Department on HIV/AIDS: briefing

Meeting report

HEALTH PORTFOLIO COMMITTEE
18 March 2003
DEPARTMENT ON HIV/AIDS: BRIEFING

Chairperson: Mr L V Ngculu (ANC)

Documents handed out:
Response to HIV/AIDS

SUMMARY
The Department has been exploring a connection between AIDS and nutrition. The nutritional intervention the Department launched had yielded good results. Traditional herbal remedies were crucial inputs in the management of AIDS patients. Research had shown that branding condoms created a perception of good quality and that the more attractive the condom the more likely it was to be used. The committee heard that research had been launched in all provinces to develop an appropriate brand name and that the Department was busy registering brand names as its property and that new specifications for condom tenders would include brand names.

MINUTES
Briefing by the Minister
The Minister, Dr Tshabalala-Msimang informed members that the Department was networking with the private sector with a view to accumulating more information on the implication of the Department's policies in the work place. The Department was reviewing its strategies in view of the SADC programme on the spread of AIDS. There was a gradual understanding of the connection between AIDS and nutrition and that the nutritional intervention the Department had launched had yielded astounding results. Traditional herbal remedies were also crucial inputs in the management of AIDS patients. She advised members to take a look at the book that has been published by the Old Mutual noting that most of the Department's nutritional programs are based on the book's findings.

Briefing by Director-General
Dr Ayanda Ntsaluba noted that the Department's response strategy was a continuation of the work done in 2000 - the fundamental emphasis was the significant effort placed on care support. This strategy was based on the understanding that the onset of AIDS had compounded the management of TB with more than 50% of TB sufferers being HIV positive. Each province had formulated a strategic plan to deal with TB.

Dr. Ntsaluba said that the other item that had informed the response mechanism was the sheer underdevelopment and the challenges posed by poverty. This had put great strain on resources but he said that the country had come a long way since 1994. The Department was looking at multi-sectoral response mechanisms and that was the way it had been expanding areas of intervention and at the same time increasing resources. In 2001 R4 billion was allocated to the health sector and an additional R 3.3 billion which was over and above what the government had allocated would go to the health sector. In total, over R6 billion would be available to the health sector in addition to what the provinces spent from their equitable share fund.

Dr. Ntsaluba admitted that the Department was faced with the critical challenge at the implementation level - noting that many health professionals lacked updated know-how to manage the ever changing HIV/Aids situation. To address these challenges, the Department was co-ordinating its activities at the inter-departmental level and these efforts would be extended to include parastals and the private sector. It was important to communicate with communities to ensure that the Department's activities were underpinned at that level. The Department was addressing the challenge of TB in the face of the scarcity of human resources and that the Department would ensure that capacity is enhanced to monitor and evaluate progress.

Briefing by Chief Director: HIV/AIDS
Dr. Nono Simelela stated that the Department's mission was premised on the primary goal of reducing the number of new HIV infections especially among the youth and at the same time reduce the impact of HIV on individuals, families and communities. She pointed out the priorities for 2003:
- to scale up key interventions: Prevention of Mother to Child Transmission (PMTCT), Voluntary Counselling Treatment (VCT), Home Based Care (HBC),
- to ensure a mid-term review of HIV/AIDS and Sexually Transmitted Infections (STI) Strategic Plan,
- to review existing policies and guidelines while identifying and addressing policy gaps and
- to implement TB Medium-Term Development Plan.

On TB Control, the priorities for 2003 were to implement uniform district based recording and reporting system, increase public awareness, reduce treatment interruption rate from 12.7% to 7.5%, introduce treatment regimen, implement joint TB/HIV activities and monitor management of Multi-Drug Resistant Tuberculosis patients.

Dr. Simelela noted that research showed branding condoms created a perception of good quality and that the more attractive a condom packet was the more likely it was to be used. Research had been launched in all provinces to develop an appropriate brand name and that the Department was busy registering brand names as its property noting that new specifications for condom tender would include the brand name.

