Issued by: Gauteng Provincial Government
14 July 1997
The Gauteng leg of the National AIDS/days last week. Our team, consisting of members from international organisations, various levels of government and the non-government sector, visited institutions and organisations from Carletonville to Heidelberg, and Pretoria to the Vaal. We looked at all kinds of programmes and initiatives, run by government and non-government agencies, at a preventive level and in the areas of treatment or care.
The aim was not only to get an understanding of how sexually transmitted diseases and HIV/AIDS are being managed and of the problems encountered by those working in the field, but to bring the issue of STDs and HIV sharply into focus. In particular, to prompt decision-makers in various sectors to recognise the needs and the opportunities which exist and to recommit themselves to giving the AIDS epidemic the priority treatment it demands.
A full analysis of the situation in Gauteng will be released as part of the national review report. But, with the impressions of the last week still fresh in our minds, we would like to share some of our main findings.
In relation to STDs (other than AIDS/HIV), the picture in this province was overwhelmingly positive. STDs were being effectively managed at almost all the clinics, health centres and hospitals visited. The approach adopted - referred to as a syndromic approach - enables nurses to diagnose and treat patients effectively (without referring them to a doctor) and this has done a lot to ensure a swift and easy access to care across the province.
Turning more specifically to AIDS/HIV programmes, the picture is altogether more mixed.
On the one hand, we encountered workers in the field - nurses, counsellors, social workers and others - performing the most amazing job of work, in a dedicated and innovative way. Their commitment was truly striking and demands recognition, especially as many of these staff are carrying excessive workloads.
We were also impressed by the extent of NGO and CBO activity in every area of AIDS work from information and advocacy, through to counselling and care (through institutions and support to care-givers in the home). there is a reasonable level of co-ordination of this hugely diverse work, thanks to the AIDS Consortium, Nacosa Gauteng and the Gauteng Health Department's AIDS Directorate.
Another positive aspect was a high level of general awareness about the transmission of AIDS and effective distribution of free condoms to almost all parts of the province.
On the other hand, we found that people with AIDS were often shunted between services, that they were subject to discrimination, their basic rights were often flouted and that they could wait for months to receive help.
It became clear to the team that care at primary level facilities is virtually non-existent and home-based care programmes few and far between. People with AIDS are being referred - often inappropriately - to HIV Clinics at the higher hospitals.
The result is that the academic hospitals are swamped with HIV referrals. The best services have become victims of their own excellent reputations. There is tremendous pressure on staff at these centres and long waiting periods for patients needing their care.
The Review Team felt that a number factors could have a significant impact in extending resources, redistributing the load and achieving a critical change in the ethos of service to people with AIDS.
It was evident that the enormous amount of effort spent on transformation on the public sector has had an adverse effect on service delivery in many government departments - and this is as true in the STD/AIDS field as elsewhere. Restructuring and policy development have made heavy demands on management. Leaving them with drastically reduced time to actively manage programmes and oversee implementation.
The Review Team was left at the end of its Gauteng investigation with the impression that sound and varied work has been done in prevention and care in the AIDS field, laying a solid foundation for expansion. While agencies in the province have clearly not come to grips with the sheer volume and variety of care needed, many opportunities and substantial resources to tackle these problems exist.
To a large degree, pooling existing resources, smarter management and working across sectors hold the key to a more effective HIV/AIDS response. However, staff shortages at certain levels of care are severe and it is clear that these services will not measure up to the challenge unless understaffing is addressed.
Finally, political commitment across the range of policy areas relevant to the AIDS epidemic is the essential ingredient in raising responses to a new level. AIDS is no vague and distant threat to the economy, to community life, the labour market and the health, education and welfare systems. It is a large, definite and immediate presence. It cannot truly be fought unless political leaders at all levels play their unique role in rallying resources and unifying people in a common cause.
Peter Busse Team Leader STD/AIDS Review Team for Gauteng
(Distributed by the Gauteng Health Department's Directorate for Health Promotion and Communication on behalf of the STD/AIDS Review Team for Gauteng. All queries should be addressed to the Review Team. Any purely technical hitches can be cleared by phoning Jo-Anne Collinge on 011 355 3234)