HIV/AIDS in South HIV/AIDS in South AfricaAfrica

Dr. Nono SimelelaChief Director: HIV/AIDS and STDs

HIV Prevalence in women HIV Prevalence in women attending public antenatal attending public antenatal clinics, 1991 - clinics, 1991 - 20002000, South Africa, South Africa

0

5

10

15

20

25

30

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

HIV prevalence in women HIV prevalence in women attending antenatal clinics by attending antenatal clinics by age, South Africa, age, South Africa, 20002000

0

5

10

15

20

25

30

35

<20 20-24 25-29 30-34 35-39 40-44 45-49

19992000

HIV prevalence in women HIV prevalence in women attending antenatal clinics, by attending antenatal clinics, by province, province, 20002000

0

5

10

15

20

25

30

35

40

1999 7.1 10.1 11.4 18 23 23.9 27.3 27.9 32.5

2000 8.7 11.2 13.2 20.2 22.9 29.4 29.7 27.9 36.2

WC NC NP EC NW GP MP FS KZN

Estimated number of AIDS Estimated number of AIDS deaths in South Africa per yeardeaths in South Africa per year

050000100000150000200000250000

300000350000400000450000500000

1998 1999 2000 2001 2002 2003 2004 2005

HIV Antenatal Surveys - HIV Antenatal Surveys - SummarySummary Nationally 24.5% of women attending

antenatal clinics are HIV positive HIV prevalence in provinces ranges from 8

to 36% 26% of pregnant women aged 20-30 are

HIV positive 17% of pregnant women aged <20 are HIV

positive Most women who are HIV positive acquired

the infection when they were <20

HIV Antenatal SurveysHIV Antenatal SurveysExtrapolation to the South Extrapolation to the South African PopulationAfrican Population

4.7 million South Africans were HIV positive in 2000 compared to 4.2 million in 1999 and 3.6 million in 1998

1 out of every 8 adults are HIV positive 1600 - 1700 new HIV infections daily

South Africa’s AIDS EpidemicSouth Africa’s AIDS EpidemicSome of the AIDS epidemic is hidden

because: The rise in AIDS cases occurs after the rise

in HIV prevalence Many HV infections are never diagnosed Many people do not reveal their diagnosisIt is estimated that there were: 200 000 AIDS cases and 180 000 AIDS

deaths in 1999 Large number of adults and children with

HIV/AIDS seen by health services

HIV and TB in Developing HIV and TB in Developing CountriesCountries

HIV increases the risk of developing active TB for those who have been infected with TB earlier in life. Risk increases from 10% lifetime to 10% per year

If newly infected, persons with HIV more likely to progress to active disease

Leading cause of death among HIV infected persons

Reducing Impacts: Priority IssuesReducing Impacts: Priority Issues

Priority Issues

Socio-economicdevelopment

Information onepidemic

Improve statusof women

Support affectedpeople & orphans

Health sectorresponses

Reduce HIV/AIDSstigma

PreventionProgrammes

Intersectoralcollaboration

Strategicchoices

Workplaceprogrammes

HIV/AIDS Strategic PlanHIV/AIDS Strategic PlanPriority AreasPriority Areas

Prevention Treatment, care and support Human and legal rights Monitoring, research and surveillance Youth - both as a specific target

population and cross-cutting through all priority areas

HIV/AIDS Strategic PlanHIV/AIDS Strategic PlanPrevention GoalsPrevention Goals

Improve the management and control of sexually transmitted diseases

Promote safe and healthy sexual behaviour

Reduce mother to child HIV transmission Promote voluntary HIV counselling and

testing Maintain blood safety Provide HIV post-exposure services

HIV/AIDS Strategic PlanHIV/AIDS Strategic PlanTreatment, Care & Support Treatment, Care & Support GoalsGoals

Provide treatment, care and support services in health services

Provide treatment, care and support in communities

Develop and expand the provision of care to children and orphans

HIV/AIDS Strategic PlanHIV/AIDS Strategic PlanHuman and Legal Rights GoalsHuman and Legal Rights Goals

Create a supportive social environment Develop an appropriate legal and policy

environment

HIV/AIDS Strategic PlanHIV/AIDS Strategic PlanResearch, Monitoring and Research, Monitoring and Surveillance GoalsSurveillance Goals

Promote vaccine development Investigate research and care methods Conduct policy research Conduct regular research and

surveillance

Selected HIV/AIDS Management Selected HIV/AIDS Management and Co-ordinating Structuresand Co-ordinating Structures

Cabinet South African National AIDS Council Interdepartmental Committee on AIDS MinMEC PHRC Directors-General Forum National HIV/AIDS Programme

Partnership SupportPartnership Support

Assist sectors to develop and implement HIV/AIDS plans

Document best practices Mobilise resources Address human rights and legal issues

STDs, Barrier Methods & TBSTDs, Barrier Methods & TB

Improve STD treatment in the public and private sector

Increase condom use Conduct HIV/AIDS/STD related research Establish pilot districts to integrate

