Impact of HIV/AIDS on Women and Girls: hearings

Meeting report

JOINT MONITORING COMMITTEE ON THE IMPROVEMENT OF QUALITY OF LIFE AND STATUS OF WOMEN
19 September 2001
IMPACT OF HIV/AIDS ON WOMEN AND GIRLS: HEARINGS

Chairperson: Ms P Govender (ANC)

Documents handed out:
Presentation by UNAIDS: HIV/AIDS: Impact on Women, Girls and Society
TAC Discussion Document: Treatment Issues for Women

SUMMARY
As part of the Committee’s Public Hearings on HIV/AIDS submissions were heard from the Treatment Action Campaign (TAC), UNAIDS and the AIDS Training information and counseling Center (ATIC). The broad theme of the public hearings (19-21 September) is to examine ways to address the impact of HIV and AIDS on women and girls.

MINUTES
Treatment Action Campaign
The TAC presenters spoke about the dramatic impact of HIV/AIDS on women economically, socially, and biologically. Women bear the brunt of HIV/AIDS in South Africa, as victims and caregivers of victims. Ms Thembisa Mhlongo about her experience of caring for an HIV+ child, Sibongile, who had died on 11 September this year. This was an emotional account reflecting the struggle women have to face as care givers and the struggle faced by the child.

Aneke Meerkotter, a volunteer for the TAC, spoke about the Mother-to-Child Transmission Prevention Program. The program aims to allow women to make choices about their own lives, by giving them choices about pregnancy and HIV/AIDS treatment. The argument was put forward that a simple, single dosage of Nevirapine to the mother and the child after birth, requiring a total of 1% the Health budget would alleviate the burden on hospitals and mothers and care givers. Despite recommendations by the World Health Commission, and certain offers by pharmaceutical companies, Nevirapine has not been made available to pregnant women. The TAC wants a national program providing free testing and counseling as well as the availability of preventative measures, like formula milk. Ms Meerkotter said that the TAC’s research was comprehensive, no further research was necessary, just implementation of the MTCT prevention program. The government’s failure to address these issues has resulted in the TAC taking the government that is provincial and National Health departments, to court.

Further reference was made to Microbiocides research. Microbiocides are placed in the vaginal area to reduce risk of infection. These would supplement condom use as a preventative measure. The need for education to prevent stigmatisation of the disease, especially at schools and the distribution of male and female condoms were suggested.

Sipho Mthathi focussed on the medical aspects of HIV/AIDS. She said that SA had made commitments to human rights, which include the right to healthcare services. With these obligations and the fact that women bare the brunt of HIV/AIDS the improvement of the healthcare system is especially important for women. The majority of healthcare system users are female. In Khayelitsha alone 3000 women were diagnosed HIV+, only 30% of these women were aware of their HIV+ status before prenatal testing. The use of public health care needs to be encouraged. Ms Mthathi pointed out that the current policy of treating opportunistic infections is not enough, as firstly, it will not eliminate the virus form spreading in the body and secondly, the form taken by opportunistic diseases in the case of HIV+ patients needed special treatment.

Ms Mhlongo spoke about the fact that Sibongile had been admitted to hospital 14 times in the last year, and that she was never formally treated for HIV. When she was treated she had very violent counter reactions to the careless administration of AZT. The administration of Anti-retrovirals (ARV’s) was also an issue in need of attention. The example of Brazil was cited where universal access to ARV’s had reduced the incidence of tuberculosis (TB) and other opportunistic infections by half, thus reducing the burden on the public health system. The need for the adequate training of health workers to treat TB as a result of HIV with new methods, and the setting up of pilot sites to distribute drugs, and to train health workers how to administer these drugs was suggested. The issue of post-exposure-prophylaxis treatment for rape victims was also raised. The decision to test offenders before giving treatment to rape victims was criticised as the drugs needed to be administered within 72 hours to be effective.

Ms Mthati bemoaned the damage done by government leaders in careless statements and always having an attitude of too many problems, with no discussion of possible solutions. She said it was time for the government to lead, finding solutions instead of problems. A summary of the presentations was given in Zulu.

Discussion
One Member asked what treatments the TAC were actually recommending and where these will be inserted into the current system. The TAC was further questioned on whether these treatments are working. A Member asked what happens to women without access to these sites.

Concern was raised over whether the National Budget could accommodate these recommendations. One Member suggested that providing condoms in schools will create problems, and that abstention was a better solution. Another member asked if those people working on the ground had noticed any improvement in attitudes to HIV+ people. One Member questioned why the TAC and other NGO’s were not always visible at clinics and areas she had visited.

Ms Maine(ANC) questioned the TAC’ s response to the government. Referring to President Thabo Mbeki’s statement on HIV/AIDS she asked if people had really become more callous towards treating the disease following this statement, as she had rather understood it as making the alleviation of poverty a key issue in relation to HIV/AIDS. She further referred to the problem of female condoms. She further referred to the problem of female condoms as merely encouraging male irresponsibility.

