," the authors commented.

The employment of thousands of lay counsellors in antenatal clinics increased the coverage of HIV testing to almost 70 percent of pregnant women by 2008, yet only 60 percent of those who tested HIV-positive, and 45 percent of their babies, received the antiretroviral drug, nevirapine, to reduce the risk of transmission.

Only about 10 percent of babies received postnatal care, and the rate of exclusive breastfeeding until six months - the safest option for HIV-positive mothers who did not have access to formula milk - was below 10 percent, the third lowest in Africa.

The Lancet authors estimated that achieving 95 percent PMTCT coverage and improving infant feeding practices could save the lives of 37,200 children a year and put South Africa on track to reach the MDG target for child mortality.

The cost of achieving this, along with better availability of basic neonatal care, was estimated at US$1.57 billion, or 24 percent of the public health budget, which the authors described as "affordable".

They emphasized that "The key gap is leadership and effective implementation at every level of the health system."

© IRIN. All rights reserved. HIV/AIDS news and analysis:

[This item comes to you from PlusNews, part of IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States. Reposting or reproduction, with attribution, for non-commercial purposes is permitted. Terms and conditions:]

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Health In South Africa In Need Of Intensive Care. 26/08/09

JOHANNESBURG, 26 August (PLUSNEWS) - A health system ill-equipped to cope with one of the most severe HIV epidemics in the world together with crushing burdens of non-communicable disease, maternal and child mortality and soaring rates of death from violence and injury.

This is the picture that emerges from "Health in South Africa", a new series released on Tuesday by UK-based medical journal, The Lancet, written by some of the country's leading researchers, doctors and public health specialists.

Six papers and six commentaries detail the roots of South Africa's health system challenges, its neglected epidemics of HIV and TB, persistently high rates of maternal and newborn deaths, a rising tide of non-communicable diseases such as diabetes, cancer and heart disease, and a burden of violence and injury which together form the country's second leading cause of death.

"Although South Africa is considered a middle-income country in terms of its economy, it has health outcomes that are worse than those in many lower-income countries," noted Prof Hoosen Coovadia of the University of Witwatersrand, and others, in the introductory paper of the series.

Little progress has been made towards achieving the health Millennium Development Goals (MDGs), the HIV/AIDS epidemic has not slowed, and progress has even been reversed in eradicating poverty and hunger, and reducing child mortality; South Africa is one of only 12 countries where child deaths have actually increased since 1990, partly due to HIV/AIDS.

Although the diagnosis for the health system is largely gloomy, the prognosis is upbeat - the authors felt that with strong leadership South Africa has the potential to overcome its high disease burden and huge health care inequities, and save hundreds of thousands of lives. "The health predicaments facing South Africa are some of the country's greatest threats since apartheid," said Richard Horton, editor of The Lancet, at the launch of the series in Johannesburg on 24 August.

South Africa's strong research base, active civil society and newly elected government, which has already made a commitment to major health care reform, put the country in a strong position to improve health outcomes and lead the way for the rest of the continent.

Leadership crucial

A recurring theme in the series is the paradox of poor health outcomes in the context of sound policies and relatively high spending. But poor leadership and a lack of accountability mean many policies have not been properly implemented, particularly at provincial and district levels, where there has been a persistent scarcity of management skills. "In the most striking example of poor stewardship, the national HIV/AIDS epidemic was allowed to spread, with relentless and massive yearly increases in prevalence," Coovadia wrote.

Former President Thabo Mbeki's "bizarre and seemingly unshakable belief that HIV did not cause AIDS" resulted in the loss of hundreds of thousands of lives and placed a calamitous burden on the health sector. President Jacob Zuma's administration has the mandate and potential to address these public health emergencies, but "Will they do so or will another opportunity and many more lives be lost?" The Lancet writers asked.

Where to from here?

Health Minister Aaron Motsoaledi, who took office in May 2009, agreed with the often harsh findings in the reports: "Clearly, in health we have arrived at the diagnosis; there can't be any argument. The problem is what do we do from there?" He noted that many of the recommendations in the series coincided with the ministry's 10-point action plan, and said there was still time to meet the MDGs if "we work together and have the will to succeed". In contrast to the combative style of previous health minister Manto Tshabalala-Msimang, Motsoaledi pledged to "extend our partnerships with all stakeholders". "It is critical that civil society, organized business and labour, researchers and academics in our country work with us to turn our health system around."

The to-do list is long, but both Motsoaledi and The Lancet authors prioritized implementing a national health insurance system, developing more effective and accountable managers, and adopting a more decentralized primary health care approach to bring services to communities.

Scaling up HIV and TB treatment and prevention, in particular the unacceptably high levels of mother-to-child HIV transmission, were also highlighted, with the caveat that the HIV/AIDS emergency not overshadow other urgent health priorities, such as the rising prevalence of non-communicable diseases.

Antiretroviral treatment means HIV-positive people will live longer and have a greater likelihood of developing diseases like diabetes and hypertension, said Prof Bongani Mayosi, head of the University of Cape Town's Department of Medicine. "We need to think of innovative ways to achieve a totally integrated system for infectious and non-communicable diseases." 

© IRIN. All rights reserved. HIV/AIDS news and analysis:

[This item comes to you from PlusNews, part of IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs. The opinions expressed do not necessarily reflect those of the United Nations or its Member States. Reposting or reproduction, with attribution, for non-commercial purposes is permitted. Terms and conditions:]

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Lethal Cocktail Of Epidemics. 25/8/09

South Africa has a “cocktail of four epidemics” – HIV/AIDS, tuberculosis, violence, poor maternal and child health and increasing chronic diseases.

Kerry Cullinan
Health in South Africa  
A special series of the Lancet focusing on South Africa spells out in painful detail how many of our health indicators are the worst in the world. But while our health system is littered with lost opportunities, the Zuma government brings the possibility of real progress, argue the series authors. Kerry Cullinan reports.
South Africa has a “cocktail of four epidemics” – HIV/AIDS, tuberculosis, violence, poor maternal and child health and increasing chronic diseases.
This is according to a special edition of The Lancet, the respected UK-based medical journal, focusing on health in South Africa which is being released in Johannesburg today (Tuesday, 25  August).
The Lancet makes depressing reading. Some of our statistics – such as for HIV, TB and interpersonal violence – are among the worst in the world. We are beset by racial and gender inequity ingrained by decades of colonialism and apartheid.
“Racial and gender discrimination, income inequalities, migrant labour, the destruction of family life and persistent violence spanning many centuries but consolidated by apartheid in the 20th century” are to blame for the current health problems, according to Professor Hoosen Coovadia and others, who wrote the introductory chapter.
The poorest 10% of households (mostly black) have an average annual income of R4 314 (mostly from grants) while the richest 10% get over ninety times this – some R405 646.
Health indicators are still badly racially skewed. In 2002, the infant mortality rate among whites was seven per 1000 babies born. For African babies, it was 67 per 1000.
There are also inequities between provinces. Western Cape children under five have a mortality rate of 46 per 1000 in comparison to KwaZulu-Natal’s 116 per 1000.
Sexual entitlement of boys is ingrained, with almost 40% of girls reporting that they were sexually abused before the age of 18.
Teen pregnancy is widespread, and half of all South African women have had at least one child by the age of 21.
The role of alcohol abuse is raised over and over throughout all the six chapters. It plays a major role in violence, including murder and rape, road accidents, unsafe sex.
“Rudeness, arbitrary acts of unkindness, physical assault and neglect by nurses have been widely reported” during the post 1994-era, according to the authors.
Aside from rudeness, there is also a shortage of skilled health staff. Thanks to the ill-conceived decision to close a number of nursing colleges to save money during former President Thabo Mbeki’s era and migration, the rate of skilled professional nurses has dropped from 149 per 100,000 people in 1998 to 110 per 100,000 in 2007.
“As many as 40% of nurses are due to retire in 5-10 years and nursing remains the most crucial area for urgent policy intervention,” note authors
Poor leadership and stewardship (taking responsibility) also run like a ruinous cancer through the public health system.
Post-1994, many inexperienced managers were placed in positions of seniority and they have struggled to deal with major challenges, particularly human resource management.
Unfortunately, “incompetence within the public sector is widespread” and government has lacked the “political will and leadership to manage underperformance in the public sector”. Loyalty rather than the ability to deliver has been rewarded.
There is no personal accountability. Leaders and managers have not been held accountable when mistakes have been made.
“Without concerted efforts to change national thinking on accountability, South Africa will become a country that is not just a product of its past but one that is continually unable to either address the health problems of the present or to prepare for the future,” assert Coovadia and others.
Former President Mbeki’s “bizarre and seemingly unshakeable belief that HIV did not cause AIDS” resulted in hundreds of thousands of lives lost and a substantial burden of ill health.
While “the public health system has been transformed into an integrated, comprehensive national service” the “ failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies”, conclude the authors.
Lancet UK editors Dr Richard Horton and Dr Sabine Kleinert conclude: “The South African people have shown extraordinary resilience during difficult times. The current leaders have survived apartheid, and often imprisonment, to fight for the future of their country. Civil society, with its strong voice, has brought about many important changes in health.
“South Africa is a young democracy with pride and hope, and above all with high expectations for a fair, equitable, and peaceful society. Its people deserve a healthy future.”
* Professor Hoosen Coovadia, Rachel Jewkes, Peter Barron, David Saunders and Di
McIntyre wrote Chapter 1, tracing the roots of current health challenges.
Click here to access the full series.
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Lethal Cocktail Of Epidemics. 25/08/09


Kerry Cullinan

Health in South Africa  


A special series of the Lancet focusing on South Africa spells out in painful detail how many of our health indicators are the worst in the world. But while our health system is littered with lost opportunities, the Zuma government brings the possibility of real progress, argue the series authors. Kerry Cullinan reports.

South Africa has a “cocktail of four epidemics” – HIV/AIDS, tuberculosis, violence, poor maternal and child health and increasing chronic diseases.

This is according to a special edition of The Lancet, the respected UK-based medical journal, focusing on health in South Africa which is being released in Johannesburg today (Tuesday, 25  August).

The Lancet makes depressing reading. Some of our statistics – such as for HIV, TB and interpersonal violence – are among the worst in the world. We are beset by racial and gender inequity ingrained by decades of colonialism and apartheid.

“Racial and gender discrimination, income inequalities, migrant labour, the destruction of family life and persistent violence spanning many centuries but consolidated by apartheid in the 20th century” are to blame for the current health problems, according to Professor Hoosen Coovadia and others, who wrote the introductory chapter.

The poorest 10% of households (mostly black) have an average annual income of R4 314 (mostly from grants) while the richest 10% get over ninety times this – some R405 646.

Health indicators are still badly racially skewed. In 2002, the infant mortality rate among whites was seven per 1000 babies born. For African babies, it was 67 per 1000.

There are also inequities between provinces. Western Cape children under five have a mortality rate of 46 per 1000 in comparison to KwaZulu-Natal’s 116 per 1000.

Sexual entitlement of boys is ingrained, with almost 40% of girls reporting that they were sexually abused before the age of 18.

Teen pregnancy is widespread, and half of all South African women have had at least one child by the age of 21.

The role of alcohol abuse is raised over and over throughout all the six chapters. It plays a major role in violence, including murder and rape, road accidents, unsafe sex.

“Rudeness, arbitrary acts of unkindness, physical assault and neglect by nurses have been widely reported” during the post 1994-era, according to the authors.

Aside from rudeness, there is also a shortage of skilled health staff. Thanks to the ill-conceived decision to close a number of nursing colleges to save money during former President Thabo Mbeki’s era and migration, the rate of skilled professional nurses has dropped from 149 per 100,000 people in 1998 to 110 per 100,000 in 2007.

“As many as 40% of nurses are due to retire in 5-10 years and nursing remains the most crucial area for urgent policy intervention,” note authors

Poor leadership and stewardship (taking responsibility) also run like a ruinous cancer through the public health system.

Post-1994, many inexperienced managers were placed in positions of seniority and they have struggled to deal with major challenges, particularly human resource management.

Unfortunately, “incompetence within the public sector is widespread” and government has lacked the “political will and leadership to manage underperformance in the public sector”. Loyalty rather than the ability to deliver has been rewarded.

There is no personal accountability. Leaders and managers have not been held accountable when mistakes have been made.

“Without concerted efforts to change national thinking on accountability, South Africa will become a country that is not just a product of its past but one that is continually unable to either address the health problems of the present or to prepare for the future,” assert Coovadia and others.

Former President Mbeki’s “bizarre and seemingly unshakeable belief that HIV did not cause AIDS” resulted in hundreds of thousands of lives lost and a substantial burden of ill health.

While “the public health system has been transformed into an integrated, comprehensive national service” the “ failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies”, conclude the authors.

Lancet UK editors Dr Richard Horton and Dr Sabine Kleinert conclude: “The South African people have shown extraordinary resilience during difficult times. The current leaders have survived apartheid, and often imprisonment, to fight for the future of their country. Civil society, with its strong voice, has brought about many important changes in health.

