HIV/AIDS Strategies: Briefing

Meeting report

SOCIAL SERVICES SELECT COMMITTEE
19 June 2001
HIV/AIDS STRATEGIES: BRIEFING

Chairperson: Ms L Jacobus

Documents handed out:
Presentation on HIV/AIDS Programme

SUMMARY
The Department identified five priority areas for the coming term. These are (1) Prevention, (2) Treatment, Care and Support, (3) Legal and Human Rights, (4) Research, Monitoring and Surveillance and (5) Information, Education and Communication. The Department specifically discussed issues such as the Mother to Child Transmission of HIV, home-based care and voluntary counselling and testing.

MINUTES
The Social Development Department’s Deputy-Director on HIV/AIDS and STDs, Ms C Serenata explained that the Department’s strategy is guided by a five-year strategic plan. The process of consultation started in July 1999 when a meeting was held with the various stakeholders from different sectors. Various amendments were made to the document until it was approved by the Minister.

A. Priority areas
These are: (1) Prevention, (2) Treatment, Care and Support, (3) Legal and Human Rights, (4) Research, Monitoring and Surveillance and (5) Information, Education and Communication. The area of Communications is often subsumed in the other categories such as Prevention. Ms Serenata pointed out that the area of Prevention is not only the responsibility of the Department, but by the country as a whole. Although many areas are very health focused, other sectors such as social development can play a role.

Prevention
Managing sexually transmitted diseases (STDs) drastically reduces incidents of HIV/AIDS. The syndromic management of STDs has worked very well in the Public Health Sector because doctors and nurses are trained in this area. In the private sector (general practitioners) syndromic management is not dealt with effectively.
Promoting safe and healthy sexual behaviour. This is done by virtue of the life skills programme, encouraging condom usage and education.
Decreasing the incidents of Mother to Child Transmissions (MTCTs).
Promotion of voluntary HIV counselling and testing.
Maintaining blood safety in the cases of blood transfusions so as not to transmit the virus. SA already has very high standards in this regard and should work toward maintaining them.
Post exposure services. There should be appropriate services for health workers who sustain injuries using needles while caring for AIDS patients.

(2) Treatment, Care and Support
In health systems the focus is on health services; specifically the staff and their attitudes in clinics and hospitals.
In communities the focus is on voluntary testing and counselling as well as on home-based care. The latter entails visiting homes, providing services and appropriate medication and even doing chores and washing the patient.
For children and orphans. This is the responsibility of the Department of Social Development which has made provision for foster grants.

3) Legal and Human Rights
Fostering a supportive social environment e.g. removing the stigma of AIDS, and creating drug literacy.
Establishing an appropriate legal and policy environment e.g. HIV testing should not result in the employer discriminating against the employee. Other African countries have commended and are learning from South Africa’s approach in this regard.

4) Research, Monitoring and Surveillance
These activities fall outside the Department’s scope because the Department is not a research body. Outsiders perform a research function by means of a tender process.
A vaccine is being developed. The Department provides R5 million to the Medical Research Council each year, while the Department of Arts, Culture, Science and Technology provides an additional R5 million. An additional R10 million is provided by private companies.
The issue of MTCTs has a very strong research component. In this regard, HIV positive pregnant women are placed under surveillance.

B. Basic Policy Focus
MTCTs
Integrated Plan for Children and Youth Infected and Affected by HIV (simply referred to as the ‘Integrated Plan’). This plan involves the Departments of Health, Education, Social Development and Agriculture. These departments have set aside R400 million for the next three financial years.

1) Mother to Child Transmission
· SA received preliminary results of meetings held in August 2000. These results included findings of studies dealing with the use of Anti-retrovirals to curb MTCTs. One study used Noviropin while the other focused on the use of Noviropin and AZT.
· The efficacy of using anti-retrovirals was established, but there is still a need to explore the issues of multi-drug resistance and breastfeeding.
· The use of AZT to curb MTCTs is not an option because of costs.
· Failure of the mother to breastfeed exclusively (i.e. if she uses a bottle and breastfeeds) reverses any benefit gained by administering noviropin during labour. Thus the virus may still be transmitted to the child.
· The Department needs R25 million per year to administer this programme.
· The Department supplies the formula for bottle-fed babies. Half of the R25 million goes toward the provision of formula for a six-month period.

2) Components of the Integrated Plan
· Life skills programmes focus on children and youth. It examines the services needed to deal with them. Grades Five to Nine are the target groups.
· Home-based care ensures that parents have home-based care if they are ill. This programme started in August 2000 and has been in the planning phase since then. The planning phase identified the need for a training manual, modules and workshops. Since planning has been completed, implementation can now take place. Cabinet has given funds to the Departments of Social Development and Health, which must be paid out to the provinces upon the submission of integrated business plans. This development is taking place in phases and is happening at different places in different provinces. At national workshops the approach of training the trainer has been used.
· Voluntary Counselling and Testing (VCT). The provinces have been prepared for this programme. Training and tenders have taken place, and rapid test kits have been purchased. These kits enable people to obtain test results in ten minutes instead of six days (as had been the case). Persons undergo pre-test counselling and are then counselled after the test. If the result is positive a second test takes place. If this result is negative, a third test takes place. Counsellors are lay people who have received training because health care workers are already overburdened. Approximately 2200 people have been trained and they will in turn, train others.

Home-based care
A member of the Department said that to date the system has operated on a family and voluntary basis. He emphasised that the Government needs to formalise the system. Government has made R500 available for each registered home-based worker. The Department hopes to register 200 home based workers by the end of the year.