Dr Nkomo, Chairperson of the Health Portfolio Committee, questioned the TAC on the guidelines they had asked to be given out at clinics and hospitals. He questioned their assertion that these guidelines were not available everywhere, asking for the TAC for research in this area. Zackie Achmat responded that the TAC had asked for the Health Committee’s co-operation in ensuring that these guidelines be distributed to all clinics and hospitals; it was not up to the TAC to research the distribution of the guidelines. Later Dr Nkomo made a point of clarity, saying that he had not asked for a survey, but rather wanted to know what empirical research the TAC had that these guidelines were unavailable in all clinics and hospitals.

Zackie Achmat responded to other questions by emphasising the major problem of anti-retrovirals. Ms Mhlongo made a very emotional appeal, talking about how the toxicity of the treatment drugs contributed to the deterioration of Sibongile’s health.

Zackie Achmat referred to the need for anti-retroviral training to teach health workers how to administer the drugs properly. The cost of anti-retrovirals was also a major problem. He said the TAC was unhappy with the health and financial departments which had turned down the offer of the triple therapy from a pharmaceutical company. Concerning microbiocides he pointed out that a document containing information on microbiocide research had been distributed. On the issue of traditional medicine there was not a sufficient legal framework to protect it from drug companies. He said that the TAC was a small, struggling NGO which was not government funded. He said its volunteers were visible, and were working in clinics as much as possible. Anekke Meerkotter said that pilot sites for the prevention of mother-to- child transmission had been set up. Sufficient research shows Nevirapine to be effective. She agreed that one of the key problems is the difficulty in accessing these sites. Mr Achmat concluded that concerning these treatment issues on the specific needs of women, it is critical that the committee demands a global standard.

Ms Kgoali (ANC) remarked on the size of man condoms for the boy child. She also remarked on the noisiness of female condoms. She suggested the distribution of condoms be abandoned as a realistic solution. Ms P Govender reminded members to maintain the distinction between civil and public sectors; such questions should be put to the Department of Health, not the TAC.

The Chairperson, Ms P Govender, informed the Committee that the hard data provided in the TAC research will be used by the Committee to get responses from the Minister of Health at next weeks hearing.

UNAIDS ‘HIV/AIDS: Impact on Women, Girls and Society’
Bunmi Makinwa, team leader of UNAIDS (United Nations AIDS) inter-country team for Eastern and Southern Africa, spoke of HIV/AIDS as a major development crisis in many parts of the developing world, especially countries in Africa. He said that responses to the epidemic needed to be gender-sensitive, realizing that the social and biological factors increased the burden of HIV/AIDS on women. He cited successful strategies that had been implemented in Uganda, Senegal, and Thailand. All of these had in common an immediate national response to the epidemic, and strong community involvement. UNAIDS supports the South African government’s HIV/AIDS and STD Strategic Plan for South Africa 2000-2005, based on the five important pillars of prevention and control, treatment and care, social mobilisation, human and legal Rights, monitoring and research.

Discussion
The Chairperson, Ms P Govender, asked how a country like South Africa deals with issues of the affordability of medicines in terms of trips, or accessing generic equivalents.
Mr Makinwa responded that the Agreement on Trade Related Intellectual Property Rights (TRIPS) is very new. There are several ways to look at the issue of affordability. Voluntary licenses can be granted by pharmaceutical companies, or compulsory licensing, which South Africa has done. It is then necessary to subsidize production or to get the company to produce it at a lower, fixed cost.

Dr Luthuli asked about the difference between sustained treatments versus anti-retrovirals.
Mr Makinwa responded that anti-retroviral treatment was a relatively new thing, involving the reduction of the viral load. The example of Uganda reflects the need for treatment and prevention campaigns working alongside one another. Here Nevirapine had been tested and was immediately adopted, however it was still available at a limited level in clinics.

ATIC: AIDS Training Information and Counseling Center
Mr Wilfred Jewel gave a brief description of the work done by this government appointed and funded centre based in Plumstead. Formed in the late 1980’s, four centers were created in four sectors. The function of the Western Cape ATIC, based in Plumstead, was to train people in Health services. It is a government organisation with NGO features. It is accountable to the director of the metropole region. The centre trains counselors and nurses. Other services include testing and drug trials, support and referral, consultations with companies in setting up HIV/AIDS policies, support for people working in clinics. It is very involved with related NGO`s. Mr Jewel called for the need for more training sites, and for testing of partners of HIV+ people.

Discussion
ATIC was asked what was being done in the rest of the province. What human resources are available in this area? Mr Jewel responded that training was done in other areas but then the budget was covered by that area.

Another Member suggested that monitoring be done to assess the impact of education in clinics, given the difficulty of assessing the situation of communities. It was also asked what the means were of attracting volunteers to become councilors. A third Member asked if ATIC had working relations with the TAC.

Mr Jewel responded that ATIC is a training organisation, it is approached by substructures with already elected volunteers. ATIC then trains these people as trainers. ATIC co-operates with the TAC, and in fact many of the TAC counselors were trained by ATIC.

The meeting was adjourned.