Issued by: Gauteng Provincial Government
WHAT THE LATEST HIV SURVEY MEANS FOR GAUTENG
April 25 1997
The latest national figures on the rate of HIV-infection among pregnant women, are cause for grave concern. In Gauteng, where at least 15,5% of pregnant women have tested positive, there is no room for complacency.
The Gauteng Health Department regards the national ante-natal HIV survey as a vital index of the course which the epidemic is taking in this country. We know that the infection is spreading rapidly in Gauteng and that we may still reach an infection rate one in five young women by the end of 1997.
THe infection rate for men in the 15 to 45 year age-group is typically slightly lower than for women. (For instance, a major health insurer put the national figures at the end of 1996 at 14% for women and 10% for men).
For some time now the Gauteng Health Department has warned that Southern African is headed for a "Uganda scenario" in relation to HIV. The latest figures underscore that this remains likely and that the epidemic has by no means tailed off. We have no wish to be alarmist, but it is clear that we can only combat an epidemic of this magnitude by an enormous effort on all fronts.
The "Uganda scenario" is not all bad news. The powerful message to emerge from Uganda in recent years is that the tide of infection can be stemmed and actually reversed. And this can be achieved with extremely limited resources, in a poor country, for the poorest of its citizens.
But to reverse the advance of HIV, international experience shows, we have to stop treating it merely as a health problem, with limited side-effects on the social welfare system. Uganda elevated the battle against HIV to a national priority and we need to do likewise.
THe Gauteng Health Department, for its part, will increase its dedicated HIV programme spending from R17-million to R27-million in the 1997/8 financial year. This is an addition to the spending by hospitals and clinics on patient care for those with HIV.
WHY HAS HIV GAINED GROUND FAST IN GAUTENG?
Gauteng features a number of conditions which are associated with the rapid increase of HIV.
What works in the fight against HIV?
Once again, we draw on international experience and particularly that of Uganda. There are well-established, essential elements to all successful programmes to combat HIV and there are clearly defined objectives.
The objectives are:
The main areas of activity relate to:
Is Gauteng following tried and tested methods?
The short answer is a qualified "yes". A wide range of govern- ment and non-government agencies are implementing many of the esta- blished strategies, but we are not operating on the scale required to make a marked impact on the epidemic. We have also not yet evaluated how well we are carrying out the vital tasks of education and information-giving.
Significantly, though, groundwork has been done in terms of a widely consulted policy framework h includes all the critical elements. There is clear direction on what needs to be done.
In Gauteng, where access to media is easier than in many other provinces, research suggests that the level of awareness of HIV as a sexually transmitted disease is quite high. But the depth of under- standing and the perception of risk appear to be insufficient to achieve safe sex practices.
Educational programmes of a more focused nature are part of the anti-HIV arsenal inuteng. The latest addition to these is the launch of an intersectoral project to launch lifeskills training in schools. The idea is not simply to equip young people to understand what HIV is, but to act on that understanding. Although this kind of empowerment of young people has been shown to bear results, the lifeskills initiative is particularly difficult to implement. It demands enormous resources of time and expertise to train lifeskills facilitators. This kind of project frequently encounters the resistance of parents, who equate any programme which deals frankly with sexual choices and sexual practices with encouraging promiscuous behaviour.
There is a rich variety of community groups in Gauteng engaged in educational work on HIV. They could do with more support and resources - not only in the form of finance, but also through sharing skills and engaging in partnership ventures.
In terms of outreach work to educate special groups, a few examples exist in Gauteng. The need greatly outstrips present activity. The same could be said of work place education, where there is enormous potential but - thus far - results are limited.
Over the last three years access to STD treatment al clinic level has increased and the treatment available is effective. However, rates of STD infection are still unsatisfactorily high and priority must be given to improving the accessibility of treatment.
Condom supply in Gauteng increased substantially last year, with 22-million condoms made available free of charge through a variety of channels. The volume suggests that the level of acceptance of condom use has improved. But the uneven distribution of condoms indicates that there is still work to be done and bulk supplies are not as reliable as they need to be.
What about care for the people with HIV?
The latest incidence figures obviously have implications in terms of the capacity required to care for people with HIV in years to come as they become seriously ill.
In February this year, the Gauteng Health Department held a two-day conference on care for people with HIV to plan a comprehensive set of services. More than 350 people attended the workshop. They represented provincial and local government, the NGO sector as well as community groups, and organisations of people with HIV.
Implementation of the approaches agreed and priorities identified by the conference is currently being worked on at regional level throughout Gauteng, with five regional coordinators driving the process.
The conference stressed that caring for those with HIV is in every way an intersectoral effort - across disciplines, across the government/civil divide, inspanning professional and lay workers alike.
In order to meet the rapidly growing demand for care, primary health care approaches, including community- and home-based care, will play a leading role. Public hospitals will mainly provide care for acute illness.
Where are we headed in the coming year?
Quite clearly the increase in the incidence of HIV is likely to require an increase in funding for programmes. As indicated above, the Gauteng Health Department intends to allocate substantially increased resources in the year ahead.
However, pumping money full-force into this area of work will not necessarily accomplish the expected results. There is a trade-off to be made in terms of speed in mobilising resources and wisdom in applying them.
We believe our best investment of additional effort and new resources will be in the following areas:
However, mobilisation of public sector resources will achieve little without a matching mobilisation of effort among the public itself. Every individual in a position of influence - from political leaders to ordinary parents - must acknowledge that HIV is no longer a distant danger and a threat to an isolated minority. It is a reality in all our lives.
We can do no better than borrow the words of Health Minister Nkosazana Zuma in urging the people of Gauteng not "to wait until we have buried too many of our family members, relatives and friends before we take steps to prevent the spread of HIV".
Dr Liz Floyd Director For AIDS and Communicable Diseases
Contact number: 082 372 0552
Released by the Directorate for Health Promotion and Communication