Provincial Workshop on Committee Report on Impact of HIV/AIDS on Women: planning; Cabinet decision on HIV/AIDS: discussion

Meeting report

JOINT MONITORING COMMITTEE ON IMPROVEMENT OF QUALITY OF LIFE AND STATUS OF WOMEN
23 April 2002
PROVINCIAL WORKSHOPS ON COMMITTEE REPORT ON IMPACT OF HIV/AIDS ON WOMEN: PLANNING; CABINET DECISION ON HIV/AIDS: DISCUSSION

Chairperson: Ms P Govender (ANC)

Documents Handed Out:
Committee Report on How Best Can SA Address the Horrific Impact of Hiv / Aids on Women And Girls?
Cabinet Statement on HIV/AIDS, 17 April 2002 (see Appendix 1)
Facilitator's Guide (see Appendix 2)

SUMMARY
The Committee made preparations for the provincial workshops that will discuss the Committee Report collated after the hearings on how SA can address the impact of HIV/AIDS on women and girls. As such, it dealt mainly with administrative problems and concerns.

The Committee also met to review the Cabinet Statement on HIV/AIDS dated 17 April 2002. More specifically, it was to determine whether government had adequately dealt with the recommendations posed by the committee in their report given in November 2001 dealing with the question: How best can SA address the horrific impact of HIV/AIDS on women and girls? The committee came to the unanimous conclusion that it had.

MINUTES
Ms P Govender (ANC) confirmed the dates set for the workshops in the various provinces. She stated that it is essential that the reports emerging form the workshops must be taken back to the provinces. She stressed that those organisations/structures involved at grass-roots level with addressing the impact of HIV/AIDS on women and girls and who have the capacity to address such issues, must be present at the workshops. This is because the committee has limited funding and if the workshops are to be a success, the organisations must take and develop the conclusions reached in the workshops further.

She stated that because of their limited capacity, the Education Training Unit had been commissioned to help organise the workshops, primarily in the form of catering and transport.

Ms B Hofmeyr from ETU went through the facilitator's guide. She stressed that it is simply a guideline from which members can deviate when presenting the workshop. She briefed the Committee on the Facilitators Guide and the accompanying Overhead Projector presentation which is a ten-slide synopsis of the Committee Report.

Discussion
Ms S Botha (DP Free State) was distressed that the Free State workshop was scheduled for the following day and that she had only recently found this out. She stated that she knew people who were really interested in this issue and now because of this mix-up, she and other interested parties would be unable to attend the workshop. Her perception was that this was a deliberate attempt to keep her from attending the workshop and felt that the committee must address this issue.

Ms Govender apologised for this and was sorry that there had been a miscommunication. She suggested that herself and Ms S N Ntlabati (ANC alt Free State) get together after the meeting and sort out their communication problems.

Ms J Kgoali (ANC Gauteng) commented that it is not only organisations that must follow through with the conclusions of the workshop, but also women, because they are the ones who are ultimately affected. She raised a concern about transport and whether she could arrange this for a colleague who lived far away. This colleague's attendance at the workshop would be useful. She also asked what materials she could get for the workshops and how soon she would be able to get these.

With regard to the transport issue, Ms Govender stated that they had a limited budget, about R7000 per province and that this was used primarily for transport and catering. The provinces had to work within this budget. On the workshop material issue, the primary material to be dealt with was the Committee Report. This report was long and complicated and in this regard she had approached the EU Parliamentary Support Programme for assistance in simplifying it. However the EU PSP had not been forthcoming. As a result all that is available is a 10 page back-to-back summary of the report. She therefore did hope that the Committee representatives would deliver the report in a simple way at the workshops.

A concern was raised over dates for the workshops. Ms Govender replied that it was up to the committee members within the individual provinces to come up with a date.

Ms Govender then stated that preparations had gone well and that she was confident that the workshops would be a success. In conclusion, she asked if there had been any further problems.

Ms S Nqodi (ANC) suggested that should there be any further difficulties, they should be dealt with as they arise. This was agreed and Ms P Govender appointed the committee clerk as the channel of communication.

Briefing on Cabinet decision on HIV/AIDS
The Chair noted that no one from the Department of Health had arrived to present the government's position on HIV/AIDS. As a result, she requested that the Deputy Chairperson Ms M Themba read through the Cabinet Statement on HIV/AIDS. In this statement it was emphasised that the government's starting point is the premise that HIV causes AIDS. Since there is no cure for AIDS, government's focus would be on prevention, especially in the fields of awareness, life-skills and HIV/AIDS education. On other issues of prevention, the government decided the following:
- Research on the use of Nevirapine to prevent mother-to-child transmission will continue and the Department of Health must issue a universal roll-out plan as soon as possible
- Provision of a comprehensive package of care to sexual assault victims must be provided
- Government is committed to the treatment and prevention of opportunistic infections
- The usefulness of anti-retroviral treatments and a commitment to work for the lowering of the cost of these drugs as well as to intensify the campaign to ensure that patients observe treatment advice given to them by doctors.
- Investigation into alternative treatments will be encouraged, especially those that could boost the immune system
- A commitment to assist families through the improving the programme of home-based care and community-based care.

