25 September 2001
Issued by Gauteng Provincial Government
Honourable Speaker and Deputy Speaker
Leaders of the opposition
Honourable members
Members of the Gauteng Aids Council
Fellow citizens
The Malibongwe Conference held in Amsterdam, Netherlands, from 13 - 18 January 1990, under the theme `Women united for a Unitary, non-racial, democratic South Africa noted with concern the potential suffering and loss of life and effect on the economy of an AIDS epidemic and resolved to:
The annual report on AIDS is a concrete expression of the movement's commitment to implement policy positions adopted by our movement since the outbreak of HIV/AIDS.
With this report we indicate work in progress, challenges and a message of hope to the citizens of our province, that in partnership with them, we will win the fight against HIV/AIDS. Together we can ensure that future generations continue to enjoy a normal life.
Guided by the input of the Premier's Committee on AIDS and the Gauteng AIDS Council, we have developed a multi-faceted strategy. This comprehensive strategy involves every provincial department and reaches every sector of society and community in our province. It involves widespread social mobilization and organisation at provincial and local level geared towards prevention and awareness raising as well as the provision of care for people living with Aids and their families.
Research sites on the prevention of mother to child transmission of HIV/Aids are now up and running in line with the national guidelines. This follows extensive preparations including the training of health workers at these sites. Each site consists of the pairing of a clinic or clinics with a referral hospital. Recently established sites are JC Dumane clinic and Natalspruit Hospital, Pretoria West/Kalafong Hospital and Carletonville clinic/Leratong/Coronation hospitals. These are in addition to existing research at Chris Hani Baragwanath/Lillian Ngoyi/Zola clinic. A new site will be opened next week at the Johannesburg Hospital.
Our objective in this programme is to reduce the number of babies born to HIV-positive mothers from themselves becoming HIV-positive or ill. The programme goes beyond simply a shot of Nevirapine. It involves voluntary testing and follow up testing of those found to be HIV positive. It involves ensuring that the appropriate midwifery practices are strictly adhered to. It involves advising mothers on the safe use of breast milk substitutes, it involves following up the babies, providing them with further health care and it involves further HIV tests. It involves counselling, education and support for a period of up to two years after the birth. It involves providing Nevirapene and breast milk substitutes. It involves intensive training and orientation of staff. It involves monitoring the possible side effects due to the toxicity of the drug.
Following widespread training and capacity building, we are proceeding with the implementation of our integrated community and home-based care model throughout Gauteng. This forms part of the strategy to develop comprehensive Aids care in all metros and districts in Gauteng.
To date we have succeeded to establish 57 Home Based Care projects throughout the province. This is in excess of the total number of Home Based Care projects in the rest of the country. These are supporting people who are ill with Aids as well as providing care services to families, providing advice, training, support, including basic supplies, and a wide range of community care programmes. The aim is to extend coverage to the whole population in the next few years. These programmes aim to reduce denial and discrimination and increase openness as well as strengthen practical support for people and their families.
It provides opportunities for cost effective care and complements existing health services.
Our media and mobilisation campaign uses both conventional methods of advertising and unique mobilization strategies to turn the AIDS campaign into an opportunity for people to become informed and to participate in creating further awareness in communities.
Our advertising reaches audiences of up to 8 million people regularly, while street and door to door campaigns saw over 8000 volunteers targeting 3.5 million commuters and people in disadvantaged areas.
On yet another unprecedented scale, we continue to distribute 7 million condoms per month. The effect of this is that we are making condoms accessible to all communities. We would be failing in our responsibility to ask people to follow our ABC message of Abstain, Be faithful or use a Condom, if we do not provide the necessary tools for them to exercise their choice in this regard.
We have put aside substantial resources to carry out our HIV/AIDS strategy and programme. We have allocated an amount of R70 million towards combating HIV/AIDS in our province. More resources are located in departments through their various programmes aimed at dealing with the epidemic. Examples of this include:
In addition to the enormous responsibilities which the Aids pandemic thrusts upon us as a provincial government in relation to the people of the province, we also have responsibilities as an employer of roughly 124 000 people. It is a requirement of the Provincial Executive Council that HIV/AIDs should form part of every department's programme, but more importantly that each department should include HIV/AIDs implications in their policy planning process.
All departments are making important progress in implementing workplace programmes which include a training programme for public servants throughout the province.
The Inter-sectoral AIDS Unit located in the Health Department provides support to all government departments and to civil society with a specific focus on youth, women, civics, media, traditional and faith healers, trade unions and the private sector
All of these institutional mechanisms are backed and coordinated at a political level by the Premier's Committee on AIDS and the Gauteng AIDS Council, which are chaired by the Premier.
The Premier's Committee on AIDS consist of Members of the Executive Council and Heads of Departments, with its main aim being to provide strategic leadership and co-ordination of the Gauteng government's AIDS programme as government and as an employer.
The Gauteng AIDS Council (GAC) facilitates the development of an AIDS response in all non-government sectors and co-ordinates these responses with government. It is comprised of community leaders chosen on the basis of their leadership roles in various sectors of society and includes people living with AIDS and their organisations.
Just as we all accept that AIDS is spread through unprotected sex or contact with blood on open wounds or cuts, we also accept that poverty exacerbate the situation.
Dr Kathleen Cravero, Deputy Executive Director of the Joint UN Programme on HIV/AIDS (UNAIDS) says the following about the link between poverty and AIDS: "We have learned that AIDS and poverty are closely connected. Unless we address AIDS we cannot make progress on poverty and unless we do more to eradicate poverty, AIDS will remain a major threat."