“South Africa is a young democracy with pride and hope, and above all with high expectations for a fair, equitable, and peaceful society. Its people deserve a healthy future.”

* Professor Hoosen Coovadia, Rachel Jewkes, Peter Barron, David Saunders and Di

McIntyre wrote Chapter 1, tracing the roots of current health challenges.

Click here to access the full series.


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A Nation Killing Itself. 25/08/09

Kerry Cullinan
(Article on The ‘violence and injuries’ paper in the Lancet series, written by Mohamed Seedat, Ashley van Niekerk, Rachel Jewkes, Shahnaaz Suffla and Kopano Ratele.)

A Cuban doctor once told me that South Africa’s national sport was hurting one another. The chapter on violence and injuries, South Africa’s second biggest killer after HIV/AIDS, is a chilling reminder of his comment.

Deaths from violence and injuries in South Africa are almost double the global average, while the death rate of South African women killed by their intimate partners is six times the world norm.

Some 3.5million people seek healthcare for injuries, half of which are caused by violence.

Young men aged 15 to 29 are the most affected, both as victims and perpetrators, with seven times as many men than women dying in homicides. The “Coloured” population is also disproportionately affected by homicides.

Women were more likely to be killed by their male intimate partners than by strangers, especially those aged 14 to 44.

Alcohol features prominently in almost violent attacks. Some two-thirds of women murdered by their partners in the Western Cape had high alcohol rates in their blood, according to a study.

Child homicides are double those of other low income countries, with boys aged 10-14 most in danger of being killed.

More than 40% of men admitted to being physically violent towards their partners, while 88% of Soweto women reported either physically or psychological abuse by partners.

Although the murder rate in the country has been reduced, there has been little reduction in the rape rate and a random population-based sample found that over a quarter of men (27.6%) admitted to having committed rape. Most men first rape before the age of 20, and half of these will rape again. Up to 14% of men admit to taking part in gang rape.

In 2003 in Gauteng, one in 35 rape cases reported involved victims aged between one and three years old, while 40% were under the age of 18.

Almost four in 10 girls report experiencing sexual violence before the age of 18, and most of this is not reported to the police.

“Girls exposed to sexual abuse as young children are at increased risk of being raped again in childhood and of experiencing intimate partner violence as adults,” note authors Prof Mohammed Seedat and colleagues.

“Boys who have been sexually abused in childhood are at risk of later becoming sexual abusers.”

In addition, many children witness violence, with 35 to 45% of children having seen their mother being beaten. Boys who witnessed this were more likely to beat their partners.

South Africa’s road traffic death rate is also nearly double the global rate, and this has steadily increased since 2003. In 2007, four out of 10 traffic deaths were of pedestrians and deaths usually peaked over weekends.

Again alcohol played a prominent role in traffic deaths, with over half dead pedestrians and almost half the drivers who killed them over the legal limit.

“Alcohol misuse, and in some parts of the country drug misuse, are major factors underlying homicides, intimate partner violence, rape, abuse of children, road deaths and other unintentional injuries,” note the authors.

They estimate the “health and social cost” of alcohol misuse to be R9-billion a year.

Excessive speed was the main culprit in 30-50% of public passenger and heavy commercial accidents.

“Income inequality, low economic development and high levels of gender inequality are strong positive predictors of rates of violence and injury,” note the authors.

The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking, and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement.

In addition, during apartheid there was very little common-law policing particularly in historically black areas and some properly crimes were justified as “redistribution of wealth” and “in general, people resisted abiding by laws.. consequently lines between criminal and community were blurred and an ambiguity about enforcement emerged”. 

Although there have been advances in development of services for victims of violence, innovation from non-governmental organisations, and evidence from research, the authors say that there has been a “conspicuous absence of government-promoted stewardship and leadership”.

The authors conclude: “The government should identify reduction in violence and injuries as a key goal and to develop and implement a comprehensive, national intersectoral, evidence-based action plan.”

Inventions must address youth unemployment, gender inequality, intergenerational violence, excessive alcohol consumption and uncontrolled access to firearms. – Health-e News

* The ‘violence and injuries’ paper was written by Mohamed Seedat, Ashley van Niekerk, Rachel Jewkes, Shahnaaz Suffla and Kopano Ratele.


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The Paradox Of Apparent Progress Yet Worsening Health Outcomes. 25/8/09

South Africa is one of only 12 countries in the world where the mortality rate for our children has got worse since 1990.

Kerry Cullinan

Despite the health of women and children being a priority for the democratically elected government, South Africa is one of only 12 countries in the world where the mortality rate for our children has got worse since 1990.

“Each year, an estimated 2 500 mothers die, 20,000 babies are stillborn, another 21,900 die before the age of one and an additional 52,600 die before their fifth birthday, most from preventable and treatable causes,” according to authors Mickey Chopra and colleagues.

HIV/AIDS is the biggest killer of both mothers and children. Pregnant HIV positive women are 10 times more likely to die in, or shortly after, childbirth than HIV negative women. Infections, mostly HIV/AIDS, cause 44 percent of maternal deaths.

Aside from addressing HIV/AIDS, poor healthcare also contributes to maternal and child deaths.

The latest “Saving Mothers” report (2007 figures) claims that 38 percent of maternal deaths in the healthcare system were “clearly avoidable”. Most were failures in care such as managing port-labour bleeding, hypertension and sepsis.

The deaths of 44 percent of babies who suffocate in the womb (intrapartum asphyxia) were “probably avoidable”, according to the latest “Saving Babies” report. The deaths of about 1,180 babies in district hospitals of birth trauma and intrapartum asphyxia were “clearly avoidable”, had the healthcare provider acted differently.

District hospitals remain the most dangerous places to give birth with twice as many babies’ deaths than at regional and tertiary hospitals, despite the fact that these hospitals deal with more complicated cases.

Using a special analysis tool called “Lives Saved Tool” (LiSF), the authors estimate that 11,500 newborns could be saved just by ensuring that a comprehensive, essential package of care was implemented properly in 95 percent of births. This package contains nothing fancy, covering simple things such as proper foetal heart monitoring, antenatal steroids for preterm babies and routine postnatal care.

One of the biggest life-savers would be the proper implementation of prevention of mother-to-child HIV transmission (PMTCT), which could save a massive 50,000 babies and children in 2015.

But the PMTCT programme has “suffered from a lack of leadership” and needs to be integrated into an overall care package for mothers and babies.

Implementing the package of care and HIV prevention would cost an estimated 24 percent of the health budget, or some R15,7-billion. To achieve this package, women would need to pay more visits to health facilities (an increase of 9.4 million visits) so more staff would be needed.

This accounts for  61 percent of the cost as the authors estimate that 189 more doctors, 2 445 professional nurses, 250 enrolled nurses and 134 nurse assistants are needed.

The other major costs are more drugs (22 percent), laboratory tests (5 percent) and overheads (12 percent). – Health-e News.

* The paper on ‘mothers, babies and children’ is written by Mickey Chopra, Emmanuelle Daviaud, Robert Pattinson, Sharon Fonn and Joy Lawn.


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S. Africa Embraces Study Critical of Health Policy. 24/08/09

NY Times

Published: August 24, 2009

JOHANNESBURG — Leading South African scientists challenged the governing party on Monday to break with its deeply flawed record on AIDS and public health, spurring the country’s new health minister to say that he and his party shared their diagnosis of systemic problems and were determined to repair them.

The decision by the health minister, Dr. Aaron Motsoaledi, to embrace the often withering assessment of his party’s failings, laid out in six papers published online Monday by The Lancet, a medical journal based in London, provided a strong signal that the governing party’s new leadership intended to shake up a badly managed health system.

It was also evidence that the long often strained relationship between the government and the country’s senior medical researchers, who at times saw their cutting-edge scientific findings ignored by their political leaders, could be coming to an end.

“We do take responsibility for what has happened and responsibility for how we move forward,” said Dr. Motsoaledi, who took charge of the Health Ministry in May.

He also said, “I am feeling quite at home and comfortable with this Lancet report.”

South Africa, still struggling to overcome the legacy of the racist apartheid system, has H.I.V. and tuberculosis epidemics that are among the world’s worst. The rate at which women here are killed by intimate partners is six times the global average.

It is also one of only a dozen nations in the world where child mortality has risen since 1990 — a period when many countries, including African ones far poorer than South Africa, have seen significant declines. South Africa, which delayed carrying out dual drug therapies proved to prevent the transmission of H.I.V. from mother to baby, could save some 37,000 children’s lives a year by 2015 by broadening the provision of such therapies, the researchers estimated.

Dr. Motsoaledi vowed Monday that he was committed to eradicating such deaths. “If others can do it, why can’t South Africa?” he asked.

The team of Lancet authors — public health doctors, epidemiologists, health economists and other researchers from South Africa — said the April elections that brought the new leadership of the governing African National Congress to power offered an opportunity for change.

The party has run the country since apartheid ended 15 years ago, but the new president, Jacob Zuma, had for years been at odds with his predecessor, Thabo Mbeki, and has pledged a new direction. South Africa’s approach to AIDS and health began to shift significantly last year after Mr. Mbeki was forced out of office by his own party and Barbara Hogan was named health minister.

The current government “has the mandate and potential to address the public health emergencies facing the country,” the authors wrote, adding, “Will they do so, or will another opportunity and many more lives be lost?”

The scientists described the calamitous and now familiar consequences of what they called Mr. Mbeki’s “bizarre and seemingly unshakable belief that H.I.V. did not cause AIDS.” But they went further to detail the management failures of his health minister, Manto Tshabalala-Msimang, that too often crippled the quality of services even after good policies were adopted.

“South Africa is this great paradox of excellent policies,” said one of the main authors, Prof. Salim S. Abdool Karim, who leads the Durban-based Center for the AIDS Program of Research in South Africa. “The problem is they can’t implement them.”

In The Lancet, the authors decried what they described as “a stubborn tendency to retain incompetent senior staff and leaders, including (until recently) the former minister of health. As a result, for many years, loyalty — rather than an ability to deliver — has been rewarded in the public sector.”

The authors of the papers prescribed what they considered an affordable agenda to improve the health system, including a more strategic effort to prevent the further spread of H.I.V.

The potential to contain the AIDS epidemic “was irretrievably lost,” they wrote.

South Africa, with less than 1 percent of the world’s population, now bears 17 percent of the world’s burden of H.I.V. infection. It has more H.I.V.-infected people than any other nation.

Expanding efforts to prevent mothers from infecting their babies and to discourage people from having multiple sexual partners, as well as moving urgently to routinely offer circumcision to men — a relatively simple surgical procedure proved here in South Africa to more than halve their risk of infection — could help the government achieve its goal of halving new infections.

But doing so will be no easy task. Dr. Motsoaledi, asked when South Africa would adopt a policy to promote circumcision, said that before moving forward the country still needed to consult leaders of various ethnic groups. Some of them practice circumcision, while the Zulu, the country’s largest ethnic group, do not. The World Health Organization recommended circumcision more than two years ago as an effective H.I.V. prevention method.

Still, there is no question that the tone of the debate between the government on one side, and scientists and advocates on the other, has lost the contentious edge that often characterized it during the Mbeki era.

Dr. Motsoaledi noted Monday that he had been classmates with Dr. Karim at the University of Natal’s medical school in the early 1980s. Dr. Motsoaledi and Dr. Karim were both students of another of the report’s authors, Hoosen M. Coovadia, a pediatrician and professor of H.I.V./AIDS at the University of KwaZulu-Natal.

“I’m quite happy and excited about this gathering and the report,” Dr. Motsoaledi said.

Professor Coovadia repaid the compliment, saying, “I’m so pleased we’ve reached a moment when we’re all going to work together.”

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AIDS, Violence Burden Health Care In S.Africa: Studies. 24/8/09

A lack of leadership has left South Africa's health system burdened by rampant HIV, poor maternal and child health services, and violent crime, doctors said in The Lancet.

By Courtney Brooks

"Although South Africa is considered a middle-income country in terms of its economy, it has health outcomes that are worse than those in many lower income countries," South African doctors said in the British medical journal.

The journal published a series of articles highlighting the challenges facing South Africa's health system, which has been transformed into a comprehensive national service 15 years after the end of apartheid.

But the country faces a collision of epidemics including AIDS and tuberculosis, as well as a high level of deadly violence and poor services for mothers and children, the articles said.

Health Minister Aaron Motsoaledi described the country's the health system as in trouble.

"Both the private and public sectors are in trouble. As government we take responsibility of the mistakes especially with regards to HIV/AIDS where wrong policies were adopted," he said at a press conference.

"However, some of the problems we have inherited from apartheid and colonialism," he added.

Motsoaledi met Monday with a team of international experts, including the articles' authors, in Johannesburg to discuss ways to battle South Africa's health challenges, which the articles blamed on weak leadership.

"Failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies," South African researchers said in one article.

