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IMPUMELELO CASE STUDIES - HIV/AIDS -
IMPUMELELO CASE STUDIES
HIV/AIDS
Impumelelo series of best practice
VOLUME: 2 9
Impumelelo series of best practice – No: 9 ‘Building capacity for service delivery’
Composite
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Series Editor:
Rhoda Kadalie
Writer:
Merav Silverman (Harvard Undergraduate)
ISBN: 978-0-620-39478-9 Impumelelo Innovations Award Trust
Published by Impumelelo Innovations Award Trust First Published 2008
PO Box 1739, Cape Town 8000 6 Spin Street, Church Square, Cape Town 8001
Project Manager: Rhoda Kadalie Design:
Kult Creative
Tel.: +27 21 461 3783
Reproduction:
Formeset Printers Cape
Fax: +27 21 461 1340
Printed by:
Formeset Printers Cape
Photographs by: Ellen Elmendorp, Eric Miller, Candice Jansen, Email: info@impumelelo.org.za
Wayne De Lange and the various projects
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Contents Section One
Introduction Chapter 1
Early State Responses to HIV/AIDS
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Chapter 2
Strategic Plan on HIV/AIDS and Sexually Transmitted Infections (STIs) for South Africa, 2000-2005; predecessor to the NSP 2007-2011
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National HIV/AIDS and STI Strategic Plan for South Africa 2007-2011 (NSP)
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Chapter 3
Section Two:
Case Studies 1. PREVENTION CASE STUDY 1 CASE STUDY 2 CASE STUDY 3 CASE STUDY 4
Section Two:
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Mothers to Mothers Ntshuxeko Health Development Organization Siyancuma HIV/AIDS Task Team Ukunakekela
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2. TREATMENT CARE AND SUPPORT CASE STUDY 5 eThembeni ARV Project CASE STUDY 6 Cell-Life Support for Anti-retroviral Treatment CASE STUDY 7 Etafeni Day-Care Centre Trust CASE STUDY 8 Genesis Care Centre CASE STUDY 9 iKamva Labantu: Home-Based Care CASE STUDY 10 Ikhono Home-Based Care CASE STUDY 11 Isbindi Umbumbulu CASE STUDY 12 Sizanani HIV/AIDS Home-Based Care CASE STUDY 13 Soweto Retired Professional Society – Food Gardens CASE STUDY 14 Wide Horizon Hospice/ Karuna Clinic CASE STUDY 15 Tjhebelo Pele CASE STUDY 16 Yabonga Children’s Project
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3. INCOME GENERATION CASE STUDY 17 GAPA: Grandmothers Against Poverty and AIDS CASE STUDY 18 Positive Beadwork Project
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4. CARE FOR HEALTH-CARE WORKERS CASE STUDY 19 Mentorship and De-Briefing Project
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Conclusions
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Lessons drawn from the Case Studies
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Focus on HIV/AIDS
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Section One: Introduction Ignorance about HIV/AIDS, the lack of targeted health education and the worsening socio-economic conditions have contributed to an increase in HIV incidence in certain age groups.
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ince the last Impumelelo HIV/ AIDS Case Studies were released in 2004, considerable improvements have been made in the South African public’s health response to the HIV/AIDS epidemic. Widespread denial that had characterized the response of senior government officials to HIV/AIDS has in certain cases begun to dissipate, allowing for more evidence-based, rational and constructive answers to the crisis. But the battle is far from over. Ignorance about HIV/AIDS, the lack of targeted health education and the worsening socioeconomic conditions have contributed to an increase in HIV incidence in certain age groups. In order to meet international and local obligations, a tremendous amount of work needs to be done to respond to the millions of people that are currently living with HIV/AIDS, their families and communities, and the ongoing work that needs to be done to prevent new infections. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) have estimated that by the end of 2006, 39.5 million people worldwide would be living with HIV. With respect to global HIV prevalence, 64% are in Sub-Saharan Africa; 77% of women living with HIV in the world are from SubSaharan Africa. Though HIV prevalence is high in South Africa, incidence and prevalence varies from province to province and within provinces as well. To illustrate, the province of KwaZulu-Natal has an
There are many reasons why the epidemic has been described as the greatest public health challenge facing South Africa by the Constitutional Court. Simply put, HIV/AIDS is not the only public health burden facing SA but it is the greatest.
Section One: Introduction
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HIV prevalence of 39.1% compared to the Western Cape, with 15,7%. But even in the Western Cape, there is a huge disparity in infection rates – for example, 32.6% of people living in Khayelitsha are living with HIV, where poverty remains a contributing factor of HIV infection. Similarly, in 2005, according to a study by the Human Sciences Research Council: • Black Africans were found to be between six and seven times more likely to be infected with HIV than non-black Africans. • Women account for 55% of infections in South Africa.
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Focus on HIV/AIDS
• In the 25-29 years age group, 33.3% of women are infected as compared with 12.1% of men at the same age. These rates can be explained by a number of factors. Most worrying is the prevalence of multiple sex partners at any given time, the high levels of gender-based violence, ongoing discrimination and the stigmatisation of people living with HIV, and the inadequate targeting of health education particularly in resource poor areas and unemployment. Children comprise a significant percentage of the total number of people infected with HIV every year in South Africa, although preventable.
