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Date : 27/03/2004
Source: Ministry of Health
Title: M Tshabalala-Msimang: Men's March against AIDS


SPEECH BY THE MINISTER OF HEALTH, DR MANTO TSHABALALA-MSIMANG, AT THE MEN'S MARCH AGAINST AIDS, DURBAN, 27 March 2004

Greetings

I am honoured to be part of this significant event in our efforts to curb the spread of HIV infection and reduce the impact of AIDS. HIV and AIDS is a challenge affecting all of us. I am delighted that men have mobilised themselves and are playing a major role in this response.

In 2002, four hundred South African men demonstrated their commitment at the National Men's Imbizo held in Cape Town. The Imbizo was convened to include men in a more organised and active way in the National Partnership Against AIDS Initiative. This is an initiative that was launched by our President, President Thabo Mbeki, in 1998 to mobilise and coordinate multi-sectoral response to the challenge of HIV and AIDS.

Since that Imbizo, men have taken an active stance in the fight against AIDS by:
* Mobilising other men within their provinces and communities
* Sensitising men around their own reproductive health through provincial and national workshops
* Accepting responsibility for their actions
* Encouraging partnership and collaboration between men and other sectors.

Almost two years later, your commitment has not diminished and even more men have joined us in today's march. More South African men have taken their rightful position at the forefront of the fight against HIV and AIDS, violence against women and children and many other social ills of our society.

Violence against women and children is as much a public health issue as a criminal justice and social development issue. We know that, in many instances, women remain subordinate. Poverty brings social marginalisation, which effectively renders them citizens without rights. Violence is widely accepted as a means of resolving inter-personal conflict and physical punishment of women and children is tolerated.

We need to scale up the support services that relate to gender-based violence and ensure that they are adequately resourced and widely available. Inadequate support services become disincentives for reporting cases of sexual violence.

There have been considerable legislative changes during South Africa's first decade of democracy that protect the rights of women promote gender equality. A range of new laws, for example the Domestic Violence Act, the Maintenance Act, the Promotion of Equality and Prevention of Unfair Discrimination Act, the proposed Sexual Offences Act and the Choice of Termination of Pregnancy Act all address gender related issues.

Their implementation and acceptability have been limited by continued discriminatory attitudes and practices, a lack of resources and inadequate training and skills. The health needs of those who have suffered sexual assault are important in the quest for justice. It would be a hollow victory to see the perpetrator sent to jail, if the individual who was attacked is left with a deteriorating health and a disease that could possibly have been prevented.

We are therefore intensifying the implementation of various interventions that give survivors of gender-based violence some chance of full recovery. This march is an indication that these interventions have support amongst many men who are responsible citizens of this country.

Programme director, being a boy and a man generally brings privileges, but it also carries high health costs. Men generally have a shorter life expectancy at birth than women. Young men die more often than young women, from traffic accidents and violence. Both these challenges are related to a perception of "manhood" that encourages men to take risks or use violence. This perception also encourages sexual and drug-related risk-taking. Men frequently delay seeking health care for illnesses that could be prevented or cured.

All these factors, particularly the reluctance to seek treatment for sexually transmitted infection, put men at a greater risk of contracting HIV infection. Such behaviours as alcohol and substances abuse increase the possibility of engaging in unsafe sex.

HIV is more easily transmitted sexually from men to women than vice versa. This is exacerbated by the tendency to have more sexual partners encourages the spread of HIV. A man with HIV is therefore likely to infect more people over a lifetime than an HIV-positive woman.

But with this initiative, men are beginning to give greater consideration to AIDS and its effects on families. Fathers and future fathers are encouraged to consider the potential impact of their sexual behaviour on their partners and children, including leaving children behind as orphans and introducing HIV into the family. Men are also encouraged to play a greater role in caring for family members living with HIV and AIDS.

Efforts are being made to encourage positive behaviours. We are building upon successful work that started with the Cape Town Men's Imbizo. We want to include as many men as possible in the national struggle against AIDS.