Former president Thabo Mbeki for years denied the threat posed by AIDS, questioning whether HIV causes the illness and delaying the rollout of life-prolonging drugs.

Lancet editor Richard Horten said the election of President Jacob Zuma earlier this year offered an opportunity to redress the mistakes of the past.

"The catastrophic failure of previous leadership to address certain health issues has broken the trust of the South Africa public and betrayed the trust of the international medical community," he said.

The articles highlighted gaping differences in health care among South Africa's provinces, pointing to the lack of national coordination.

In the Western Cape, home to Cape Town, 80 percent of tuberculosis cases were cured in 2007. In KwaZulu-Natal, where the port city of Durban is located, the rate was as low as 40 percent.

Poor mother and child services mean South Africa was among just 12 nations that saw child mortality increase since 1990, the journal said.

AIDS remains the biggest challenge to South Africa's health system, with 5.5 million people living with HIV -- about 17 percent of the world total.

But many people with HIV also suffer from tuberculosis, while ailments like obesity, heart disease, substance abuse and anxiety and depression are also on the rise, the articles said.

South Africa's alarming crime rate poses another burden to the health system, the articles said, including the high incidence of homicide, domestic abuse and rape.

The violent death rate in South Africa is nearly five times the average worldwide, according to the report.

"Violence is profoundly gendered, with young men (aged 15-29 years) disproportionately engaged in violence both as victims and perpetrators," the researchers said.

"Half the female victims of homicide are killed by their intimate male partners and the country has an especially high rate of rape of women and girls."

Copyright © 2009 AFP. All rights reserved.


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SANAC CEO Charts New Direction For Slumbering Giant. 20/8/09


JOHANNESBURG, 20 August 2009 (PlusNews) - The South African National AIDS Council (SANAC), long perceived by activists as largely dormant, awakened to make groundbreaking recommendations to government earlier this month. Dr Nono Simelela, who takes over as the new CEO on 1 September, spoke to IRIN/PlusNews about where she would like to take the council.
Despite the challenges, Simelela said she was drawn to her new post at SANAC primarily because it would offer her a chance to work in a sector she feels passionately about, and in what she called a “conscious environment” – given current political leadership – which the country desperately needed.
Simelela was the first South African black woman to qualify as a specialist obstetrician and gynaecologist, which led to a 20-year career in the Department of Health, culminating as chief director of the National HIV, AIDS and TB programme in 1998 until she left in 2004. It was a time when HIV treatment was largely unavailable and the fight against HIV/AIDS under the country’s then health minister, Dr Manto Tshabalala-Msimang, was heavily politicized.
“I think everyone knows it was a very challenging time in South Africa … in many ways. The magnitude of the epidemic was really brought to the fore, and the need to move quickly, in terms of treatment and care, was evident,” Simelela told IRIN/PlusNews on the phone from London, where she heads the technical knowledge and support division of the International Planned Parenthood Federation (IPPF).
“It was tough and you had to hang in there, [but] I think that it was necessary. The fact that we did get a plan and have people accessing treatment has been a huge positive outcome.”
She said South Africa’s antiretroviral programme – one of the world’s largest – remained one of its biggest achievements, but also noted the recurring drug shortages, poor monitoring and evaluation, and the need to slow new infections.
“We haven't really established a robust monitoring and evaluation system across all sectors, including government. We’ve got the National Strategic Framework, and targets that have been set, but we need a robust tool to monitor progress so we know what needs to be done,” she said.
“The fact is that we have an epidemic that is raging, and new infections are still occurring. We need to go back to the prevention side of things to look at what we’re not doing well enough.”
The road ahead
Simelela said she hoped the mix of local and international experience of the HIV epidemic would help her and SANAC make much needed changes. At the forefront would be strengthening provincial and district AIDS councils, which are not only points of service delivery but also collect crucial data.
“We have a lot of good policies, but when it comes to implementation they falter,” she said. “We need to be sure provincial and district councils are able to implement their HIV/AIDS plans. It should almost be a bottom-up approach - issues would come up at the district level and the national council would then look at ways of resolving them.”
Although long inactive, SANAC still provides a crucial interface between government and civil society, ensuring that the people implementing policies at whatever level are held accountable. Simelela told IRIN/PlusNews that the reawakened giant meant a renewed opportunity to make a difference in people’s lives.
“For me, it’s almost more about an agenda for social justice, not only to provide people with treatment but to raise issues around HIV, such as the economic issues that, I think, South Africa is grappling with now,” she said.
“There’s a way to respond but at the moment we need to coordinate that response – I get the sense that if we work collaboratively across all sectors, there is a chance we can turn things around.”


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‘AIDS-Free SA Is Possible’ 13/8/09

 Health E

Simelela gets a second chance to fight pandemic
DR NONO Simelela, former head of the country’s Aids programme, is returning to lead the South African National Aids Council.
Simelela, who signed on the dotted line at the recent International Aids Society meeting in Cape Town, left South Africa five years ago.
Though she maintained at the time that her decision was based on personal reasons, it was known that her work under the then Health Minister Manto Tshabalala-Msimang had become untenable.
One of Simelela’s health department allies in the fight to secure treatment for people living with HIV and prevention therapy for pregnant mothers, former health director-general Ayanda Ntsaluba had left in 2003 to join Foreign Affairs.
Simelela has been director of the technical knowledge and support division at the International Planned Parenthood Federation (IPPF) in London.
Speaking via e-mail from London Simelela said she was “very happy” to be coming back.
“I know things are going to be better,” she said. “I feel lucky to get a second chance to do this work with the support of all the stakeholders. An Aids-free South Africa is possible. We all need to believe this and work towards this vision.”
Sanac, the chairperson of which is Deputy President Kgalema Motlanthe, is primarily responsible for steering the country towards reaching the National Strategic Plan targets that include initiating 80percent of those needing treatment on antiretrovirals and halving all new infections by 2011.
Before joining IPPF, Simelela worked for 20 years in the Department of Health, initially as a senior lecturer and clinician in the department of obstetrics and gynaecology at the Medical University of Southern Africa.
She later became head of the National HIV, Aids and TB programme in the Health Department, a position she held from 1998 to 2004.
Despite attempts by Tshabalala-Msimang to drag her feet on any interventions involving antiretroviral drugs, Simelela led the early national programmes in prevention of mother-to-child transmission of HIV and with Ntsaluba played a pivotal role in the implementation of the country’s treatment programme. – health-e news
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SA Needs More ARV Research. 5/8/09


Johannesburg - Health Minister Aaron Motsoaledi called on the generic medicine industry on Wednesday to invest more into researching the long term effects of antiretroviral drugs.
He said HIV/Aids was a chronic disease which in some cases required people to already start taking medication in their 20s.
That meant some patients could end up using the drug for as long as 50 years.
Motsoaledi expressed concern about the unknown side effects of such long exposures to drugs.
"Should the generic industry not be investing more in post marketing? It is not an additional expenditure but an investment," he said.
Motsoaledi made the remark in a speech read out on his behalf by Anban Pillay, chief director of financial planning at the health ministry, at a conference on generic medicine in Sandton, Johannesburg.
The minister lamented the triple burden of disease on South Africa and said the worldwide outbreak of swine flu was making matters worse.
"The H1N1 virus adds to this [burden]," said Motsoaledi.
'Right to quality healthcare'
The triple burden of disease referred to communicable diseases, chronic diseases, and violence and injuries.
He said all South Africans had to the right to quality healthcare. South Africans had become too used to seeing long medicine queues at state hospitals.
"Every person must have access to essential medicine," the minister said.
Motsoaledi was scheduled to address the conference himself but cancelled late on Tuesday night due to an extended Cabinet meeting.
Another conference on generic medicine was being hosted in Sun City this week.
At the latter event, Vikash Salig, chief executive officer of Dr Reddy's Laboratories, warned against lower grade or incorrect concentrations of active pharmaceutical ingredients in generic medicine.
He said the Medicines Control Council recently reported on this happening, referring specifically to anti-tuberculosis drugs used in the public sector.
"Generic medicines are a safe and effective alternative to originator drugs for South Africa," said Salig.
"The incorrect use of raw materials has been addressed by the MCC. All companies (both generic and innovator) have to provide comprehensive documentation when changing a source of raw material."


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TAC Calls On National Health Council To Adopt SANAC Proposals. 4/8/09


For months now, TAC and the ALP have warned of the dire shortage of funds for the national antiretroviral treatment programme. Health Minister Motsoaledi has promised that sufficient resources will be mobilised to ensure against a repeat of the Free State moratorium on ARVs in other provinces. Provinces have reported that they have inadequate funds to continue ARV roll-outs, and that treatment stock-outs will result from September onwards unless the Department of Health and Treasury mobilise additional funds. Minister Motsoaledi has raised the possibility of ‘ring-fencing’ provincial ARV budgets to ensure that adequate funds are available for these essential medicines. TAC and the ALP support the Minister’s commitment to needs-based budgeting and to dedicating a budget to the specific provision of essential medicines.Over a thousand HIV-positive people in South Africa continue to die every day due to their inability to access ARVs in the public health sector. Government must mobilise the necessary funds to save the lives of people living with HIV by expanding the ARV roll-out and meeting the targets of the National Strategic Plan. Increasing funds for antiretroviral therapy will reduce costs of expensive clinical care for treating AIDS-related infections, as well as averting new infections.

The South African National Aids Council (SANAC) has approved numerous changes to our ARV treatment guidelines and recommended other significant changes to national HIV policy. The National Health Council will meet this week (6 August 2009) to discuss these changes, as well as the financial resources required for their implementation.

Changes to HIV/AIDS policy agreed upon during SANAC Plenary1)    Providing antiretroviral therapy (ART) at a CD4 count of 350 cells/mm3 Treatment guidelines call for patients to be initiated onto treatment at a CD4 count of 200, but the average CD4 count of a patient initiated onto treatment is 87(Venter 2009). Starting treatment earlier will reduce the burden and costs of opportunistic infections as earlier treatment strengthens a patient’s immune system, and helps to fight off infection. Research has shown that starting treatment at a CD4 count of 350 and above improves a patient’s chances of survival by 69% (Kitahata 2009).

Starting treatment earlier will also reduce new HIV infections. A patient’s viral load is a high risk factor for transmitting HIV to ones sexual partner or through mother to child transmission. Earlier treatment will reduce new infections as ART reduces a person’s viral load. Mathematical models have predicted that increasing the number of individuals diagnosed with HIV and on antiretroviral therapy has the potential to significantly slow the pace of the epidemic (Granich 2008).

2) Providing ART to all HIV-positive infants.

The Children with HIV Earlier Antiretroviral Therapy (CHER) trial conducted in South Africa showed the benefits of starting infants infected with HIV immediately on treatment. The investigators found that starting ART before 12 weeks of age reduced early mortality by 76% and HIV progression by 75% (Violari 2008). The results of the CHER study prove that early HAART initiation has a strongly protective benefit in HIV-positive infants, greatly reducing HIV disease progression and mortality. The WHO and US guidelines recommend early infant treatment on the basis of this study.3) Providing ART to all HIV-positive TB patients. South Africa has a growing TB epidemic. In South Africa, TB is closely linked to HIV and 53% of TB patients test positive for HIV. TB is the leading cause of death for people living with HIV. Recent research has shown that TB patients with HIV should be initiated simultaneously onto treatment for HIV and TB. Starting treatment simultaneously has been associated with a 65% increased survival rate (Velasco 2009). Scaling up access to ART is vital to reducing rates of new TB infections. It is essential that these changes are adopted by the National Health Council and that a plan is developed to mobilize adequate funds to support their implementation.
Background information What is the National Health Council? The National Health Council is an advisory body to the Health Minister made up of government officials. The National Health Council was established under the National Health Act, 2003 (Act No. 61 of 2003). Functions of the National Health Council are laid out in Section 23 of the National Health Act. These functions include advising the Health Minister on:

a) policy concerning any matter that will protect, promote, improve and maintain the health of the population including:
responsibilities for health by individuals and the public and private sector
targets, priorities, norms and standards relating to the equitable provision and financing of health systems
efficient coordination of health systems

e) the implementation of national health policy
The HIV&AIDS and STI Strategic Plan (2007-2011) is South Africa’s national health policy for the treatment and prevention of HIV/AIDS. The implementation of this policy is a function of the National Health Council.