Dr. Simelela outlined the Department's successes by noting that so far 600 sites were implementing the PMTCT and that guidelines for PMTCT rollout has been provided together with training guides and tools. She continued that a video on PMTCT/IF had been produced in four languages and that the PMTCT resistance studies had been started together with the PMTCT study. There has been a National rapid appraisal on STI management and that the fieldwork on patient-ready treatment kits had been completed. Traditional healers have been appointed to help in the management of HIV/AIDS ailments and that there has been a marked decline in syphilis.

Dr. Simelela pointed out the Department planned to meet the challenges posed by HIV/AIDS by providing AZT & 3TC at hospitals for rape victims and at the same time start an intensive forensic training program. The Department would forge appropriate partnerships to reduce the health impact of rape, maximise conviction rates and reduce incidences of rape. The Department had so far rolled out 982 Voluntary Counselling and Testing (VCT) sites and couples counselling, directory manuals together with posters and pamphlets had been developed and supplied.

Dr. Simelela outlined the objectives for 2003/4. The Department hoped to consolidate financial systems and facilitate the strengthening of departmental links for collaboration in poverty alleviation programmes. The Department would support and capacitate the provincial government to strengthen internal and external programmes which would facilitate response to HIV/AIDS at the local government level. The budget for HIV/AIDS and TB stood at R668,668,000 out of which R333,556,000 was in conditional grants to provinces and R 500 million was allocated to the provinces as an equitable share fund. She identified lack of human resources and the skill base as the foremost challenge and that there was no integrated planning at district level and an absence of monitoring and evaluation work.

Discussion
Ms Malumise (ANC) asked if introduction of Neviropine projects were undertaken under pressure or the roll-out was a well co-ordinated policy driven initiative.

Dr. Simelela replied that the way it had been reported in papers caused the impression that the government was doing nothing until the Constitutional court ruling. The Department had its own timing based on the collection of the available data but that it was forced to hasten the implementation of the project as a consequence of the Constitutional court ruling. The roll-out of neviropine stemmed from government policy and not as a result of the constitutional court ruling.

Ms Baloyi (ANC) inquired if there was capacity within the Department to spend the huge budget it has been allocated.

Dr. Simelela replied in the affirmative noting that the National Department did not experience the problem of budget roll-outs as was the case with the provinces and that the Department does indeed spent all the money allocated to it.

Ms Baloyi asked how the private practitioners got the training to manage aids related complications whilst there was a shortage of this expertise in the Department.

Dr. Ntsaluba replied that the Department had developed some guidelines but that the handicap was lack of monitoring mechanisms to see how these measures work and that poor adherence to the guidelines was noted in some establishments. The Department was working on a harmonised system that would bring the bring sector aboard.

Ms Baloyi wondered why the Minister was advising that nutritional healthy foodstuffs be sourced from outside the country when it was possible to cultivate traditional cultural foods locally to alleviate the unnecessary financial burden to the state.

The Minister replied that she did not suggest that there were no exotic traditional foods that were rich in nutrition but only sited what was available in the SADC countries to illustrate the importance of nutrition in the management of Aids.

Ms Kalyan asked if medication was available at the hospitals for the treatment of victims of sexual assault.

Dr. Ntsaluba replied that intervention mechanisms already exist but that the Department was adding a component of co-ordination to the management of treatment for the victims of sexual assault.

Ms. Kalyan wanted a quantification of the prevalence of herpies in patients.

Dr. Ntsaluba pointed out that there was a significant presence of herpies but that the Department had noticed a change in character of STD noting that it was difficult to quantify the prevalence rate.

Ms Baloyi enquired if any, corrective measures the Department was taking to ensure that the program for the roll-out of neviropine succeeded.

Dr. Ntsaluba replied that the Department was perfecting the inter-sectoral approach to promote dialogue and build consensus among all the stakeholders.

Ms Kalyan noted that the African renaissance promoted the concept of finding an African solution to African problems and wondered why the Minister had appointed an AIDS dissident to head research on the nutritional management of HIV/AIDS.

The Minister replied that she was not the appointing authority for Dr. Durand but that he had been appointed by the SADC committee on AIDS. Dr. Durand was appointed due to his extensive research on nutrition as a management component of Aids and that he ran a successful programme that benefited many patients including some South Africans adding that his CV would be posted on the internet to correct perceptions about his qualifications.

Ms Malumise asked the Department proposed to tackle the perennial problem of scarcity of human resources.