It is therefore clear that, without larger developmental programmes to combat poverty, the world will never overcome the scourge of this pandemic.
The impact of the virus on the developmental goals of developing nations in particular has been devastating. Decades of gains in education and health are rapidly being eroded, and the economic profile of the most vulnerable groups is worsening. As household income drops, children are forced to leave school to either care for ill family members or work to provide an income. Given low skills levels, they are tied into menial labour with little hope of advancement.
The vicious cycle of poverty continues and is given an added boost by the strains that the pandemic places on systems such as health which is also affected by an increase in Aids related care demands and Aids-related deaths amongst its workers.
It is clear that breaking the cycle will require focused attention on poverty alleviation programmes. Studies conducted by the World Bank in Uganda, Côte d'Ivore and Thailand for example have found a correlation between countries with high HIV infection rates and declining economies.
A report by FAO (the United Nations Food and Agriculture Organisation) published in May this year found an important causal link between HIV/Aids and declining food security. These relate both to production in rural households being affected by breadwinners being struck down by the virus and the declining income and health status of households dependent on other productive sectors for an income.
Food security, a study in Tanzania showed, is further undermined when a woman in the household dies because the primary responsibility for household nutrition rests with women in many households in the developing world.
Nutrition impacts directly on vulnerability to opportunistic diseases and the recovery rate of people with Aids. Good nutrition is both important for disease resistance and the quality of life of people with Aids. This is evidenced by the story told by Mama Veronica Khoza, aged 64, who runs the Tateni Home care project in Mamelodi together with a group of volunteers in her community. They have committed themselves to care for people living with AIDS by giving them support, love and care. Ma Khoza says the following about one of her patients:
"In 1999 I was phoned by a nurse from a hospital to fetch Patrick (name altered to protect identity of individual) who was under the care of the hospital for some time. Patrick was so sick and presented with abscesses around the whole of his body. He was mentally confused and did not want anything to do with anyone. He was taken to his sister's place by my colleague. Even though he did not want us to talk to him or touch him, we gradually persuaded him and assured him that he was in good hands after which he started to cooperate.
We started to take care of him by cleaning his body to remove all the pus that was in his many sores around his body. After six months of hard work and long periods of interaction with him, he came over to me to ask if he could talk to me about his life. I agreed and he told me of things he says he had never told anyone, including his family and friends. He said to me I have lived all my life to this age but my family does not know me. He asked for me to act like his mother. By this stage, Patrick, who a few months ago was just waiting to die, was a different person all together. He had become a new person who was positive about life. As I speak to you, he asked us to help him to find something to sell so that he can live a decent life once again. Other than taking nutritional supplements we provide to him regularly, Patrick does not have access to AIDS treatment but now lives a normal life.
This is just one story among many such stories of people who, together with hospitals and their families, had resigned themselves to the fate of death, counting each day as it went past. It shows that with a little bit of support, many lives can be prolonged. We have learnt here at the Tateni Home care that it takes building a relationship with our patients and allowing them to speak about their feelings as well as patience, cooperation and the support of those living around them to make a difference. We invest a lot of our time as volunteers to save lives this way. Nutrition also plays a major role in this process. If everyone, every community can follow what we do here at Tateni, so many people do not have to die in our country. With a little bit of help we can make a difference."
Apart from the messages and testimonies we receive from people on the ground such as mama Veronica, there are indeed early indications of changes in the age groups of the under 20s with high levels of knowledge and stabilising HIV infection rates which according to international experience, is where you expect to find the first changes to show. Further research is required to measure this more accurately.
If we were to take Uganda as an example, for the obvious reason that they have succeeded to turn the tide around, we note that fact that infections on youth went down in that country was the result of their focus on prevention, education and mobilizing campaigns focused on youth and high-risk groups.
We have learnt from this experience and believe that our focus too on the youth and special risks groups will yield positive results. We are putting more money where the risks are higher and where the impact will also be higher. We are using methods that have been proven to work elsewhere, and these also include the provision of condoms, dealing with Sexually Transmitted Infections, VCT and MTCT, communication and education.
The work we do around HIV/AIDS paying more attention on a partnership with the community is triggering an effective civil society response to the epidemic.
Our AIDS plan for next year will continue to encompass the following:
We take this opportunity to reiterate our call to encourage voluntary counselling and testing. We recognise that this is a decision which rests with each individual. It is a private decision that should not be coerced and that no-one else can take on your behalf. However we believe that knowing ones HIV status is in ones own interests. If a person knows their own HIV status, they can take appropriate steps. If a person is HIV positive, it means they then have the opportunity to do what is necessary to get the support and care that they need, to ensure that they enjoy a long and productive life and to ensure that they do not infect others - and are not reinfected themselves.
On this occasion we renew our pledge to continue to support those who bear the pain of loss as they remember their loved ones who have died. We recommit ourselves to care for the sick and the needy through both moral support and practical measures.
We recommit ourselves to intensify our efforts to prevent discrimination against people with HIV/Aids and to continue to mobilise all sectors of our society to fight against the disease.
We rededicate ourselves to ensure the effective implementation of the National programme of action and the Gauteng Aids Strategy.
We call on all political leaders in the province to join hands in fighting the scourge of HIV/AIDS. Let us commit ourselves to ensure that no person with Aids ever again dies a cold and lonely death. Together as government, NGOs, churches, civic bodies, young and old, men and women, let us pledge to stand together to provide the love and support that people living with Aids deserve. Let us in every home, in every workplace and in every community be true to our claim to be a caring nation.
Thank you