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IAS Applauds South African Government for Commitment to Dramatically Scale Up HIV Treatment and Urges All Countries to Meet Their HIV/AIDS Commitments. 31/7/09

IAS 2009 Live

New Evidence Presented in Cape Town Shows Dramatic Reductions in AIDS and Non-AIDS Mortality and Morbidity with Earlier Treatment
31 July 2009 (Cape Town, South Africa) - The International AIDS Society (IAS) today applauded the South African government for moving quickly to consider a more aggressive approach to scaling up provision of antiretroviral therapy (ART) for people living with HIV across the country, in the wake of strong evidence of individual and community benefits of earlier treatment presented at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, held two weeks ago in Cape Town. The South African Health Council is reviewing its ART roll-out plans over the coming weeks.
Recent reports from WHO and UNAIDS on the global AIDS pandemic have indicated that substantial increases in HIV investments over the past several years have expanded access to ART and HIV prevention interventions, reducing AIDS-related morbidity, mortality and HIV incidence in many high-burden countries. The success of the global response to AIDS has also catalyzed increased funding for tuberculosis and malaria.
Evidence presented at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, held two weeks ago in Cape Town, demonstrated dramatic reductions in TB and malaria incidence in HIV-positive individuals. Furthermore, a number of presentations urged that universal provision of antiretroviral therapy (ART) to people living with HIV would have a major impact on reducing HIV transmission, in addition to keeping people alive, well and productive in their communities.
IAS President Dr. Julio Montaner noted, "The evidence is absolutely clear. We must treat people earlier, and we must achieve universal access to ART for all people living with HIV who need it. Future generations will judge how quickly the global community responds to this urgent priority. We must move from an emergency response to a sustainably financed plan to control the HIV epidemic within a generation."
At their July 2005 summit in Gleneagles, G8 leaders committed to universal access to HIV prevention, care and treatment interventions by 2010, commitments which all UN Member States committed to at the end of that year. However, progress on these commitments was noticeably absent from this year's G8 communiqué, and most countries are not on target to meet universal access goals.
A report released by Medecins Sans Frontières (MSF) immediately prior to the Cape Town conference noted that delays, logistical failures and reductions in HIV financing are already having an impact on the availability of antiretroviral (ARV) drug supplies and other medical commodities. The report provided details of stock-outs of ARVs and other medical commodities in six African countries.
"G8 nations have committed billions of dollars in economic stimulus packages and bailouts for the very institutions that triggered this recession, while AIDS and other health care priorities have diminished on the political agenda", said Dr Montaner. "HIV is not in recession, and greater investments in HIV and other public health priorities are required from the international community, particularly given that ART is now known to have preventive as well as therapeutic benefits." He added, "Health is a fundamental prerequisite of global development, not a fringe benefit which can be cut during difficult economic times."
About the IAS
The IAS is the world's independent association of HIV professionals, with over 14,000 members in 188 countries working at all levels of the global response to HIV/AIDS. IAS members represent scientists, clinicians, public health, policy experts and community practitioners on the frontlines of the epidemic. The IAS is the lead organizer of the biennial International AIDS Conference and the IAS Conference on HIV Pathogenesis, Treatment and Prevention.
For more information:
Lindsey Rodger (Communications Officer)
International AIDS Society
Geneva, Switzerland
Tel: +41 22 710 0832
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SHARP - Tech Innovation Boosts HIV/AIDS Fight. 29/7/09

IT Web

 [ Johannesburg, 29 July 2009 ] - Science and technology minister Naledi Pandor has unveiled an initiative aimed at increasing the number and quality of products to prevent, diagnose and treat HIV/AIDS.

The South African HIV/AIDS Research and Innovation Platform (Sharp) forms part of the Department of Science and Technology's (DST's) efforts to fund HIV/AIDS research, facilitate the development of innovative technology solutions, and develop safe and affordable HIV/AIDS-related technologies.

Sharp will be based and managed at Lifelab, one of the three Biotechnology Regional Innovation Centres (BRICs) set up by the DST. The DST has allocated R45 million for the centre over the next three years.

Speaking at the opening, Pandor maintained government remains committed to intensifying investment in research and development of safe and affordable HIV/AIDS-related products and technologies. She added Sharp was aligned with the department's mandate to ensure science and technology make an impact on growth and development in all areas.

“As it is, there are too many people living with HIV/AIDS, a high rate of new infections and, tragically, too many people dying of the disease. A coordinated effort by the research community, government and the private sector is, therefore, required. While the solution has to include multi-components and sectors, science and technology is a central factor in the effort to fight the disease,” she said.

Increasing funding
According to Candice Pillay, Sharp platform manager, the centre has been established to allow for partnerships between government and private investors, NGOs and business.

“The DST is providing initial funding for Sharp; however, it is imperative to the success of Sharp that we establish strong consortiums and networks to bid for international research funds and to leverage funding from non-governmental sources,” she stressed.

Pandor also noted in her address that the funding allocated to the centre was a good start, but that the department would increase its funding over the years. While she noted additional funding would not be available through the department's budget, she urged the director general, Phil Mjwara, to source additional sources of funding for the centre.

Pillay notes this added funding is necessary, saying: “This will ensure the development of cutting-edge innovations is not hindered by the lack of resources. We, therefore, encourage all interested parties to be part of the solution so that together we can help explore and identify solutions to deal with the pandemic in the country.”

The minister also noted supplementary funding would ensure the centre met its mandate, which includes making the commercialisation of products and services that come from research projects possible.

More investment
The DST also noted it remains committed to intensifying political support and efforts towards the research and development of anti-HIV/AIDS-related products and technologies, saying this was “critical to turn the tide against AIDS”.

The department, through its BRICs, has funded projects and the establishment of several companies focusing on HIV research, development and product innovation.

Arvir Technologies, a collaboration between Lifelab and the CSIR, is one such company. It uses technology invented by the CSIR for the production of highly-active antiretroviral therapy.

Another company is iThemba Pharmaceuticals, which is funded by Lifelab and BioPad. In partnership with international scientists, it has invented technology for the production of certain HIV drugs which it has licensed for development locally.

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New Effort To Fight Aids Unveiled. 29/7/09


South Africa The Good News
 Wednesday, 29 July 2009
A new government initiative to fight HIV/Aids in South Africa was unveiled by Science and Technology Minister Naledi Pandor on Tuesday.

"South Africa is investigating every possible avenue to beat the  virus," Pandor said at the launch of the SA HIV/Aids Research and Innovation Platform (Sharp) in Johannesburg, according to a statement issued by her department.

The initiative aims to combat HIV/Aids through scientific and technological research, the development of new drugs, diagnostic tests and vaccines.

Pandor's department pledged R45 million to Sharp over three years.

The country last year had the highest number of people living with HIV in the world.

It was "heartening" that South Africans were taking the "seriousness of the disease to heart" by changing their lifestyles,  she said.

"HIV prevalence in the total South African population has stabilised at a level of around 11 percent. Moreover, there has been a decline in HIV prevalence among young people aged between 15  and 24, from 10,3 percent in 2005 to 8,6 percent in 2008, which is good news."

However, among adults aged 25 and over, the number of people living with HIV increased 1,3 percent between 2002 and 2008.

"What is encouraging, though, is the fact that the number of people, especially young people, who reported using a condom in their most recent sexual encounters has increased dramatically, which indicates that we are getting the 'safe sex' message across."

This offered hope in the country's battle with HIV. However, statistics were still too high and the country needed to step up efforts in fighting it.

For more information on Sharp, downloand a pdf from the Department of Science and Technology's website.



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To Fight TB, Focus On HIV Too, Say Experts. 27/7/09

Business Day

 SA HAS made progress in controlling and curing tuberculosis (TB) since experts from the World Health Organisation (WHO) visited the country in 2005, but after their visit last week they said a greater emphasis was needed on patients with HIV, who are susceptible to TB.
Staff from the WHO , the US Agency for International Development , the Stop TB Partnership and the Foundation for Innovative Diagnostics (Find) observed TB treatment and management in SA last week.
The experts’ review included observations of the provision of care in clinics and hospitals, interviews with TB service managers and health workers.
They looked at TB and HIV co- infection, multi-drug resistant TB (MDR-TB) and extreme drug resistant TB (XDR-TB) and public- private partnerships .
Giorgio Rosigno, the CEO of Find, said SA had excellent TB- testing facilities and a capacity to produce new drugs.
“We are looking at the country as a pool of innovation and we hope that it will share experience with the rest of the continent.”
The TB defaulter rate — patients who stop taking their medication prematurely — had declined and the cure rate increased.
Dr Norbert Ndjeka, director of TB and HIV control at the Department of Health, said the number of MDR-TB and XDR-TB patients was low. Departmental statistics showed that the number of MDR- TB patients in the first quarter of this year went down to 1128 from 3757 in 2007, while XDR-TB went down to 113 from 493 in 2007.
The defaulter rate for MDR-TB went down to 93 from 387 and for XDR-TB to six from nine.
Rosigno said SA had an important role to play in the global fight against TB, and there was room to improve the global partnership.
The review team found there had been major improvements in the quality of, and access to, diagnosis and treatment of TB available at health facilities — resulting in increased case detection and treatment success.
They also found that human resource capacity in TB control was sufficient in some provinces, while drugs were generally available and in sufficient quantities.
The experts recommended that weak infection control measures — active surveillance of HIV/TB infection — be improved. Nongovernmental organisations working on HIV should also work on TB.
“HIV testing for TB patients had increased beyond 90% in many of the visited facilities. There should be management of TB/HIV co-infected patients at the same facilities with effective infection control measures.”
The team said despite the progress , 1% (about 461 000) of the general population still got sick with TB every year, driven by the HIV epidemic. Ndjeka said about 60% of TB patients were cured every year, while 7% died from TB/HIV co-infection.
Leopold Blanc, from WHO Stop TB, said despite the areas of concern, “we are encouraged by the progress made in this regard. It is, however, vitally important that you look more closely (to) aggressively addressing TB/HIV co- infection and TB within HIV programmes and infection control”.
Infection control should be strengthened through the formation of national and provincial infection committees and assigning this responsibility to dedicated persons, Blanc said.
Health Minister Aaron Motsoaledi expressed confidence in the ability of the health system to respond to the TB pandemic even in the context of HIV and AIDS.
“Moving forward, we have to strengthen around the areas that the review draws our attention to,” Motsoaledi said.
- Meanwhile, six medical experts from the universities of Stellenbosch and Cape Town wrote last month that a class of antibiotic called aminoglycosides and capreomycin were effective in treating MDR-TB, but these drugs had known dose-related adverse effects. The experts wrote in the South African Medical Journal patients might risk permanent hearing loss .
Ndjeka agreed that hearing impairment, including permanent hearing loss, had been documented around the world after the injection of aminoglycosides and capreomycin.
But “there are no better drugs than these injectable agents, hence the benefits of using them outweigh the risks”, he said.
Of the five drugs — aminoglycosides, capreomycin, kanamycin, Amikacin and ofloxacinused — used in treating MDR-TB, kanamycin, amikacin and ofloxacin were the strongest components .
“That is why kanamycin or amikacin are used during the injectable phase of MDR-TB treatment around the world, not just in SA,” he said.
The experts said aminoglycosides were known to persist in inner-ear tissue for six months or longer after they had been administered. “These drugs appear to generate free radicals that trigger (the) deaths of sensory cells and neurons.
“SA is therefore potentially facing the risk of a significant proportion of the population acquiring aminoglycoside-induced permanent hearing loss,” they said.
Ndjeka said it was recommended that all MDR-TB patients receive audiological tests before, during and up to six months after receiving an aminoglycoside injection. “ If hearing impairment is diagnosed early, precautions may be taken to prevent irreversible hearing loss,” he said.
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80% of HIV Positive People on ARVs by 2011. 03/06/09

Government has set a target of having 80 percent of HIV-positive people in the country on antiretroviral treatment by 2011.

Compiled by the Government Communication and Information System

BUA News
Date: 03 Jun 2009

By Gabi Khumalo
Cape Town

President Jacob Zuma, in his State of the Nation Address in Cape Town on Wednesday, also said that government would, also by 2011, aim to reduce the rate of new HIV infections by 50 percent.

Mr Zuma said government was concerned at the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease in the past 15 years.

He said government had to work together with stakeholders to improve the implementation of the Comprehensive Plan for the Treatment, Management and Care of HIV and AIDS which aims to reduce the rate of new HIV infections by 50 percent by the year 2011.

"We have set ourselves the goals of further reducing inequalities in health care provision, to boost human resource capacity, revitalise hospitals and clinics and step up the fight against the scourge of HIV and AIDS, TB and other diseases," President Zuma said.

During his budget speech on February, former Finance Minister Trevor Manuel allocated an additional R932 million to the Health Department's HIV and AIDS grant in the 2009/2010 financial year.

These funds were expected to be used to screen more pregnant women for HIV and to phase in an improved drug regimen to prevent mother-to-child HIV transmission.

Over 630 000 people are on government's anti-retroviral programme currently and the Medium Term Expenditure Framework provides for an increase to 1.4 million by 2011/12.

- BuaNews


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AIDS Cuts Swathe Through Councils. 17/03/09

Jo-Anne Smetherham 



Many ward councillors are dying young, probably of Aids-related illnesses, which could contribute to "ineffective local government" in future.

These are the conclusions of an Institute of Democracy in South Africa (Idasa) study by Kondwani Chirambo and Justin Steyn, who warn that their findings are a wake-up call for policy makers.

They found that the age expectancy of councillors appeared to be 51 years.

Of the ward councillors interviewed, 17 percent knew of a fellow councillor who had died of Aids-related illness and 59 percent said they had lost a family member, friend or relative to the syndrome.

