Date: 28/10/2002
Source: Ministry of Health
Title:Rooting out Stigma-combating discrimination


SPEECH BY THE MINISTER OF HEALTH AT SUMMIT OF PEOPLE LIVING WITH AIDS, Eskom Conference Centre, Midrand.

Comrades, friends, sons and daughters of the African soil, I greet you all. I am very happy to be here and for the opportunity to share this special moment with you today.

This SANAC (SA National AIDS Council) summit for the sector of people living with HIV and AIDS has been long overdue. But I hope that it will give all of us the opportunity to share our experiences and put our heads together in seeking a common understanding and vision on how to tackle the spread of HIV and mitigate the impact of AIDS at different levels.

People Living With AIDS have been for a long time been one of the marginalized sector due to stigma and discrimination attached to a positive HIV status. This practice has led to a lot of communities not being able to respond appropriately in the provision of care and support due to ignorance, lack of support and in many instances due to discrimination.

We have to applaud courageous men and women who came out public to declare their status with an effort to educate communities and rally for support. Their acts and deeds have enlightened a lot of us. However, there is still a significant number that still need to be educated so as to encourage mind shift and start providing necessary support.

People living with AIDS are the most powerful advocates and living examples of the hope that society will conquer against the spread of the virus. You bring sensitivity to our approaches, as their inputs are invaluable in designing interventions that will have maximum impact. You bring together nations and communities to play their rightful role in the fight against HIV and AIDS.

I am relieved that at least today I do not have to start by having to convince my audience that we indeed have a major challenge on our hands and that we all must take the responsibility to address it. We are committed to ensuring that South Africa triumphs against the spread of HIV infection, the ill-health brought by AIDS and the emotional destruction, which accompanies these.

The theme of this Summit - "Rooting out Stigma: Combating Discrimination" - is probably most appropriate. I believe that it is addressing one of the most difficult components of our response to HIV in this country. It is difficult because you cannot measure its impact, you cannot put indicators for it to assess progress. It is an intangible process which is extremely destructive.

Stigma is an individual perception. It often arises when one person makes a judgment on another and on the basis of this judgment withdraws and isolates himself from the so-called "victim".

We all know that in our societies there are many groups, which suffer stigma, such as those who have TB, those who have different sexual preferences, those with different religions, etc. When it comes to HIV infection there is an inherent belief that those who are infected did something wrong. Now we all know that this is a fallacy and that all of us are living with HIV - who ever we are, wherever we come from.

The fact that we are human and that we have relationships makes us all part of a world with HIV. The challenge is to get everyone to accept that no one is immune from HIV and AIDS. We are all affected and we need to live positively with this reality. I would like you comrades to bring your collective wisdom to this challenge. How do we get all South Africans to identify with HIV as our struggle in the same way we embraced the fight for liberation? At that time all of us united against a common enemy and fought. We did everything in our power to resist being taken over. Why can't we do the same with HIV infection?

In the current discourse, the fight is characterized as the responsibility of Government and in a way a fight for those who are living with HIV exclusively. The most popular question is: "what is government doing about it?" People living with HIV have come together to fight but those who perceive themselves as being unaffected watch silently from the sidelines. This cannot be, comrades. We have to challenge this approach and get everybody to find a way to make this his or her challenge as well.

An unfortunate impression has been created that government in particular is not committed to tackling this epidemic. I do not want to go back to highlight some of the commendable progress we have made in this country largely through the commitment of resources by government, a recognition and support for sectors such as the People living with AIDS sector and the strengthening of partnerships with all other committed stakeholders.

However I want to say something, which does sometimes make me sad. Many of you here know the history of our struggle. Given that knowledge, is it possible that our new government can suddenly ignore the needs of the people or fail to pay attention to what people say they want from government?

Our collective challenge comrades, is to come up with strategies, which will be equitable, affordable, accessible and sustainable. No one must assume that it is always easy to respond to such challenges. Sometimes as policy makers we are faced with hard ethical questions and choices.

In a country where more than half of the population is historically disadvantaged, how do you make decisions on who should benefit and who should not? Given the threat posed by HIV and AIDS, how do we articulate decisions, which seem to benefit some and not others? As I said comrades, let us find a common way to respond in such a way that we move together as friends and fellow South Africans. I am keen to hear what recommendations will come out of this Summit on some of these pertinent questions.

You elected this government and you should rest assured that it is doing everything in power to address this major challenge. What is needed is for all sectors to join hands in partnership with government and other sectors to ensure that our interventions are a success.

A typical example is with regard to the Universal Roll-out Plan for prevention of mother-to-child-transmission of HIV. On top of training, budget and proper health facilities, the most critical challenge is community attitudes. As government we continue to put resources to upgrade health facilities for testing, counselling and monitoring for the roll out this programme. Addressing discrimination against HIV-positive mothers can only be addressed if we get the support of different sectors in charging attitudes within our communities.

The quality of life of those infected with HIV is a major concern to government. Health of people living with AIDS can be improved greatly through the effective treatment, management and prevention of opportunistic infections.