Discussion
The Chair opened up the discussion by asking the committee to comment on whether or not the Cabinet Statement on HIV/AIDS adequately addressed the recommendations posed by the Committee to government in their November 2001 Report. She asked specifically for comments on recommendations that were made in the areas of Mother-to-Child transmission, rape/sexual assault and the supply of more affordable medicines.

Ms Kgoali welcomed the statement by government, noting that all relevant issues had been addressed and that there was now clearly a way forward.

A committee member raised the concern that rape-victims must be made aware of their rights and of the services available to them. They must be counselled after a rape and it must be ensured that they are tested.

Ms Govender commented that this issue would be better dealt with in the provincial workshops.

Another committee member expressed the view that media campaigns are distorted as they promote the use of condoms rather than abstinence.

The Chair's response was that the meeting must keep to the matter of the Committee's Report.

Ms Kgoali stated that another serious problem is the denial by HIV positive people as well as their relatives of the fact that they are infected with the disease. In this regard, proper counselling is required and it is important that the government helps out with this.

Ms Govender outlined the main elements of the Cabinet Report that she regarded as being important. They are:
- the provision of Nevirapine and the initiation of a universal roll-out plan;
- the provision of a package of care to sexual assault and rape victims;
- the risk of using anti-retrovirals and a plan to deal with this problem; and
- the establishment of a standardised national protocol including a plan on how this will be rolled out.

She stated that one of the recommendations of the Committee was that the plan must be operationalised and it is clear that government has done this. She concluded that this was a clear statement of hope and expressed a desire to see the implementation of government's plans as soon as possible.

With a unanimous acceptance of the Cabinet's statement on HIV/AIDS, the meeting was adjourned.

Appendix:
STATEMENT OF CABINET ON HIV/AIDS
Cabinet today received a comprehensive briefing on the implementation of government policy on HIV/AIDS. The meeting reiterated government's commitment to the HIV/AIDS and STI Strategic Plan for South Africa, 2000 - 2005 (pdf).
This comprehensive programme is backed up by a massive increase in resources. The total budget to be spent mainly through the Departments of Health, Social Development and Education was R350m in 2001/02; it has been increased to R1-billion in this financial year, and will go up to R1.8-billion in 04/05.
Cabinet welcomed the progress that is being made in ensuring that the South African public in general and the youth in particular are aware of the dangers of the epidemic. It called on all South Africans to take full responsibility and care for their lives. Government will intensify the awareness campaign, as part of its comprehensive strategy against HIV/AIDS. The challenge is to ensure that awareness continues to translate into a change in behaviour.
In conducting this campaign, government's starting point is based on the premise that HIV causes AIDS. It is also critical for us, as a nation, to note that there is no cure for AIDS. In this regard, promoting awareness and life skills and HIV/AIDS education forms the core of our approach.
A critical element of this strategy is the strengthening of partnerships among all South Africans and their organisations to fight this epidemic. Government commits itself to this objective, and will participate actively in the review of SANAC currently underway, in order to strengthen the organisation. "Core SANAC Ministers", now including the Minister in the Presidency and the Minister of Arts, Culture, Science and Technology, will be constituted into a Presidential Task Team on AIDS, headed by the Deputy President. Further, measures will be introduced to strengthen government structures dealing with this matter.
On other issues of prevention, the meeting decided as follows:
Research on the use of Nevirapine against mother-to-child transmission will continue; at the same time as government implements the temporary ruling of the Constitutional Court. In the meantime, the Department of Health is working on a Universal Roll-out Plan to be completed as soon as possible, in preparation for the post-December 2002 period.
Cabinet decided that, with regard to cases of sexual assault, government will endeavour to provide a comprehensive package of care for victims, including counselling, testing for HIV, pregnancy and STI's.
In this regard, survivors will be counselled, including on the risks of using anti-retrovirals as preventative drugs, so they could make an informed choice. If they so choose (as is the case with needle-stick injuries), they will be provided with such drugs in public health institutions. A standardised national protocol in this regard will be finalised as soon as possible.
With regard to treatment, Cabinet emphasised the commitment of government to treatment and management of opportunistic infections. No South African should be sent away and not treated irrespective of their HIV status. Given the critical importance of drugs dealing with infections such as meningitis, oral thrush, TB and pneumonia, Cabinet urged the public, especially People Living with AIDS, to assist government in monitoring their availability.
On anti-retroviral treatments in general, Cabinet noted that they could help improve the conditions of PWA's if administered at certain stages in the progression of the condition, in accordance with international standards. However, because these drugs are too costly for universal access and, because they can cause harm if incorrectly used and if the health systems are inadequate, government will continue to work for the lowering of the cost of these drugs, and intensify the campaign to ensure that patients observe treatment advice given to them by doctors.
Further, alongside poverty alleviation and nutritional interventions, government will encourage investigation into alternative treatments, particularly on supplements and medication for boosting the immune system.
Cabinet reiterated government's strong commitment to assist families affected by the HIV/AIDS epidemic. We are also improving the programme of home-based care and community-based care, for which allocations of R94.5-million have been made this year, and R138-million in 2004/05.
Government calls on all South Africans to join hands in a campaign of hope: to mobilise our strength as a nation and as individuals to ensure that, we are able to manage, reduce and, in the long-run, defeat this epidemic. We have it in our power to achieve this objective. What is critical is that we should work together as a united force to achieve the best interests of our society.
Other matters pertaining to this campaign are contained in the following documents:
Continuity and Change in HIV/AIDS Policy, 17 April 2002
Summary of Government's position following Cabinet's discussion, 17 April 2002
17 April 2002
Issued by: Government Communications (GCIS)