The researchers also found that 285 of the 589 by-elections held between February 2001 and December 2007 had most probably been held because of the deaths of councillors.

Most of these councillors were 49 or younger and 70 percent in this group had probably died of Aids-related illness.

"We are talking about a large pool of people dying in just six years. To have lost them all is, I think, quite frightening," said Chirambo.

He said an estimated 28 000 South Africans a month died of Aids-related illnesses.

The calculations were based on work by the Actuarial Society of South Africa, and assumed that young councillors' deaths could be attributed to the same causes as those of the general population.

Their study concludes that "the high rate of deaths among councillors is likely to compromise South Africa's ability to build an experienced corps of politicians at local level. Similar impacts on the administrative system might contribute to ineffective government."

The shortage of skilled staff in municipalities, anecdotal evidence of high absenteeism, illnesses and deaths "are all indicative of a silent but worrying impression of institutional incapacity in South Africa's local government structures", the study concludes.

Interviewed, Chirambo said: "There is hope, providing the right measures are put in place.

"The age ranges and life expectancy of the councillors certainly are striking and the picture is gloomy. But it is not hopeless, particularly in this age of (Aids) treatment."

Municipal managers and HIV and Aids officers interviewed said HIV and Aids had increased absenteeism among all levels of staff, although there were variations across municipal boundaries.

There were "consistent suggestions from administrative staff that indicated infections within low-income grades", the study found.

"Although it cannot be pinned on HIV and Aids, the description fits advancing HIV related infections. This has key implications for productivity.

"As key players succumb to infection, effectiveness can be expected to decline, takingwith it accountability," the report says.

The research, published in the Idasa publication Aids and Local Government in South Africa, is believed to be the first of its kind in a hyper-endemic zone.

It was carried out in 12 municipalities in the Western Cape, Northern Cape, Free State and KwaZulu-Natal, and aimed to investigate how HIV and Aids affects political systems, rather than measuring this impact precisely.

The Department of Provincial and Local Government
expects municipalities to play a pivotal role in fighting the epidemic, but this is unrealistic, "given capacity issues".

"Municipalites in this study present a picture of desperation in terms of how they handle this - Policies are in place in some, but not all."

The researchers focused on 3 895 directly elected ward councillors out of 8 951 nationwide. They interviewed many of them, as well as managers of HIV and Aids programmes, of the Independent Electoral Commission, of municipalities, and of the Integrated Development Plan.

Steyn said Aids deaths would deplete expertise in local government, causing a widening gap between the electorate's expectations and the ability of municipalities to deliver.

"This has the potential to bode really ill. But like everything else, it is problematic only if government does not take action," Steyn said.

Neither the Health Department nor the SA Local Government Association responded to a request for comment.

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AIDS: SA Politicians in Denial. 07/03/09

News 24

Cape Town - Many councillors believe it would be political suicide to publicly disclose their HIV status, according to an Idasa study on the effects of the disease on local government.

Lead author Kondwani Chirambo said on Tuesday he was aware of only one local councillor, a woman from the Free State, who had publicly declared she was HIV-positive.

Neither in South Africa, nor in any of six other African countries he had studied, had any other politician at any level had the courage to do so.

"To disclose their status is political suicide, they believe," he said.

The study said there was a general fear among the 112 ward councillors interviewed by researchers that disclosure of HIV status could ruin political careers.

"On the one hand, councillors express a fear of rejection by the electorate, who may deem them unfit for office if they are known to be HIV-positive.

"On the other, they see a danger of political opposition presenting them as incapable of ruling. The emerging data creates the impression that HIV/Aids denialism permeates politics."

The study said 233 local councillors in the 22 to 49 year age group died in office between February 2001 and December 2007, and it could be assumed that 70% of those, or 161 individuals, died of Aids.

The deaths were equivalent to two-thirds of the strength of the National Assembly.

Losing this number of people at leadership level was "not a phenomenon to be ignored".

The fact that most of the deaths occurred among councillors younger than 51, should raise the alarm over institutional memory and effective local governance.

"How can we possibly expect to build capacity in politics if the people who should lead will die before the age of 50?" the study asked.


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ANC 'Accepts Responsibility'. 03/04/09


Johannesburg - The ANC accepts "collective responsibility" for the policies and programmes of past administrations since 1994, it said on Friday.

The ruling party was reacting to a report in The Times that the party intended to apologise to the nation for former president Thabo Mbeki's policy on HIV/Aids which was blamed for the death of thousands.

"It accepts collective responsibility for both the achievements and shortcomings of successive ANC administrations since 1994," spokesperson Jessie Duarte said in a statement which noted the media reports but did not say whether an apology could be expected.

The party intended prioritising the implementation of the National Strategic Plan 2007-2011 on HIV and Aids.

Apology for Aids denialism

The Times report said there were discussions on a proposal within the ANC alliance about the need for MP's who served under Mbeki to apologise for not publicly questioning his denialist views on HIV and Aids.

"We owe it to the nation. We, as MPs, were there and we failed to rise up," the paper said, quoting an ANC MP which it did not name.

The proposal would see an ANC parliamentary ad-hoc committee, composed of MPs, drawing up the apology to the nation.

The party would work to expand access to treatment, care and support to 80 percent of all HIV positive people and their families, Duarte said.

"As the ANC's 2009 manifesto says, the ANC will work to reduce the rate of new HV infections by half by 2011 through an aggressive prevention campaign."


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Access to Grants: Child Support Grant to 18/02/09

Lyn's Comment:
In his State of the Nation Address for 2009, The President of South Africa committed to progressively extend the Child Support Grant (CSG) to 18.   It was widely expected that Minister of Finance Trevor Manuel would announce the beginning of the roll-out of the extension of the Child Support Grant to 18 in the 2009 budget.  This did not happen.  Read the feedback from a number of organisations:

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Black Sash Media Statement – Budget Speech Reaction

11th February 2009

In the Black Sash we are keenly aware of the global economic crisis, and respect the fact that the Finance Minister Trevor Manual has had to perform a balancing act to manage competing interests and needs.

In fact, the Black Sash believes that this Budget is arguably the most important in the history of our democracy, in that it shows how we as a society deal with one another at a time of crisis. In this light we commend the Minister’s rhetoric, which states that his first guiding principle has been the protection of the poor.

We are concerned however, that this principle has not been carried through in several vital respects.

The Child Support Grant:

We find it unacceptable that the Minister has not committed funding to extend the Child Support Grant to the age of 18 - reneging on the promise made by the President in his State of the Nation address just last week.

This, despite the fact that he says there is "compelling evidence that the child support grant has contributed significantly to reducing child poverty." Indeed, civil society has presented much such evidence over the past few years that social grants remain the single most effective intervention into poverty.

We do not understand why the Minister is only giving the extension of the Child Support Grant "consideration" at a time when a commitment is what is urgently needed by the nearly two-and-a-half million of children who fall through the security net just as they enter the vulnerable years of their adolescence.

A mother in a village in the North West dared last year to take the Minister of Finance to court where she called for the extension of the Child Support Grant for all poor children under 18 years. In the absence of the Minister of Finance committing to an extension, the Black Sash calls on the Pretoria High Court to safeguard poor children's constitutional rights to equality and social security.

Grant increases:
The 5.5% increase for old age pensions and the 4.5% increase in the child support grant are substantially below the current inflation of 10.3% (CPIX December 2008). Worse than this, it can never provide for the increased pressures on households that the global economic crisis will bring.

One in three South African households eke out their survival without a worker in the home. With a conservative estimate of unemployment at 23.2% (more like 40% when ‘discouraged’ workers are included) this leaves millions of able-bodied adults dependent on the grant money brought into the home by their most vulnerable members (the children and the aged).


The Minister has quoted Ben Okri - "But if we refuse to face any of our awkward and deepest truths, then sooner or later, we are going to have to become deaf and blind." Have we, as a society, become so used to extraordinary levels of unemployment that we no longer hear or see it as the appalling affront to human rights that it represents?

The Black Sash is deeply concerned that no new provision has been made to protect workers who are being retrenched in the face of the global financial crisis.

Communities, already mired in poverty, cannot afford for one more person to lose their job. And yet, we know that however creatively government and business attempts to deal with this problem, there will be job losses.

We are disappointed that the Minister has not announced any convincing plan to protect these families.
* He has not provided income support for the unemployed;
* He has not concretised the President’s commitment to rolling out increased levels of the Social Relief of Distress Grant (SROD). In fact the SROD did not feature in his speech at all. This, despite the fact that communities are currently experiencing major conflicts as the limited provision for SROD is depleted, demonstrating again the huge gaps in our Social Security provision;
* While we refute claims that the Expanded Public Works Programme’s (EPWP’s) will create jobs, we acknowledge the potential of such programmes to intervene against poverty. However, we share the Minister’s apparent lack of conviction that they will reach the ambitious targets set. Desperate people should not have to wait for inefficient bureaucracies to receive urgently needed income support.

Social solidarity:
We cannot forget that our national crisis of poverty and unemployment pre-dates the global financial crisis.

The Black Sash is concerned that the budget remains "deaf and blind" to the unemployed of our country – the millions who have been told for fourteen years, to wait for growth to trickle down into jobs, have once again been told to wait while we manage the global crisis and a shrinking economy.

There has been a negligible adjustment to the tax regime where we have called for sacrifices by privileged members of our society, who by international comparison, have huge wealth and a very high standard of living.

We are disappointed that the Minister has not challenged South Africans to exercise maximum national solidarity in this time of global crisis, in favour of the poor.

For more information or interview requests, please contact:
Sarah Nicklin
Black Sash Media Officer
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Children’s Institute, University of Cape Town - 11/02/2009

Press release in response to the 2009 Budget Speech
11 February 2009

By not extending the Child Support Grant the Minister of Finance has failed poor children and dishonoured the President’s promise. The extension to children up to their 15th birthday was announced by him last year in February 2008 and implemented on 1 January 2009 and is
therefore not news. The 2009/10 budget includes nothing new on the CSG.

This is despite the President’s commitment in his State of the Nation Address to progressively extend the CSG to 18.  On 5th February 2009, the Children’s Institute welcomed the President’s commitment in his State of the Nation Address to extend the Child
Support Grant to children under 18 years of age. He said: "[G]overnment will sustain and expand social expenditure, including progressively extending access to the child support grant to children of 18 years of age…" (page 14)

This is the first time the President has announced this commitment, and we expected the Minister of Finance to fulfil this promise by first extending the grant to children up to their 16th birthday this year and then children up to 18 over a two year period.

Last year the President announced in his State of the Nation Address that government was considering how to support vulnerable children aged 14 to 18 but did not commit to an extension of the CSG to 18 years. The Minister of Social Development then promised an extension of the CSG to 18 years in a phased manner in his media briefing in Parliament in
February 2008. However in his February 2008 budget speech the Minister of Finance only announced an extension to children up to their 15th birthday and no further. In March 2008 the Minister of Finance opposed a court case for the extension to 18 in the Pretoria High Court (Mahlangu v Ministers of Social Development and Finance). The papers filed on behalf of the Minister of Finance indicate that the Minister of Finance is opposed to any further extensions of the Child Support Grant. He does not argue that the extension is unaffordable, but that extending the CSG is not the appropriate intervention for older children.

In the 2009 Budget speech, the Minister of Finance shows that he has softened in his opposition but is not yet willing to commit any budget:
"Compelling evidence that the phasing-in of the child support grant has contributed significantly to reducing child poverty has emerged in recent research, and so consideration is being given, subject to affordability, to the extension of the child support grant to the age of

We are disappointed that the Minister of Finance has not committed to any further extensions of the Child Support Grant. His budget speech contradicts the President’s State of the Nation Address. Why is the Minister of Finance not honouring a pledge to fulfil children’s constitutional rights? The Finance Minister’s failure to commit to the necessary finances means the President pledge will remain an empty promise. This despite calls from all major children’s rights organisations, the SA Human Rights Commission, COSATU, and commitments by the President and the Minister of Social Development. The website of the Minister’s own political party, the ANC, states that the Child Support Grant will be extended to children under the age of 18 years in one-year steps starting in 2009.

There are approximately 2, 4 million poor children aged 15 to 18 years whose care givers desperately need the small CSG to help them feed, clothe, house and educate their children. These 2, 4 million children will continue to suffer for another three years. If the Minister had followed the President’s lead, he should have at least announced an extension to children up to their 16th birthday to start on 1 April 2009. This would have meant that just over 700 000 poor children would have been able to get the grant in 2009 at an estimated cost of only 1,9 billion to the State. The Department of Social Development has done the cost calculations and these show clearly that the extension to 18 years is affordable.

In 2008 approximately 8, 1 million children under 14 were receiving the CSG. In January 2009 children under 15 years also became eligible. The grant is valued at R230 (soon to increase to R240 in 2009) and is one of the State’s most effective poverty alleviation programmes. Research done in 2006 already shows that children who live in households that receive the CSG are more likely to be in school, and have better access to food and health care.