Dr. Ntsaluba identified three critical interventions that the Department has put in place namely to put pressure on training institutions to interact with the changing face of the AIDS problem, to build strong regional centres to analyse and familiarise with the problem and to promote and encourage the continued professional training through up-grading of the available information.

Dr. Rabinowtz (IFP) lamented that it was frustrating that what is normally presented on paper was not what happens on the ground. She faulted the Department for its failure to harness and optimally put to use the home based care intervention program noting that it was important for the Department to try and decentralise health services.

Dr. Simelela noted that the on-set of HIV/AIDS had amplified the many limitations the country was faced with at the implementation level. She stated that government could not channel all resources to the management of HIV/AIDS when on the other hand it was faced with serious poverty and under-development. The home based care program could not be implemented effectively due to the impoverished terrain in which many communities resided noting that it concerned the government to first address the question of capacity before these programmes could be effectively rolled out.

Dr. Jassat (ANC) asked what implication the long drawn legal battle on the roll-out of neviropine had on the budget of Mpumalanga province.

Dr. Ntsaluba pointed out that while the case was pending in court it created a lot of problems for the Department but that since the issue had been resolved the Department had learned many lessons and was taking corrective measures to prevent any future recurrence of a similar scenario.

Dr. Cachalia (ANC) asked why the Department did not utilise tertiary institutions for all its research needs and why some research findings by these institutions were questioned instead of helping the Department formulate the correct policy.

Dr. Ntsaluba noted that the Department for the most part would prefer to partner with tertiary institutions in matters of research but that there were certain specific issues about which the Department sought some targeted data to facilitate a particular policy intervention. He explained that in such a case the Department would go it alone and define a narrow area of investigation especially where issues were clear and uncomplicated. The Department does, however, object to research findings undertaken by tertiary institutions which had serious policy implications yet the Department is not consulted about the process.

Ms Mnumzana (ANC) noted that the impact of Aids at the work place was a matter of serious concern. She then inquired to what extend the Department partners with the private sector to ensure that Aids prevention programmes were properly implemented at this point and that there was proper monitoring thereof.

Dr. Ntsaluba replied that government and the private sector were forming a stronger partnership to address the challenge posed by Aids at the work place noting that there were many levels of intervention where the government partners with the private sector. The underlining principle was that work place programs were not compulsory but that this had been streamlined through the work place code of good practice. He added that the King Commission's in-put had recommended that there be more co-ordination and synergies in operations to make this program work.

Dr. Luthuli (ANC) said that concern had been raised regarding the cost of monitoring pilots site and more so the laboratory facilities and asked if there were any developments on this issue.

Dr. Ntsaluba assured the committee that only the latest technology was applied in the testing sites and that every effort was made to ensure that such tests were full-proof.

Dr. Luthuli expressed satisfaction that finally nutrition had taken its rightful place in the management of opportunistic infection noting that there was no controversy that indeed nutritional intervention had a positive effect on the health of PWAs. She urged the Department to begin an intensive campaign to educate the masses on the role of nutrition in the management of Aids and to encourage people to use traditional foods.

Ms. Mathibela (ANC) expressed concern at the incidence of the escalation of TB and wanted to know whether the Department was taking precautionary measures to test all the family members of sufferers to ensure everybody was put on the treatment regimen.

Dr. Ntsaluba explained that the incidence of TB escalation was both as a consequence of the onset of HIV/AIDS and the advent of improved reporting. Contrary to the belief that the Western Cape was leading in TB cases it had now been proven that Eastern Cape and KZN were at the top of the list only that Western Cape was good at its reportage. Everybody was exposed to TB and that indeed most people had a dormant TB strain only that the deterioration of the immune system due to the onset of HIV/AIDS helped to inflame the TB to an acute stage.

The chair clarified that the Minister did not mean to say that nutrition was the only intervention the government had put in place to manage HIV/AIDS but that it was one form of intervention that the government recommended for people with AIDS. He asked the Department to capacitate medical personnel to ensure that they were competent to manage the new challenges posed by Aids. He hinted that the Committee might want to interact with medical schools to find out what programmatic interventions they had put in place to update medical personnel on these new challenges.

Meeting was adjourned.