Appendix 2:
PROVINCIAL WORKSHOPS ON GENDERED VIOLENCE, HIV/AIDS AND POVERTY

FACILITATORS GUIDE
The parliamentary Joint Monitoring Committee on Improvement of Quality of Life and Status of Women has compiled a report based on national hearings on the links between HIV/AIDS, gendered violence and poverty. The committee has decided to enrich the report by holding provincial workshops involving key stakeholders from civil society and government. The workshops will also look at links between child rape and HIV/AIDS. Special emphasis will be placed on the role of men and strategies that should be developed to change behaviour and attitudes.

The workshops will have the following components:
· The committee will summarise the report concentrating on problems identified, their causes and proposed solutions
· Organisations present will be given an opportunity to make submissions that will enhance the consultation process
· Delegates will participate in commissions that focus on: a) violence against women (especially children), b) prevention strategies for HIV/AIDS and c) treatment strategies for HIV/AIDS. An over-arching theme will be the role that men play in each area and the strategies that should be developed to target them.

The Education and Training Unit [ETU] will assist with facilitation and recording. The members of the national committee will present the report and together with their provincial counterparts will lead the discussion in commissions.

The member of the committee coordinating the workshop in that province will have to meet with the PPU and key provincial MPLs to decide which submissions will be delivered orally in the workshop and which will only be tabled in writing.

Organisations invited will be asked to prepare submissions should they wish to do so. Submissions should be in writing and should be sent to the PPU beforehand if possible. Only about six submissions of ten minutes each, will be presented at the workshop because of time constraints and a selection process will have to take place to decide which ones will be presented orally and which ones will only be tabled in writing.

Ensure that a broad spectrum of submissions is included in the workshop programme. For example try to include a range of submissions that deal with the different issues on the programme and come from different types of organisations, rather than six that deal with child rape only. The main criterion for oral presentation should be that the submission adds value to the report and discussion that will be held in commissions. The relevant committee in the provincial legislature should be encouraged to make a submission

FACILITATORS NOTES

WHO DOES WHAT?

The programme will be coordinated by members from the national committee responsible for that workshop together with an ETU facilitator. Chairs will be drawn from national and provincial MP/MPLs. Members of the national committee must present the report.

Commissions must be have a facilitator and a rapporteur - decide who will do what beforehand and use MPLs, members of the committee and ETU facilitators for this. Brief facilitators to make sure they understand what should be covered and what form the report should take. Proceedings will be captured in summary form by an ETU capturer. In provinces where a HANSARD recorder is available, they will also be used for detailed capturing.

TRANSLATION

Decide on options for translation methods beforehand so that you can come with
a concrete proposal if it is needed. Options are:
1. Simultaneous in small groups - if very few people need it, place them next to someone who will do simultaneous translation - in most workshops an ETU facilitator can do this in plenary.
2. Sentence by sentence in plenary - someone stands next to presenter and translates every sentence. In most workshops an ETU facilitator can do this in plenary.
3. Summary translations every few minutes

ETU will provide stationery, registration forms, copies of materials and financial management and disbursements. Disbursements will only be made for amounts agreed between ETU and the province beforehand and in line with ETU's procurement policy.