It is important, for treatment purpose, as well as prevention, to increase access to voluntary counselling and testing. The scaling up of voluntary counseling and testing programmes poses a challenge to people living with AIDS to become counselors. We know that you would do this with passion and understanding towards those being counseled. Your involvement will provide guidance to those who test negative and give courage to those who test positive. Your involvement will serve as a major step towards positive living.

It is also important that as we talk about issues of treatment, we acknowledge the critical role of different kinds of treatment most of which are available free of charge in the public health sector. Treatment for opportunistic infections, such as meningitis, oral thrush, TB and pneumonia, is very important in managing AIDS. We estimate that government is spending approximately R4 billion in management of these AIDS related illnesses.

Good nutrition is a critical component of boosting the immune system and fighting diseases. Therefore, Government's poverty alleviation programme and nutritional interventions should be viewed as an essential part of the fight against HIV and AIDS. I am sure many of you are aware of the many coping strategies and simple interventions which people currently implement. A good example is the use of home remedies such as garlic and olive oil. I think it is important to make these efforts part of our response them to be part of our many programmes.

We are also encouraging investigation into alternative or complementary treatments and medication for boosting the immune system. However a protocol for research into such treatments is critical and we have therefore drafted such a protocol for submission to the Medicines Control Council.

The success of a treatment programme depends largely on the availability of drugs. We therefore need to ensure that we have an uninterrupted supply of all medicines to all health facilities. You can help in this regard by preventing theft of medicines and hospital supplies. All of us, especially people living with AIDS, should help monitor the availability of drugs, and report any problems as we come across them.

Cabinet has been discussing very extensively the issue of provision of anti-retroviral drugs in the public health sector. The major challenge comrades, is that these drugs are at present too costly for universal access. Some estimates have suggested that for one million people to get this treatment, this would require about R7-billion. However, the Department of Health and Treasury is doing further work on these and other cost implications.

The other critical element is the effects of incorrect use and the harm that can be caused by inadequate health systems. This underlines the need for the drugs to be used under appropriate supervision and monitoring.

We are actively engaged in addressing these challenges, in order to create the necessary conditions that would make it feasible and effective to use antiretrovirals in the public health sector.

We continue to work for the lowering of the cost of these drugs and to intensify the campaign to ensure that patients observe treatment advice given to them by doctors. As a sector, you may need to explore ways in which you can mobilise around raising awareness of our people of the importance of observing treatment advice. This is not only about AIDS but also about all the illnesses affecting our people.

The major cause of stigma is ignorance. We are therefore also focusing strongly on education and training. For instance, out of 27 000 registered medical practitioners only 2 000 have been trained in providing care for people with HIV/AIDS. This has required that the Department of Health run a series of training programmes in collaboration with academic institutions and other role players to address this backlog.

We are working together with provinces to disseminate guidelines on HIV/AIDS and TB care and other supportive information to ensure that health care workers are adequately skilled in providing care and support to those who need it.

People living with AIDS as a sector are particularly powerful and well positioned in ensuring that our response in this country is the best. We need to learn how to tackle the private nature of HIV infection and to have a collective response. Our current understanding and application of confidentiality requires us to have an open and honest dialogue.

We need to ask as to how do we ensure that in the context of health provision we practice respect for individuals and ensure that we take collective responsibility. As individuals and communities we need to internalize these matters and really reflect on them. How do we overcome the fear, which I believe contributes to the negativism and discrimination?

Denial is sometimes a response to fear. Sometimes fear can lead to despair. I know that as a country we probably have not done enough to prepare for the severe emotional and psychological trauma, which is the outcome of this huge challenge. We therefore need to accelerate interventions in this regard.

The nature of these interventions can only be guided and informed by those of us who are living openly with HIV. They can teach us how to live without fear and with dignity within the epidemic. They can teach us how to express intimacy, desire and sexuality in the age of the virus. We must learn together.

A "one-size fits all' approach is never going to work. We need a fusion of problem-solving approaches that apply to different categories of human needs. Obviously, clinical care is necessary, but so is counseling, social and nutritional support, spiritual support and coping strategies for the family and plans for the children. The critical point we must accept is that we need each other in order to survive. We need to strengthen our partnerships and ensure that our relationship is based on mutual trust and respect. Each one of us must identify our strengths, our responsibilities and our rights. We have to find a way to communicate with each other, share insights and experiences and work together.

The loss and pain associated with this epidemic are already too much for many to bear. But this may be have a positive aspect because in every crisis there comes a time for helplessness and a need for burden sharing instead of burden bearing.

It is a time for truth telling, the end of painful silence and the beginning of closeness. Talking is the basis for healing. I know that we all are aware that there is still no cure for HIV infection and AIDS. But even in the absence of a cure, the healing process can begin. It can begin in the hearts of each and every one of us.

We can start by together acknowledging our fears, our choices, our practices and how we interact. This is the beginning of our walk to freedom, away from the despair and pain. We can stop the blaming, the stigmatization, and the marginalisation. We can start by reaffirming that to be alive today is to be in a world with HIV. Our best weapon is SOLIDARITY!

I wish you well in your deliberations and would like to take this opportunity to reaffirm government's commitment to the fight against this silent enemy. Remember ALL OUR ACTIONS COUNT.

I declare this Summit officially open.