Research has also shown that there is a link between the income of a family and a child’s ability to stay in school. Families with more income are more likely to be able to keep their children in school until the end of grade 12. School drop out rates get worse from the age of 14 years. Increasing the CSG to children aged between 15 and 18 years will therefore have a positive impact on school attendance and help ensure that children finish the education that they need in order to become productive workers in the SA economy. Giving families the income they need to keep their children in school is therefore an investment in the growth of the economy: The money that the State spends on the CSG extension will result in increased return on investment for the country in the long term. It is a short sighted approach to look only at the short time costs.

The 2, 4 million poor children affected by the Minister’s failure are predominately Black children, who live mainly in impoverished rural communities or informal settlements. Their caregivers are mainly young women who are also the group most affected by the HIV pandemic. Without the financial support of the CSG these children’s chances of completing their education is reduced. If the State does not invest in these children now, they will struggle to break free from the bonds of poverty that have denied them equal opportunities since the days of apartheid. For these children, the promise of substantive equality in the Bill of Rights is still not a reality.

Paula Proudlock
Lucy Jamieson
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Media Release ACESS. 12/2/09

Media Release ACESS

ACESS is shocked and surprised by thefailureoftheMinisterofFinanceTrevorManueltoannouncethebeginningoftheroll-outoftheextensionoftheChildSupportGrantto18.

“There is wide support for immediate roll-outofthegrant from almost all political parties. There is a strong consensus that it is notonly a right thing to do butalso a necessity in light ofthe current recession. Poor families have been devastated by highfoodprices and joblosses and directcashsupportwouldnotonlyhelpthembutalsostimulatetheeconomy.saidPatriciaMartin, ACESSdirector.

A one year roll-out for children to age of 16 would cost the state 1.9billion, and it would reach 700 000 poor children who are at the moment not getting any kind ofdirectcashsupport from the state.

“We are particularly surprised in the light ofthe President’s announcement last week ofthe state’s supportof a progressive roll out ofthechildsupportgrantto18. The ANC has also committed itself tothe roll out, and confirmed in a meeting with us recently that the roll out would begin this year. TheMinister is clearly taking a position on this which is out of line with most people’s thinking on the issue.

For more information call
Alison Tilley 083 258 2209
Bukelwa Voko 082 945 8504

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Approximately 30 deaths a day. 22/02/2009

Approximately 30 deaths a day as Free State ART shortages continue
TAC Electronic Newsletter  22 Feb 2009

The ART moratorium in the Free State was enacted almost four months ago. Since then, the HIV Clinicians Society conservatively estimates that about 30 people have died every day due to their inability to access ART in the province. Approximately 15,000 people in need of treatment are on a waiting list. However, many were turned away during the moratorium without being added to the waiting list. Others have had their regimens interrupted due to the drug stock-outs.

Despite promises by the provincial Department of Health in the Free State that the antiretroviral treatment (ART) moratorium would be lifted last week, TAC continues to receive complaints from doctors and activists in the provinces that they still do not have access to drugs.

No new patients have been given access to ART at Pelonomi, and ongoing shortages of the antiretroviral 3TC have forced patients to default on their regimens, reported on Friday 20 February by Sello Mokhalipi, a TAC activist in the Free State. In addition, 3TC has not been available for three consecutive days according to Makhalipi, who conducts drug readiness programmes for pregnant women at Pelonomi Hospital, and was one of the organisers of the TAC protest march there on Tuesday 10 February.

A doctor from the provincial Department of Health recounted how two women had presented at Pelonomi on Monday 16 February to access ART for their babies. The women were told that no drugs were available, but that they should wait until 2 pm that afternoon at which time they would arrive. At 2 pm, they were told to come back the following Friday (27 February). The women were afraid to talk to journalists as they feared that this would derail their chances of accessing ART for their babies. This fear of punishment by the Health Department for speaking out about ongoing ART shortages is dogging healthcare workers and patients, and Mokhalipi has been warned by healthcare officials that he is under surveillance at Pelonomi because he is a member of TAC.

During the time in which the ART moratorium was in place, a glossy internal newsletter of the Free State Department of Health (distributed in healthcare facilities across the province) included a section on ‘Alternative Remedies’, which highlighted the healing capacity of beetroot, garlic, olive oil and lemon. This section glowingly documented an ‘experimental project’ run by Tine van der Maas at the National Hospital in Bloemfontein. Click here to download a copy of the pamphlet. Van der Maas is the force behind the quack remedy ‘Africa’s Solution’, which is promoted as a cure for HIV. It is a damning indictment of the Free State Department of Health that this information was being disseminated at clinics across the province while patients desperately in need of ART were being denied access.

On Wednesday 11 February a circular was sent to staff at ARV sites advising them to follow a set of guidelines in the initiation of new patients. These guidelines were vague and unrealistic, with the recommendation that ‘prescribers are to consider the staggering of initiation of new patients from the existing waiting list over one to two months’. One doctor explained that it would be at least six months before provincial healthcare sites are able to catch-up with the ART waiting list, and that patients will continue to die in the interim because of a lack of treatment.

On 18 February, the Premier of the Free State, F. B. Marshoff, gave her ‘State of the Province’ Address. The speech was 6, 757 words long, and devoted a mere 143 words to HIV/AIDS in the province. The Premier made no mention of the ART moratorium and other severe cutbacks in healthcare services which have caused death and suffering in the province she leads. Instead, the Premier spoke of structural changes within the Provincial AIDS Council and of increased co-operation with other stakeholders, and gave no concrete information regarding the ART roll-out, TB treatment or PMTCT in the province.

Actions to ensure ART is made available in the Free State

The Programme Implementation Committee (PIC) of the South African National AIDS Council (SANAC) has established a committee to monitor developments in the Free State, and to ensure that ART is made progressively available to all who need it. This committee is comprised of the Director General of Health, Thami Mseleku, Yogan Pillay, Helen Rees, Ashraf Coovadia and Mark Heywood.
• Dr. Pillay visited Bloemfontein on Monday 16 February in response to continued complaints from patients regarding their failure to access ART at local healthcare sites.
• The committee held a teleconference on Wednesday 18 February to discuss the continued treatment shortages in the Free State despite promises by the provincial Department of Health that drugs should have been available in all Bloemfontein clinics by 18 February and throughout the province by 19 February.
• David Kalombo, an ARV site accreditation officer from the National Department of Health, has committed to daily checks to establish whether clinics have received drugs, and the National Department of Health has promised to support a communication campaign via radio and newspaper which will encourage people to go to healthcare sites to seek ART.
• The SANAC Treatment Task Team has drawn up guidelines on treatment for people who are very sick with AIDS and therefore in need of rapid access to treatment. These will be distributed in the Free State shortly.
TAC/ALP Action

On Thursday 26 February, a meeting of civil society is taking place at Pelonomi Hospital. TAC, ALP and others will discuss the establishment of an Interim Committee to visit clinics across the Free State to establish whether ART is being progressively made available to all those in need.

TAC and ALP continue to monitor ART access in the Free State very closely, and to demand that the Department of Health mount a transparent investigation into the ART moratorium in the Free State. The figures responsible will be held to account for enacting a series of measures which violated the rights of patients there.

Director General Mseleku has admitted that the financial crisis in Health Departments affects every province. Provincial and district TAC members must report any information about ART stock-outs or cutbacks in healthservices so that the Free State ART moratorium, and the needless suffering and death is has caused, will not be repeated.


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Rape Has Become Normal. 05/03/09


Johannesburg - Only countries at war suffer as much sexual violence as South Africa, Doctors Without Borders said on Thursday in a global report highlighting the problem of rape. 

"The figures we have are alarming, but they are just a tip of the iceberg as most cases go unreported," said Meinie Nicolai, operational director for the group, known by its French initials MSF. 

"In conflicts rape can be used to humiliate, punish, control, inflict fear and destroy communities," MSF said in the report. 

"In times of stability, sexual violence is also a grave problem, devastating health and lives," it said. 

Some of the countries that suffer the most rapes include Liberia, Burundi, the Democratic Republic of Congo, South Africa and Colombia. On average in those countries, 35 women are raped every day, MSF said. 

Although sexual violence is exacerbated in war, MSF says it also affects millions of people living in post-conflict countries or even in stable environments. 

In South Africa, rape is associated with criminal activity and domestic violence. 

"We have noticed that rape in societies has become normal, it has become normal to be raped," said Janine Josias, an MSF doctor working in Khayelitsha, outside Cape Town. 

Khayelitsha has one of the highest rape incidences in a country where it is estimated that a woman is violated every 26 seconds. 

But Josias said a growing number of men were also being raped.

"We have seen a growing number of males who are victims of rape. Generally boys and men go unrecognised and untreated," she said.

Women still make up the vast majority of victims, however. 

In 2007, MSF treated over 12 000 victims of sexual assault worldwide, in both conflict settings and stable environments.


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SA Budget Boost for Aids Fight. 13/02/09

February 11, 2009
(Sapa, February 2009)

An additional R932 million will be added to the health department's HIV and Aids grant in the coming financial year to extend the screening of pregnant mothers, says Finance Minister Trevor Manuel.

"We are budgeting to extend screening of pregnant mothers coming into the public health system, and to phase in an improved drug regimen to prevent mother-to-child HIV transmission," he told MPs in the National Assembly.

According to his 2009 Budget, the department will receive an additional R932 million to screen all pregnant women, step up the prevention of mother-to-child transmission, and to improve drug regimens by implementing dual-and triple-therapy.

The 2009 Estimates of National Expenditure, tabled on Wednesday, says voluntary counselling, testing and other services are now provided in more than 95 percent of health facilities.

According to the document, the department's goal is to increase the number of pregnant women who are tested for HIV from 80 percent in 2009/10 to 95 percent in 2010/11.

It says attention still needs to be given to the new dual-therapy programme for the prevention of mother-to-child transmission "to ensure that every mother is screened and managed appropriately to prevent HIV infections in babies".

About 1.9 million female condoms were distributed in the past year, with "steady progress" in this area.

However, only 169 million male condoms were distributed by September 2008, well short of the target of 450 million. This was partly due to a batch of defective condoms that had to be recalled during the year.

By the end of November last year, 630 755 patients had been started on ARV (antiretroviral) therapy, of which 574 496 were adults and 56 279 children. More than 200 000 new patients started treatment in the past 12 months.

"Funding by government and donors will allow the number of people on treatment to grow from 630 775 in 2008/09 to 1.4 million by 2011/12," the document says.

Despite the mortality rate among young adults deteriorating, HIV and Aids prevalence had levelled off at high rates. As a result, there was an urgent need to extend treatment.

"HIV and Aids prevalence has levelled off at high rates and prevention programmes need to be accelerated."

The disease was placing a burden on the health sector, and as a result "the quality of health services is sometimes not optimal".

The 2007 ante-natal care survey had found there was a one percent reduction in HIV prevalence between 2006 and 2007.

Strategies to improve HIV prevention will be implemented to achieve the target of a 50 percent reduction in new infections by 2011, the document says.

Speaking in the House, Manuel said the provision of free ARV treatment had persistently features in tips sent to him by the public through the years.

"Jackie Mondi of Berario wrote an extensive tip in 2003 calling for a special fund for fighting HIV/Aids; that the focus should be on both care and prevention," Manuel said.

(Sapa, February 2009)

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SA Judge Cameron Profiled. 27/01/09

New York Times Profiles Openly HIV-Positive South African Justice Cameron

Jan 27, 2009 Kaiser Daily HIV/AIDS Report

The New York Times on Saturday profiled South African Justice Edwin Cameron, who "became the first -- and still remains the only -- senior office holder anywhere in southern Africa, and perhaps in all of Africa, to announce he was infected with HIV." According to the Times, nearly 10 years ago Cameron "stunned" the judicial panel considering him for South Africa's highest tribunal -- the Constitutional Court -- when he told them, "I am not dying of AIDS. I am living with AIDS." Soon after, Cameron also made the "extremely rare" decision to challenge then-South African President Thabo Mbeki's policies regarding HIV/AIDS, knowing that Mbeki "held the power to decide whether to name him to the Constitutional Court," the Times reports. After revealing his HIV status and challenging Mbeki, Cameron "was promoted to the appellate court" but was not considered for the Constitutional Court until last year, "assuming until then that his clash" with Mbeki over AIDS would "ruin his chances -- an assumption fellow judges and lawyers say was almost certainly accurate." After Mbeki was forced to resign in September by the ruling African National Congress, Cameron sought an appointment to the Constitutional Court again, a promotion he received this month, the Times reports.
According to the Times, Cameron in the early 1990s founded the AIDS Law Project, but he "may ultimately be most remembered for speaking with intimate candor about his personal experiences with HIV" in interviews and his memoir, titled "Witness to AIDS." In his memoir, Cameron recounts his experiences living with HIV and his sense of renewal after beginning antiretroviral therapy in 1997. He also describes his efforts to increase antiretroviral access for other HIV-positive people in South Africa. "Here I was, blessed with renewed vigor and life and health and energy and joy," he said, adding, "Here I had my life given back to me. How could I keep quiet?" (Dugger, New York Times, 1/24).
EDITORIAL NOTE: Justice Cameron's book "Witness to AIDS" was written with the prize money received from his Kaiser Family Foundation 2000 Nelson Mandela Award .
Reprinted from You can view the entire Kaiser Daily HIV/AIDS Report,   search the archives, and sign up for email delivery.  The Kaiser Daily HIV/AIDS Report is published for, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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Social Assistance Regulation Amendments 26/03/09

Amendment to social assistance regulations clarifies right of patients in hospitals to continue to receive social grants
Press Release AIDS Law Project

On 26 February 2009, the Department of Social Development (DSD) amended the Regulations Relating to the Application for and Payment of Social Assistance and the Requirements or Conditions in Respect of Eligibility for Social Assistance (Social Assistance Regulations). These regulations set the conditions of eligibility for all recipients of social grants in the country. The amendment corrects the definition of an "institution funded by the state" to properly exclude patients in hospitals. This clarifies that patients who are in hospital are entitled to continue to receive their social grants, including patients being isolated with multi-drug resistant (MDR) or extensively drug resistant (XDR) TB.