One of the problems is that these workers have been getting infected while caring for patients with HIV. Hospitals are filled with AIDS patients and home-based care allows the patient to receive quality care based on dignity and respect.

Discussion
Ms S Ntlabati (OFS-ANC) asked if home-based workers are being paid R500 already or if this must still be implemented.

A Department representative replied that the government was still in the process of implementing this. This amount will not only be paid to AIDS caregivers, but to all registered home-based care workers.

Dr P Nel (OFS-ANC) asked what infrastructure is being made available to the terminally ill outside of hospitals. He suggested an integrated plan with the Department of Housing.

The Department representative responded that hospices have previously been used. However treating people through the hospices is not the same as home based care. The Department is therefore focusing on a home-based care system and developing a referral system which can identify patients who are ready for home-based care.

Dr Nel referred to the statement that the private sector is not addressing STDs adequately. He asked why this is the case and what the Department is doing about it.

Ms Serenata remarked that dealing with sexually transmitted diseases is easier for public sector workers as they receive a course on the issue. In addition they have access to health care workers unlike the private sector. However there is a programme which General Practitioners are encouraged to attend which may remedy the problem.

Dr Nel asked if there is a document on MCTC guidelines for members use.

Ms Serenata explained that the National Department is the policy driving body and that the provinces were responsible for implementation. Thus the National Department will not have information unless it has been requested from the provinces. She suggested that members request this information straight from the provinces. In addition, guidelines can be obtained by looking at the training manual, research framework and MTCT protocol. In October 2000 the Department launched nine guidelines, which have yet to be distributed.

Ms J Vilakazi (KZN-IFP) remarked on the extreme poverty in certain areas where victims’ families are unable to fend for themselves. Mr Tlhegale agreed with this comment and asked if the family of an AIDS patient is given any financial support.

The Department representative replied that there is an integrated plan for dealing with poverty relief. The Department of Social Development looks at the provision of grants for these families.

Mr J Tlhegale (North West-UCDP) said that the Department in the North West was working on piloting a Bill on HIV/AIDS. He asked if anything like this was happening at National level.

Ms Serenata said that she had not heard of this Bill. There is however no such legislation at National level.

Mr Tlhegale asked whether people usually come for testing if they feel sick or if they are tested simply to determine their HIV status.

Ms Serenata replied that this is an individual issue. Very often a woman’s partner is tested once a woman becomes involved in the MTCT programme.

Rev P Moatshe (North-West-ANC) expressed concern that the Department promotes safe sex behaviour but does not seem to be promoting abstinence.

Ms Serenata said that the Department advocates the ABC approach i.e. Abstinence, Be faithful and Condoms. In reality however one cannot ignore the impact good quality condoms has on reducing the rate of spread of the disease. She agreed that it is better to convince children to delay their sexual debut.

Rev Moatshe asked if one could contract AIDS through ‘tongue-kissing’.

Ms Serenata replied that there is no evidence to show that the virus can pass via saliva.

Rev Moatsha asked how breastfeeding affects the MTCTs and if it is encouraged.

Ms Serenata answered that using Noviropin during labour, transmission of the virus to the child can be reduced by 30%. If a mother breastfeeds exclusively this reduction is maintained for a two year period. If there is mixed feeding there is a reversal of its efficacy. Thus if a mother is unable to breastfeed exclusively the Department provides formula and suggests that the mother should not breastfeed at all.

Mr B Mkhaliphi (Mpumalanga-ANC) asked what the connection between bottle-feeding and diarrhea is.

Ms Serenata responded that research has shown that a breastfed baby gets its nutrients from the mother. When a mother bottle-feeds there is a risk that she will not wash the bottle properly or that the water she uses may be contaminated.

Mr Mkhaliphi referred to the peer groups volunteering at schools. He asked if these groups are included in the category of home-based care workers.

A Department representative said that this group will not receive the R500 as they are not home based care workers. Instead they are classified as on-site information providers.

Mr Mkhaliphi asked if rapid testing is readily available in the provinces.

Ms Serenata answered that rapid testing is readily available. A tender has been issued and provinces now have to order the kits as required.

Mr Mkhaliphi asked if there is a demand for the female condom.

Ms Serenata responded that the female condom was very popular with women in pilot sites. They are however very expensive. Although EU funds are being used for this purpose they cannot be distributed as readily as male condoms. Only four million female condoms will be supplied this year while 450 million male condoms will be distributed.

The Chairperson asked if persons who had been tested and had not yet obtained their results could be tracked. She pointed out that It is important that people are informed of their HIV status in order to prevent the spread of the disease.

Ms Serenata said that people who did not return to get their results were difficult to track. This makes rapid testing revolutionary because a person can be given his/her results in ten minutes. However sometimes people do not want these results immediately and then there is a risk of these people not returning to obtain their results.

The Chair referred to the fact that children born to HIV positive mothers sometimes only test positive two years after birth. She asked if there was any way to track these children and mothers and if this monitoring expense is included in the R25 million.

Ms Serenata replied that this monitoring does occur as part of the research programme. Field workers do the monitoring. The problem is that there are only two sites per province and if people come from outside that geographical area, they often give false addresses. Monitoring is included in the R25 million.

Dr Nel asked if the MTCT policy document includes the post-partum treatment of the mother.

Ms Serenata said that the focus is no longer just on keeping the baby alive but on ensuring that the mother lives to look after the baby.

The meeting was adjourned.