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A Human Sciences Research Council study conducted in 2005 found that: • In children aged 2-4 years, 4.9% of boys and 5.3% of girls are living with HIV. • Among adolescent girls, aged 15-19, the rates of infection have reached 16%. • However, among young women aged 20-24 years, HIV prevalence rates increased to 28-30%. There are many reasons why the epidemic has been described as the greatest public health challenge facing South Africa by the Constitutional Court. Simply put, HIV/AIDS is not the only public health burden facing SA but it is the greatest. The combinations of TB and HIV pose particularly unique challenges. HIV prevalence, the rate of new TB cases and the low TB cure rates suggest a system in crisis. As a consequence, SA is faced with: • An overburdened health system that remains unequal and divided; • An overwhelmed and unreformed social welfare system;
• The disruption and breakdown of many communities and family units due to apartheid and the migrant labour system; • High levels of sexual and domestic violence against girls and women; • High levels of mobility that facilitate the spread of HIV; • Increasing levels of poverty and poor literacy levels, increasing the vulnerability particularly of girls and women; • High rates of sexually transmitted infections; • Patriarchy and gender subordination that fuels unsafe sexual practices; • Cultural and traditional norms that undermine behaviour change and sexual autonomy. Given these conditions, an appropriate, effective, and socially responsible response from government, the private sector and civil society is urgently required. However, government’s mishandling of the epidemic continues to generate considerable controversy, both locally and abroad.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) have estimated that by the end of 2006, 39.5 million people worldwide would be living with HIV. With respect to global HIV prevalence, 64% are in SubSaharan Africa; 77% of women living with HIV in the world are from Sub-Saharan Africa.
Section One: Introduction
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CHAPTER 1 Early State Responses to HIV/AIDS
up of representatives from various interested sectors (but excluding medical researchers and key NGO groupings), as well as specialist technique advisory teams;
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rior to the HIV/AIDS/STD Strategic Plan (2007-2011) for South Africa, and the previous 2000-2005 Plan, there were a number of key responses to the epidemic since 1992. In 1992, the National AIDS Coordinating Committee of South Africa (NACOSA) was launched to develop a national strategy on HIV/AIDS. After extensive consultation, the National AIDS Plan was drawn up and endorsed by the new government in 1994. However, many argue that it was never implemented.1 Responsibility for coordinating government responses rested with the Directorate: HIV/AIDS & STDs in the National Department of Health (DoH). In 1997, a South African National STD/HIV/AIDS Review was conducted in respect of the NACOSA plan, which identified a number of the strengths and the constraints of the plan. In the light of this review, subsequent initiatives included: • Appointing HIV/AIDS Coordinators in each province; • Establishing an Inter-ministerial Committee on AIDS in 1997, which was later replaced by the now restructured South African National AIDS Council (SANAC) then made
After extensive consultation, the National AIDS Plan was drawn up and endorsed by the new government in 1994. However, many argue that it was never implemented. 1
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The key goals of this strategy were to prevent HIV transmission, reduce the personal and social impact of infection and mobilize and unify local, provincial, national, and international resources.
Focus on HIV/AIDS
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• The Partnership Against AIDS, launched by former President Mandela in 1998, to mobilize all sectors to work together around the epidemic; • The Beyond Awareness Campaign, a multimedia, multi-activity, communications campaign; • Developing various targeted HIV/AIDS policies by the Department of Education, for learners and educators, for the management of syndromes of STIs, and post-exposure prophylaxis following occupational exposure to HIV by the national Department of Heath; • Establishing the SA AIDS Vaccine Initiative in 1998; • Establishing a national Interdepartmental HIV/AIDS Committee (IDC);
CHAPTER 2 Strategic Plan on HIV/AIDS and Sexually Transmitted Infections (STIs) for South Africa, 2000-2005 Predecessor to the NSP 2007-2011
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n 1999, the Minister of Health, Dr Tshabalala-Msimang initiated a comprehensive HIV/AIDS and STD 5-year plan which was approved by the South African government in January 2000. The document aimed to “guide the country’s response as a whole to the epidemic. It is not a plan for the health sector specifically, but a statement of intent for the country as a whole… so that all our initiatives can be harmonised to maximum effectiveness”. The 2000-2005 Strategic Plan aimed to provide:
• Developing a Strategic Framework for AIDS Youth Programme; • Improving collaboration between HIV/AIDS/STD and TB programmes. Although the plan was very ambitious, very little was done to implement it fully. In addition, a regional response to the epidemic, a Southern Africa Development HIV/AIDS/STD task force, was also established. This group prepared a plan for the period 19992003 with the broad goals of achieving a coordinated and multi-sector response among the 14 member states. However, commentators are concerned that the substantive cost impacts of the epidemic for the region have not been adequately recognized, and that policies and efforts needed to be coordinated more efficiently.
• Effective and culturally appropriate information and education; • Increased access and acceptability for Voluntary Counseling and Testing (VCT); • Improved STD management, treatment of opportunistic infections and condom promotion; • Improved care and treatment of HIV-positive persons and people living with AIDS.
The HIV/AIDS and STD 5-year plan approved by the South African government in January 2000 aimed to “guide the country’s response as a whole to the epidemic.
Section One: Introduction
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