In February 2008, the ALP became aware that patients' disability and other social grants were being cancelled after they were admitted to a drug resistant TB facility. The position of the DSD at the time was that individuals isolated in DR TB facilities could not continue to receive social grants because they were being cared for in "institutions funded by the state" according to the Social Assistance Regulations. This interpretation of the regulations created disincentives for individuals to seek care for DR TB and left many of their family members without any income while the patients were in isolation.

In October 2008, the ALP, the Treatment Action Campaign (TAC) and the South African Human Rights Commission (SAHRC) met with the DSD to discuss these concerns. The DSD representative stated that they had misunderstood their own regulations as it was never intended that an "institution funded by the state" would include public hospitals, other than psychiatric hospitals and treatment centres for drug rehabilitation. The meeting made clear that the regulations required clarification in order to resolve the problem. With this amendment, this has now been done.

Call for Information:

While the amendment to the Social Assistance Regulations clears the way for patients to continue to access their social grants while in hospital, it is up to the South African Social Security Agency (SASSA) to ensure the regulations are actually implemented. SASSA has already stated in conversations with the ALP that, as of mid-November 2008, all DR TB facilities should have begun receiving visits from local SASSA offices and that patients have been being facilitated in accessing their grants.

We call for any health care workers or patients experiencing problems in getting access to social grants to please contact the AIDS Law Project so that we may follow-up with both DSD and SASSA officials to resolve the matter.

AIDS Law Project:

Phone: 011 356 4100
Fax: 011 339 4311


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South Africa: Serious Shortage In ARV Funding 19/6/09


JOHANNESBURG, 19 June 2009 (PlusNews) - A one-billion rand (US$123 million) shortfall in South Africa's public sector antiretroviral (ARV) programme could jeopardise treatment programmes as soon as September, a health expert has warned.
Mark Heywood, deputy chairman of the South Africa National AIDS Council (SANAC), commented on the lack of funding at the relaunch of the national AIDS Charter on 18 June.
The charter written in 1992 became the founding document of the AIDS Consortium, one of the country's largest such organisations, which redrafted the charter to reflect progress in combating the disease, and close any remaining gaps in the human rights of those living with HIV. Among the additions were an increased focus on vulnerable groups, and the inclusion of traditional leaders and their role in the epidemic.
"We've made major strides, and one of the strengths of the charter was that it guided our progress on the national strategic framework at a time when people were still stoned to death ... when kids were still taken out of school and people were chased out of their homes for being HIV-positive," Heywood told IRIN/PlusNews.
"But I'll tell you what we haven't achieved ... we don't actually have ARV treatment for most of the people who need it." Given the major shortfall in funding, Heywood said, the country was likely to see ARV shortages similar to those in Free State Province last year.
In early November 2008, Free State experienced a shortage of essential medicines, including ARVs; a provincial moratorium barred new patients from getting the life-prolonging medication, resulting in a waiting list of over 15,000 people.
At public clinics in Edenvale, outside Pietermaritzburg in KwaZulu-Natal Province, there might be enough drugs currently, but staff shortages were preventing patients from accessing ARVs, Heywood said.
In view of situations like these, it was crucial that the newly launched charter be redrafted urgently to reflect people's right to sustained ARV access, as well as children's rights to adequate sex education and access to condoms. An estimated 700,000 people are on treatment in South Africa, but an estimated 1,000 die daily as a result of AIDS. "We don't actually have political commitment from government to deal with the epidemic," Heywood said. "As a chairperson of SANAC, I don't see it; I don't see the [necessary] urgency."
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We Were Wrong. 04/04/09

“We owe it to the nation. We, as MPs, were there and we failed to rise up,”

Apr 04, 2009

THE ANC is planning a post- election apology to the nation for former president Thabo Mbeki’s disastrous HIV-Aids policy, which has been blamed for the deaths of thousands of infected people.

“We owe it to the nation. We, as MPs, were there and we failed to rise up,” said an ANC MP.

The Times has established that there are behind-the-scenes discussions within the ANC alliance about the need for MPs who served during Mbeki’s tenure to apologise to South Africans for failing to publicly question his denialist views on HIV-Aids.

Insiders said the proposed move enjoys support from within the ANC, the South African Communist Party and Cosatu.

The proposal would see an ANC parliamentary ad-hoc committee, composed of ANC MPs, drawing up the apology to the nation.

Parliament’s deputy speaker, Nozizwe Madlala-Routledge, has also called for a Truth and Reconciliation Commission into the role of government in relation to the pandemic.

Madlala-Routledge served as deputy to former health minister Manto Tshabalala-Msimang for three years, before she was fired by Mbeki in 2007.

She championed HIV-Aids issues and received widespread support for disagreeing with her boss’s controversial views on the pandemic. She also undertook a public Aids test in 2006, a move that irritated her former bosses.

Last year, the Harvard School of Public Health released a damning report that revealed that more than 330000 lives were lost because of Mbeki’s and Tshabalala-Msimang’s failure to provide antiretroviral drugs between 2000 and 2005.

The report placed the blame on Mbeki’s government for failing to implement a feasible and timely antiretroviral treatment programme.

Madlala-Routledge said South Africa could benefit from a TRC process on HIV-Aids.

“Will a greater understanding of this period of Aids denialism not help prevent something like this happening again?” she asked at the launch of a book on the subject on Wednesday night.

The launch of the book on Aids denialism, title ‘The Virus, Vitamins and Vegetables’, was held in Durban to celebrate the end of the denialism era.

Attempts to reach Mukoni Ratshitanga, Mbeki’s spokesman, were unsuccessful.

Health Minister Barbara Hogan’s spokesman, Fidel Hadebe, said he was not in a position to say whether the minister would support such a move, as she was on a plane back from China at the time the inquiry was made.

Professor Salim Abdool- Karim, director of the Centre for the Aids Programme of Research in South Africa at the Nelson R Mandela School of Medicine in Durban, supported the call for an HIV- Aids truth commission: “This would be trying to reconcile what happened so we can put it in the past and not keep raising it.”

He said he did not see an HIV-Aids truth commission as merely a means of granting amnesty, but rather as exposing what went wrong with the government’s response to the pandemic through the testimony of people who were centrally involved.

Abdool-Karim was one of only four orthodox HIV scientists among dissidents on Mbeki’s first HIV-Aids panel in 1999, which was later expanded to include more scientists from South Africa.

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Zuma, HIV and the New SA Cabinet. 14/05/2009

Lyn's Comment:  South African's waited with great interest to hear which moves new President Jacob Zuma would make in his cabinet. His decision to replace Minister Barbara Hogan raised some concern.  News reports bring different viewpoints:

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South African President Zuma Appoints New Health Minister To Replace Hogan. 13/05/09

Kaiser Daily HIV/AIDS Report - Wednesday, May 13, 2009

South African President Jacob Zuma on Sunday appointed physician Aaron Motsoaledi as health minister, replacing Health Minister Barbara Hogan, who was appointed to a public enterprises position, London's Guardian reports. Motsoaledi previously served as a provincial education minister. Hogan had been appointed to the post last year to replace former Health Minister Manto Tshabalala-Msimang (Smith, Guardian, 5/10).

According to AFP/, Zuma responded to concerns about the appointment, saying that Motsoaledi is a "well-known doctor who has handled this department at a provincial level in the past." Zuma added that Motsoaledi is "a very energetic and able comrade so I don't think you should be very worried."

HIV/AIDS advocates said the leadership change at the Health Ministry could hinder South Africa's efforts to address HIV/AIDS. Mark Heywood, a spokesperson for the Treatment Action Campaign, said Zuma's decision to replace Hogan is "very disappointing," adding, "We have an entirely new political team responsible for health at a time where the health system is in critical need of resuscitation and in need of continuity and understanding."

Zuma has said he is committed to fighting HIV/AIDS, and advocates are calling for "visible leadership for a strong national response," AFP/ reports. According to AFP/, a "challenge" Zuma faces is finding enough funding to maintain the country's antiretroviral drug program, which is the largest national antiretroviral program worldwide and provided about 700,000 South Africans with treatment as of November 2008. The South African government plans to increase funding for HIV/AIDS programs by 932 million rand, or about $112 million, and double treatment over the next three years; however, the country also is facing its first economic recession in nearly two decades, AFP/ reports (AFP/, 5/11). 

Reprinted from You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at . The Kaiser Daily HIV/AIDS Report is published for, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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TAC Statement On New Cabinet Appointments And Resources For Health. 12/05/09

TAC Electronic Newsletter

12 May 2009

The Treatment Action Campaign (TAC) welcomes the appointment of Dr. Aaron Motsoaledi as the Minister of Health, and the re-appointment of Dr. Molefi Sefularo as the Deputy Minister of Health. Both the Health Minister and the Deputy Health Minister have an immense responsibility to protect the health and human rights of people in South Africa, and to achieve the targets laid out by the National Strategic Plan for HIV/AIDS 2007 – 2011.

TAC will support the ministry in its responsibility to rebuild the health system and to implement progressive policies and programmes. TAC will also continue to closely monitor health policy development and implementation, and resource allocation for health under the leadership of Minister Motsoaledi and Deputy Minister Sefularo to ensure that government commitments to healthcare delivery are achieved. This is particularly important in the current economic climate.

As of May 2009, about 700,000 people have been initiated onto ARVs in South Africa’s public health sector. But at least double the current number of people who are on ARVs need treatment urgently to survive. It is government’s responsibility to make ARVs accessible and sustainable, as stated in the NSP and enshrined in the constitutional right to the progressive realization of health care.

A severe lack of funding threatens the achievement of the NSP targets. Department of Health officials have admitted that the budget allocation for ARVs through the current HIV/AIDS conditional grant to provinces will not be nearly sufficient to treat 220,000 people this year.

There is also a drastic shortage of money to fund the other NSP target interventions and coverage. A Statistics South Africa report indicates that South Africa’s official unemployment figure has increased from 21.9% in the last quarter of 2008, to 23.5% by March 2009, with economists estimating that the real unemployment rate exceeds 30%. A recent report by the World Bank details the negative effects that rising unemployment and reduced earnings have on health outcomes.

Reduced income makes people less likely to seek medical attention when they are sick as they can no longer afford to travel. It also forces people to buy cheaper, less nutritious food which leads to an increase in malnutrition. Poor households are likely to be the worst affected because they have less room to re-adjust their expenditure. Despite the fact that clinic visits may contract in times of economic recession, the actual demand for these services increases as people face greater difficulties in accessing adequate food and housing.

Minister Motsoaledi and Deputy Minister Sefularo will have to confront the serious health challenges resulting from the economic downturn and to implement policies that cushion the poorest sectors of society from the effects of the downturn, as these communities bear the brunt of decreasing access to public health services.

TAC’s support for the previous Health Minister, Barbara Hogan, was premised partly on Hogan’s extensive background in financial management as the chair of parliament’s Finance Portfolio Committee, but also on her commitment to engage in and understand the severity of the problems of healthcare delivery. During her time as Health Minister, Hogan worked tirelessly to improve the South African health system. After the enactment of an antiretroviral ‘moratorium’ in the Free State province – a four month period during which no new patients were initiated onto ARVs as a result of poor fiscal planning and management in the province – Hogan planned for the establishment of a team of budgeting experts to monitor the budgeting processes of provincial Departments of Health.

TAC is therefore disappointed that Minister Hogan was not reappointed as the Minister of Health, but congratulates the Minister on her appointment to the Department of Public Enterprises. TAC is confident that her leadership and expertise will have a positive impact on her important new position. Minister Motsoaledi and Deputy Minister Sefularo must continue the decisive work done by Minister Hogan. Specific attention must be given to reforming the Department of Health, implementing measures to alleviate the critical shortage of human resources in the public health sector, scaling-up the ARV roll-out and achieving the targets of the NSP, and vastly improving the implementation of TB control measures and treatment.

