Issued by the Presidency
10 April 2000
Annually, for the last decade, South Africa has conducted a national survey of HIV rates among women at public antenatal clinics in an attempt to understand the patterns of HIV in our society. The results are awaited with mixed feelings.
Eagerly, because of their inherent value to the planning process and the hope that they will suggest that prevention programmes are having an impact. With nervousness, because throughout the 1990s the surveys showed an exponential growth in the HIV rate.
In 1999, for the first time since we began measuring the HIV rates among pregnant women, the percentage of women who tested HIV-positive was a bit lower than in the previous year. We resisted euphoria but said maybe there were signs that HIV was beginning to slow down in its onslaught.
This year, the graph showed a slight upswing. Nothing as sharp as the increases of the early '90s, but not the further decline that many hoped for. Just as we resisted euphoria in 1999, we need to resist despondency this year.
In addition to the overall HIV prevalence rate, the survey reveals trends across age groups and across regions that suggest gains in some areas of prevention - for instance, among teenagers and the management of sexually transmitted diseases (STDs) -- and a lack of progress in others.
Perhaps the most significant feature of the survey is that it compels the nation to recognise the magnitude of the HIV/AIDS problem in a solid and serious way.
HIV/AIDS remains a national priority for the government and we have a clear vision of how to respond. We are also aware that the response should be all-inclusive, and the partnership is visible in the South African National Aids Council (SANAC), which leads a multi-sectoral strategy bringing together 35 sectors of civil society and government, working to combat the disease at different levels. The collective response could be the reason for the rising AIDS awareness levels in the country that are estimated at over 90%.
Government has a coherent five-year Strategic Plan for combating HIV/AIDS and other sexually transmitted diseases - a framework that combines a range of interventions that have proved successful in other countries confronted with controlling the spread of the HI virus.
The strategy consists of four priority areas:
Most South Africans will have encountered aspects of prevention strategies that aim to promote safe sexual behaviour and non-discriminatory behaviour against people living with AIDS - the adverts and the street campaigns; the dramas on television and at schools and hostels; the free condoms in many expected and unexpected places.
Few of us, however, appreciate the sheer volume and diversity of these activities. If there is an area where partnership has taken root, it is here - involving an assortment of influential people from employers to entertainers, from pastors to sex workers, from trade unionists to traditional healers, from politicians to many other high profile figures in society.
Less recognised features of the prevention strategy include ensuring easily available, good quality treatment for all sexually transmitted diseases. Our free public clinics offer effective interventions, as the recent survey confirmed by recording a real decline in syphilis rates among pregnant women.
Prevention also includes addressing the safety of blood available for use in transfusions and expanding the services available for people to test their HIV status and to receive supportive counselling. The year 2001 will see progress in relation to facilities for voluntary testing and counselling as we introduce new rapid tests in many clinics.
The tragedy of babies being infected with HIV at birth cannot fail to move us. The year 2001 will see advances as we establish 18 research sites to respond to the mother to child transmission challenge.
In the last year, we have developed guidelines for health workers and caregivers in order to raise the standard of care in several critical areas and health workers will be trained to implement these. Setting up systems for home-based care is an essential step if we are to relieve the load on our hospitals to ensure that every person in the terminal stages of AIDS has a reasonable level of comfort. Success of this programme will, however, depend on the closest co-operation of groups and individuals in communities.
We have also conducted an ongoing campaign on various fronts to secure medicines that are essential for the treatment of many infections that characterise AIDS. This has entailed negotiating with drug manufacturers and also combating them in court.
Government also funds and actively supports research - from the highly specialised research into AIDS vaccines, to the search for viable new approaches to treatment and care; to policy research and the kinds of surveys referred to above. South Africa's surveillance expertise is highly regarded and the World Health Organisation has adopted our antenatal survey as a model. (WHO).
As Government, we would like to assure South Africans that we will continue to work tirelessly to fight HIV/AIDS.