9.00am Registration

Use the forms in the training box. Give each delegate a file, report, nametag, pen, 10 sheets of paper. Distribute the pamphlets at the end of the workshop when you can divide it equally between delegates.

If organisations bring other materials put it on a separate table for display.

9.30am Welcome, introduction, objectives and process
A provincial member who is from a relevant committee or gender structure should do this session and cover the following:
1. Welcome all and mention the kinds of organisations and institutions at the workshop. Determine if translation is needed and get someone to do it if necessary. See options above.
2. introduce the national members, ETU facilitators and key provincial politicians and gender structure reps. Be sensitive to protocol and do not leave people out who may get offended.
3. Use overhead [OH] 1 and OH2 to cover the aims and programme
4. Introduce the national member who will do the report

9.45am Report of national hearings: findings and recommendations
A member of the national committee [or two members] must do this report.

Use the Input attached at the end of these notes and the set of overheads marked 0H 3a - 3e. The session should be chaired by another member of the national committee.

The report should not take more than 40 min. so that at least 30 min are available for questions and discussion.

The discussion should be chaired in a way that allows for participation and the chair should not be too strict. Ask for questions or comments, not only for questions. if debates and serious disagreements arise that completely dominate the session, the chair should refer them to the commissions for discussion.

11.00am TEA

11.20am Submissions from provincial government and organisations [5-6 oral submissions of 10 min. each and questions]

This session should be jointly chaired by a member of the national committee and an MPL from a relevant committee.

The submissions should have been decided before the workshop since people were asked to make them when they were invited. [See page 1 for process]. if submission shave been decided use 0H4 to explain the process and then start with the first one. Be strict on time since every submission ahs about 10 minutes for presentation and 15 min for questions.

If submissions were not sorted out beforehand, try to ask during registration if people have submissions and to find a way of dealing with them.

If there are no formal submissions this session will have to be run in a very flexible way. Use OH 5 to explain the issues for discussion in commissions and ask if any organisations or institutions would like to make a small input based on their experience. Stress that discussion will happen in the commissions, but we want to hear from people who feel their experience will help us to better understand the issues. Go through the topics one by one so that all the people who want to speak on a topic do it before you move to the next one. Try to allocate time fairly and to limit speakers to about 5 minutes each.

1.00pm LUNCH

1.45pm Commission briefing
ETU facilitator use OH 6 to explain the commissions and the questions that will be discussed. Make sure the venues are written on the OH and that there are facilitators and rapporteurs for each commission. Committee members and MPLs and ETU facilitators should be used for this.

2.00pm Commissions
1. Gender based violence, especially against female children
2. Prevention strategies
3. Treatment strategies

The commissions will focus on strategies with a special emphasis on the positive role men could play and the strategies to target them.

The purpose of commissions is to give people a chance to discuss the report's recommendations and to add to them or suggest amendments. A second objective is to focus on the role of men and what they can do to encourage positive behaviour and attitudes among other men.

Commission facilitators should make sure that discussion flows and that all questions are dealt with. We have put few questions so that there will be enough time.

Commission 1:
1. What do you see as the main causes of violence against women and children, especially female children?
2. Do you agree with the recommendations in the report? Are there any additions or changes you want to make that will help stop violence against women/children? Please be as practical as possible and say how your proposal can be implemented. [put the report's recommendations on newsprint beforehand]
3. What should be done to involve men in the fight against gender violence and what can be done to change the behaviour and attitudes of men who commit this violence?

Commission 2:
1. What do you see as the main causes of the rapid spread of HIV/AIDS in South Africa?
2. Do you agree with the recommendations in the report? Are there any additions or changes you want to make that will help prevent the spread of HIV/AIDS? Please be practical and say how your proposal can be implemented [put the report's recommendations on newsprint beforehand]
3. What can be done to change the attitudes of men whose sexual behaviour spreads HIV/AID? How can we best target them?

Commission 3:
1. What do you see as the main needs in terms of testing, counselling and treatment for people with HIV/AIDS?
2. Do you agree with the recommendations in the report? How should we respond to the cabinet call to monitor and ensure access to available treatment? Are there any additions or changes you want to make that will help provide improved testing, counselling and treatment for people with AIDS? Please be practical and say how your proposal can be implemented - bear in mind cost and capacity issues. [put the report's recommendations on newsprint beforehand]
3. What should be done to effectively target men for testing and counselling?

3.20pm Commission reports to plenary

Co-chaired by Member of committee + MPL

Allow 10 minutes for each commission report with a few minutes for additions from members of the group.

Run a brief discussion on the way forward concentrating on:
What can be done at local level flowing from this workshop.

The chair from the committee should then explain the way forward in terms of the report and its additions and thank everyone for their participation.

4.00pm Closure and TEA