For further comment please contact:
TAC’s General Secretary, Vuyiseka Dubula: 082 763 3005
TAC’s Chairperson, Nonkosi Kumalo: 074 194 5911
TAC’s Policy, Communication and Research Co-ordinator, Rebecca Hodes: 079 426 8682.

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Mixed Reaction Over New Health Minister. 12/05/09

Anso Thom

Many in the health sector have expressed disappointment over the removal of Barbara Hogan as health minister and have adopted a wait-and-see attitude towards her largely unknown replacement Dr Aaron Motsoaledi, Education MEC in Limpopo.

Traumatised by the legacy of former health minister Dr Manto Tshabalala-Msimang, all those contacted for comment said they thought that Hogan had been doing a good job and it would have been in the interest of a health system that is teetering on the brink of collapse to bring some stability into the sector.

However, President Jacob Zuma moved Hogan to the Public Enterprises ministry, which many reluctantly agree is a better fit for the finance boffin, and replaced her with the 50-year-old Limpopo doctor and father of two.

Very little is known about Motsoaledi’s recent activities other than his career in the Limpopo legislature where he has largely held the Education portfolio with short stints as health and agriculture MEC in the poverty stricken province.

However doctors who fought the apartheid government in the eighties remember him from their struggle days when the National Medical and Dental Association (NAMDA) was formed.

NAMDA came into existence in 1982, a couple of years after a group of doctors broke away from the then Medical Association of South Africa (MASA) when the Black Consciousness leader, Steve Biko, was killed in police detention.

He had been inadequately cared for by three doctors who belonged to MASA and were never disciplined by the organization.

“I know him from way back during the NAMDA days,” confirmed Dr Peter Barron, who has been working as a freelance consultant for the health department.

“I remember him as a very energetic, enthusiastic and competent person,” recalled Barron, echoing the sentiments of several other public health specialists contacted for comment.

Motsoaledi is also believed to be close to the widely respected deputy health minister Dr Molefi Sefularo and enjoys the support of KwaZulu-Natal premier Zweli Mkhize, chair of the ANC’s health committee.

Member of the Democratic Alliance, Michael Holford battled to produce much criticism of the man he worked with in the Limpopo legislature for the past couple of years, describing him as a “big talker”, but “fairly effective, an approachable and likeable chap”. Holford said Motsoaledi would not be afraid to shift incompetent people: “He likes people who can do the job.”

A source within the African National Congress who asked to remain anonymous said there was speculation that Hogan had been shifted at the behest of the Congress of South Africa Trade Unions and others who were not happy with her questioning around the National Health Insurance policy which is being thrashed out within the party’s health structures.

“Everyone has their own interests at heart and Hogan was determined to ensure there was public consultation and the process is transparent. I think Motsoaledi will have to show strong leadership to manage all the stakeholders,” he said.

Democratic Alliance leader Helen Zille said her party was relieved that there was no place in the Zuma Cabinet for a number of ministers from the previous administration whose tenures were nothing short of disastrous, including Tshabalala-Msimang. 

She said appointments which raised alarm bells included the shifting of the “highly effective Barbara Hogan from Health to Public Enterprises in what appears to be punishment for her outspoken comments on the Dalai Lama”.

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AIDS Activists Raise Concerns. 11/05/09

Questions about the strength of the health ministry

11/05/2009 12:00  - (SA)  

 Johannesburg - President Jacob Zuma tapped an obscure provincial politician to guide the nation through the world's worst HIV crisis, raising questions about the strength of the health ministry.

Aaron Motsoaledi, a medical doctor currently serving as a provincial education official, will take office as the new health minister on Monday - the second change in the post in less than a year.

The outgoing minister Barbara Hogan had won praise for breaking with the denialist policies of former president Thabo Mbeki and his health minister Manto Tshabala-Msimang, known as Dr Beetroot for shunning life-saving drugs for vegetables.


Zuma immediately sought to dispel concerns about the appointment, calling Motsoaledi "a well-known doctor who has handled this department at a provincial level in the past".

"He is a very energetic and able comrade so I don't think you should be very worried," Zuma added.

But activists warned that repeated changes in a ministry known for disorganisation would do little to focus the nation's efforts on easing the plight of the 5.7 million South Africans living with HIV.

"I have to say that it's very disappointing," said Mark Heywood, spokesperson for the Treatment Action Campaign pressure group, noting that changes in leadership had also been made at the provincial level across the country.

"We have an entirely new political team responsible for health at a time where the health system is in critical need of resuscitation and in need of continuity and understanding."

Credibility challenge

 Zuma carries heavy baggage into his fight against HIV. He's a polygamist in a country where multiple sex partners have pushed up infections, and was number two under Mbeki, who caused long delays in the roll out of life-saving drugs.

But his biggest credibility challenge will be overcoming a 2006 bombshell while on trial for rape, for which he was acquitted, when he said he faced a small risk of infection in unprotected sex with his HIV positive accuser.

Zuma, who headed the country's national Aids council at the time, went on to say that he had showered to minimise the chance of contracting the disease.

The much-ridiculed statements have haunted him ever since, despite an apology and his political comeback to the country's top office.

"Zuma's 'shower theory' has undermined his authority on HIV/Aids and raised concerns about his capacity to effectively lead the government in the struggle against HIV/Aids," said Elizabeth Mills of the University of Cape Town.

"Zuma has not demonstrated leadership with regards to sexual monogamy nor condom use," she added.

Visible leadership

The new president has committed himself to strong Aids messages but activists want visible leadership for a strong national response.

"I hope we will avoid destructive messages and controversies which detract from combating the HIV epidemic," said Laetitia Rispel of the Centre for Health Policy at the University of the Witwatersrand.

Another challenge will be finding cash to maintain the world's largest anti-retroviral drugs programme that had nearly 700 000 South Africans on treatment at the end of November.

The government plans to boost its battle by R932m and double treatment over the next three years. But Zuma's team is facing the country's first recession in 17 years.

"I look forward to seeing how he translates rhetoric into practice as our new president. Time will tell," Mills said.Should Zuma prove us wrong in our cautious optimism, then South Africans will stand up together and fight until we are heard. We've done it before, and we'll do it again."



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Tough Task for New Minister. 11/05/09

11 May 2009
Luzuko Pongoma


Incoming Minister of Health Dr Aaron Motsoaledi may be unknown to many but he will soon be making headlines because of the huge and difficult job awaiting him.

Although he has served as an MEC for education in Limpopo, Motsoaledi is faced with one of the biggest challenges in the new Cabinet – restoring the public’s faith in the public health system.

Motsoaledi has the unenviable task of fixing the dysfunctional department of health.

Treatment Action Campaign spokesperson Rebecca Hodes said that her organisation welcomed Motsoaledi’s appointment.

“But Motsoaledi has to work hard to be able to deliver on the national strategic plan which aims to provide 80percent of people living by 2011 with HIV with treatment,” Hodes said.

She said that Motsoaledi must also eradicate the ARV waiting list because people were dying of opportunistic infections because of low immune systems.

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New Health Minister: Motsoaledi. 11/05/09

May 11, 2009


The newly elected president Jacob Zuma made sweeping changes to Cabinet on Sunday as he unveiled a team of 34 ministers.

One of the surprises in the new cabinet was when Zuma named Aaron Motsoaledi health minister and moved Barbara Hogan to the key ministry of public enterprises after just six months at health, during which she was widely praised for taking into hand a shambolic portfolio.

The new Health Minister Aaron Motsoaledi, has a Bachelor of Medicine and a Bachelor of Surgery from the University of Natal. He is a former acting premier in the Limpopo province and was previously also an education MEC in the same province. His deputy Molefi Sefularo was health MEC in the North West province and appointed Deputy Health Minister by Motlanthe last year.

The African Christian Democratic Party (ACDP) announced their surprise at the appointments and said: "One would have expected Barbara Hogan to have been reappointed as Minister of Health in view of the widespread acclaim she has received in this position. The relatively unknown Dr Aaron Motsoaledi who has been appointed in her place leaves unsure whether his appointment will bring the necessary service delivery in this important ministry."

They added that it was hoped that Hogan's reassignment to public enterprises would bring a fresh approach to this ministry in view of the huge challenges facing parastatals such as SA Airways, the SABC and others and the billions of rands of state funds being spent on parastatals. – (Sapa, May 2009)

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AIDS Casts Long Shadow over Zuma Presidency. 06/05/09


April 25 2009 at 09:25AM

By Susan Comrie

When Jacob Zuma is sworn in as president on May 9, he will not only inherit power and prestige, he will also inherit a country crippled by HIV and Aids.

While opposition parties are anxiously waiting for the final results, some facts and figures remain unchanged.

About six million South Africans are HIV-positive and 60 percent of those who desperately need ARV treatment still have no access to the drugs that could save their lives.

This week marks 25 years since scientists discovered the Human Immunodeficiency Virus (HIV).

At the time, the US secretary of health hailed the discovery as a major turning point in the battle against Aids and predicted it would take as little as two years for a vaccine to be available.

Twenty-five years later there is little to celebrate.

Optimists point out that at least the country's HIV infection rates have finally stabilised, but the harsh reality of statistics like these is that for the 1 000 South Africans who are infected with the virus every single day, another 1 000 die too young and with little dignity.

The ANC describes South Africa's ARV treatment programme as "amongst the best and most comprehensive in the world", and with 700 000 people on treatment, South Africa does have the largest treatment programmes.

At the moment, though, only four out of 10 people who need ARVs have access to them.

This is despite the fact that the government approved the rollout of ARVs to all HIV-positive South Africans more than five years ago.

The government's National Strategic Plan on HIV and Aids aims to provide 80 percent of HIV-positive South African with treatment by 2011.

But lately no one has been feeling very optimistic about the government's ability to deliver on that promise.

"As we're rolling that out we're coming up against massive constraints," says Lance Greyling, chief whip of the Independent Democrats.

"Even rolling out to 80 percent will be hard, because we're experiencing massive difficulties now. We don't have enough health professionals and we don't have enough funding."

Funding the Department of Health's ballooning ARV costs is a problem most political parties have been reluctant to tackle. But department director-general Thami Mseleku has made it clear that the Zuma government won't have the luxury of putting off the decision, saying earlier this year that "the numbers (of new patients) are very huge and are rising fast".

He added: "As a country, we will get to a stage where we will never be able to afford the figures required for treatment."

In the Free State that point has already come and gone - 15 000 people who were due to start treatment in November were told they would not get ARVs because the province had already used up its ARV budget.

Last year the health department asked the Treasury for an extra R1 billion to meet the rapidly increasing number of HIV-positive South Africans who immediately need treatment; it got R300 million.

"From a human rights perspective, we cannot even allow such a choice that because of constraints we are going to leave some people without treatment," says Deputy Health Minister Dr Molefi Sefularo.

"But there is an element of realism in the government's targets and we have to accept that we won't be able to reach everyone.

"People will always fall through the system."

Reckless spending by the health department has been devastating in the past and the new Zuma government will be under pressure to show that it is as tough on corruption as it claims to be.

The DA, for one, has raised questions about how the Kwazulu-Natal health department could afford to spend R824 586 on the opening function for a clinic in Greytown that cost R600 000 to build.

The new health minister, Barbara Hogan, and her deputy have promised that under their leadership there will be "fewer parties with freebies and caps" and more focus on spending where it's needed - training nurses to distribute ARVs and supporting home-based care projects. The ANC has also promised to cut new infection rates by 50 percent through an aggressive awareness campaign.

South Africa has a long history of ineffectual and misguided campaigns to raise awareness about the risks of unprotected sex and multiple partners, and both the ANC and opposition parties agree that in the future less needs to be spent on glossy magazine ads and more on face-to-face interactions in communities.

Unfortunately, awareness campaigns are often overshadowed by political leaders and prominent celebrities who provide a never-ending list of people who "forgot to play it safe".

The question is whether president-in-waiting Zuma can provide the leadership necessary to change the country's endemic attitude problem towards HIV/Aids.

Cope says Zuma's statements during his rape trial are proof that he should not be trusted to bring a change in attitude among South Africans.

"The fact that the ANC has chosen a man who does not take the issue of HIV/Aids seriously is something very devastating," says Cope spokesman Palesa Morudu.

"We need to be serious about HIV/Aids and our views on women.

"And we are not convinced that he can provide that kind of leadership."

One suggestion put forward by almost all opposition parties is for government ministers and members of parliament to undergo public HIV tests, to encourage ordinary South Africans to get tested.

"I hope more and more prominent leaders in government would step forward for voluntarily tests," says Sefularo.

"But it's a very delicate situation - there are questions of stigma and privacy.

"When I go into the townships I'm struck by the extent to which HIV is becoming more and more of an open conversation, but we need to meet their courage halfway.

"It has always been the ordinary people who have taken the lead with many epidemics, but the elite do need to narrow the gap."

This article was originally published on page 6 of Pretoria News on April 25, 2009

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