The Department of Health has developed risk-reduction measures targeted mainly at men. For example, we have programmes that specifically focus on long distance truck drivers and shebeens. These programmes are aimed at encouraging consistent practice of safe sex and to reduce the number of sexual partners.

We also have a very strong relationship with the traditional leaders across the country. These leaders are assisting in spreading the messages to the most remote communities.

To reinforce prevention efforts, the Department of Health is implementing the Comprehensive Plan for Management, Care and Treatment of HIV and AIDS which was adopted by Cabinet in November last year. This Plan strengthens the health system, enabling it to provide a series of interventions aimed at maintaining optimal health and reducing the progression from HIV to development of AIDS.

In February, we conducted an initial assessment of 110 facilities in all 53 districts of the country. Action plans to address the challenges and strengthen the capacity of facilities were developed. Accreditation teams from the Department of Health have commenced a second round of visits to provinces to formally accredit facilities that meet the requirements. The accredited facilities will be announced within the next few days. Our aim is to have one service point in every district within the first year of implementation.

These facilities will begin to enrol patients. This process includes:
* Doing CD4 counts and viral load tests to establish the progression of the disease
* Providing interventions that prolong progression of the disease including nutritional and micronutrient supplementations, providing complementary and traditional medicines and improving step down care. An intensive training programme is being implemented to assist health workers to effectively provide these services.

Patients with a CD4 count of 200 or below, and want to use antiretroviral drugs, will begin to undergo a treatment literacy programme to ensure that they understand the complicities of this programme and they strictly adhere to treatment.

During our meeting with the MECs earlier this week, we took the view that interim measures to procure these drugs should be explored and used only in situations where sites have been fully accredited. We want to also ensure that quality standards of the programme are not jeopardised.

This temporary measure will not replace the national tender process, which is far better suited to sustainable drug supplies, most competitive prices and meeting longer term demand that the programme may create.

More than 40 pharmaceutical companies and suppliers have expressed interest to supply the drugs through the national tender process. These companies have until Friday, April 02, to submit their proposals. A process of short-listing will follow and negotiations will take place with the short-listed companies during the month of May to secure the most competitive prices.

I must emphasise that this Plan is about choices. Those who use traditional and complementary medicines, for instance, are encouraged to do so. Government has transferred more than R6 million to the Medical Research Council (MRC) to assist in the research and development of traditional medicine. MRC is also our main partner in implementing a broader research programme for this Plan.

We are also providing supplementary meals and micronutrient supplementation particularly for those who are food insecure. An extra R4 million has been allocated to increase volume of these nutritional supplements. Training is being provided to ensure that our health workers understand all the elements of the Plan, including national treatment protocol that has been adopted. We are also recruiting more staff to improve management capacity at national and provincial level and service delivery in our facilities.

This is a major programme that is recognized internationally as the biggest initiative ever taken against HIV and AIDS. Last week for instance, I presented this Plan to the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria and discussed it with the Director General of the World Health Organisation, Dr Jong-Wook Lee. There has been great enthusiasm amongst our international collaborating partners and local stakeholders in supporting the implementation of the Plan.

The success of this Plan is very much dependent on our ability as South Africans to mobilize communities to support people living with HIV and AIDS. I urge the Men in Partnership against AIDS to assist us in addressing the challenge of stigma that remains a stumbling block in our response to HIV and AIDS. Let us ensure that people are supported in sustaining whatever treatment option they choose.

Let our men from all nine provinces use this march to address the challenges of inequality, discrimination and violence against women and children that still face us.

The task facing each one of us gathered here today is to mark the ten years of democracy with a selfless undertaking to create a better and healthy environment for all of us as men, women and children. This requires our collective action and individual responsibility.

Each one of us should adopt the theme of Khomanani - Caring together for life.

Thank you.

Issued by: Ministry of Health
27 March 2004
Source: Department of Health (http://www.doh.gov.za)

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