HIV/AIDS/STD and TB care Interact with traditional healers

Care, Counselling & SupportCare, Counselling & Support Implement home-based care Collaborate to render care for children

infected and affected by HIV/AIDS Investigate options for caring for the

carers Ensuring training and capacity building Coordination of programmes for PWAs Development of guidelines & manuals Reducing stigma and increasing

community responsibility

Youth ProgrammeYouth Programme

Assist youth organisations to develop and implement HIV/AIDS plans

Promote, co-ordinate and support the implementation of life skills in primary and secondary schools

IDC and NGO FundingIDC and NGO Funding

Develop minimum HIV/AIDS programmes for government departments

Conduct HIV/AIDS impact studies Fund and monitor NGOs

Major Policy Drives MTCT Programme Integrated Plan

Life Skills in primary and secondary schools Home-based care (HBC) Voluntary HIV counselling and testing (VCT) Community mobilisation

Participants: Health, Education, Social Welfare

R125 million in 2001/02

Care and Support Programme Identified 2 empowerment projects – 3 more

to follow Assisted NAPWA to strengthen its

organisation Established a database of PWA Support

Groups in all nine provinces Appointment of Care and Support focal

persons in all provinces Provision of basic home-based care drugs

and supplies for 4 project, using WHO funding

Care and Support Programme Completed guidelines: adult &

paediatric palliative care, curriculum for caregivers, HBC training manual, HBC Guidelines, Nutritional Guidelines for PWAs

Models developed for HBC developed

Workshops for home carers and religious leaders

Counselling Programme VCT strategy and business plans

completed Tender for rapid test kits awarded Rapid test quality assurance

protocols developed VCT sites selected in all provinces Counsellor training in all provinces

(2219 trained to date)

Youth Programme Workshops with youth formations –

targeted and lobbied 36 to date Launched the SA AIDS Youth

Programme (SAAYP) Assisted in the launch of the

Tertiary HIV/AIDS Media Project

Life Skills Programme Audit of life skills programme (LSP) Development of support materials

for teachers, also a parent guide

Partnership Support 8 PWAs employed by government Sectoral links established:

Traditional leaders, SALGA, Hospitality industry, Transport, Business, FBOs, Women, CMA, Trade Unions

Capacity building workshops in these sectors

Funding the national antenatal survey

STDs, Barrier Methods, Research & TB Syndromic Management established in

PHC facilities Materials on STDs available STD training mandatory CPD

requirement for private GPs Support for projects, including Lesedi &

Lechabile (Welkom), Mothusimpilo & WRAP (Carletonville), National STI Initiative, Trucking Project

STDs, Barrier Methods, Research & TB Stratified surveillance piloted in

Gauteng – national implementation to follow

Collaborate on the SA Microbicide imitative

National Male Condom Policy Female condom introductory

strategy Traditional Healer training

Government AIDS Action Plan Mass media advertising Provision of communication resources Major Projects:

AIDS memorial quilt Tertiary Institutions Media Workers Living Openly

Training of celebrity AIDS ambassadors

Government AIDS Action Plan PR campaigns Provincial GAAP personnel

appointed Partnership Support AIDS Helpline – increase in call

rates

Planned Activities

Up to the end of the financial year

Care and Support HBC Train-the-Trainer workshops Capacity building workshop for

men living with HIV/AIDS Project and Financial Management

training for HBC focal persons PWA capacity building workshops Develop guidelines for the care of

children orphaned by HA

Care and Support Marketing care and support services

through Soul City Workshops for religious leaders and

home carers National drug literacy campaign Training workshops for HCWs on the

Clinical Management Guidelines Implementation of economic

empowerment programmes for PWAs

Counselling Programme Provincial Train-the-Trainer

workshops Training of HIV/AIDS counsellors Develop and launch monitoring

and evaluation tools for VCT VCT promotional campaign

Youth Programme Develop strategic and operational

plans for youth formations targeted

Lobby additional formations

Life Skills Programme Teacher guide and learner activity book

for grades 8 and 9 Adolescent Reproductive Health Care Flip

Chart for all secondary schools Develop peer education norms and

standards Youth Risk Behaviour Survey Develop age-appropriate IEC materials

for primary school learners

STDs, Barrier Methods, Research & TB Audit of HIV/AIDS research Establish a comprehensive

surveillance system Increase support to targeted STD

interventions Prevalence studies in specific

populations (gay men and drug users)

STDs, Barrier Methods, Research & TB Revise and reprint materials National summit on sex work Increase condom social marketing Expand female condom introduction Implement a Logistics Management

Information System for condoms Review traditional healer training

manuals

MTCT Programme Implement MTCT in at least 25

sites in all provinces Providing Nevirapine and formula

feeding Cost = R25 million Appointing provincial MTCT

coordinators (2 per province)