Chapter 9: HIV/AIDS and Sexually Transmitted Diseases
White Paper for the Transformation of the Health System in South Africa

1. Background and Introduction

Approximately 1,8 million people are infected with HIV in South Africa, and more than 700 new infections occur every day. The government states its committment to the National AIDS Control Programme (NACP) to combat the epidemic. This is a comprehensive and co-ordinated programme, based on the National AIDS Convention of South Africa's (NACOSA) National AIDS Plan.

2. Objectives

The National AIDS Control Programme (NACP) focuses on 5 central objectives:

• To prevent the spread of the epidemic. This will be achieved through the promotion of safer sexual behaviour, the adequate provision of condoms and the control of sexually transmitted diseases (STDs);
• To protect and promote the rights of people living with HIV or AIDS;
• To use the mass media to popularise key prevention concepts and develop life skills education for youth in and out of school;
• To reduce the personal and social impact of HIV/AIDS through the provision of counselling, care and social support; and
• To mobilise and unify local, provincial, national and international resources to prevent and reduce the impact of HIV/AIDS.

3. Guiding principles

It is recognised that the spread and prevention of HIV/AIDS can only be dealt with within the context of addressing the underlying socio-economic factors. In addition, the following principles will guide future efforts to control HIV/AIDS:

• Civil society and government will be involved in controlling the spread and impact of HIV/AIDS. This joint effort is needed because the government cannot implement the NACP on its own.
• People living with HIV or AIDS will be involved in all strategies, including prevention and care. Further, there will be no discrimination against people infected with HIV/AIDS, and their legal rights will be protected.
• The emphasis will be on capacity-building at all levels, to accelerate HIV/AIDS prevention and control measures.

3. Implementation strategies

3.1. Involving Government and Civil Society

Various strategies are proposed to ensure the involvement of both government and Civil Society.

Government: Since the government cannot implement the NACP alone, it will provide leadership, and co-ordinate the activities of all role-players. The government will also ensure that appropriate funding is provided for the implementation of the NACP. An interdepartmental task team will be convened to develop an approach which involves all government sectors.

Civil Society: Mechanisms to involve civil society and other stakeholders are also proposed. The NACP will continue to work collaboratively with NACOSA, nationally and provincially. It is envisaged that NACOSA will provide guidance to the Programme. Further,

• A National HIV/AIDS and STD Advisory Group will be established to provide guidance to the NACP. Its members will be representative of all stakeholders, and will be appointed by the Director-General for Health.
• A Committee on NGO funding will be formed to co-ordinate support for NGO/CBO activities.
• The private sector is encouraged to support the activities which fall within the framework of NACOSA's National AIDS Plan.
• Working relationships with international agencies will be furthered, in order to secure technical and other support.
• A Committee will be established to co-ordinate research on HIV/AIDS and STDs.
• The NACP will develop communication channels between the Programme, stakeholders in the Department of Health, and Civil Society.
• The NACP will establish a clearing house, which will disseminate information to the public.

3.2 Key strategies

The following key strategies to control the epidemic have been identified:

• A Life-skills programme for youth will be developed. The programme will be sensitive to the developmental and cultural dynamics of different communities, while ensuring that factual information is provided. One objective is to have HIV/AIDS and STD education as a component of a broader health education programme.
• Mass communication media, e.g. radio and T.V., will be used to popularise key prevention concepts.
• The quality of STD services in the public and private sector will be improved.
• Access to barrier methods, such as condoms, will be improved. A range of barrier methods, including female barrier methods, will be made freely available. Health workers will be trained to assist people in using these methods.
• All persons infected with HIV, or suffering from AIDS, should receive appropriate care and support. This will include access to counselling services and drugs for treatable opportunistic infections. To achieve this, there will be close collaboration with other Directorates in the Department of Health.

3.2. People Living with HIV/AIDS

• People living with HIV or AIDS will be involved in decision-making forums and in prevention, education and care-giving activities
• Guidelines for HIV testing should be adhered to.
• Legal reform, which will prohibit discriminatory practices, will be undertaken.
• Further, the vulnerability of women to HIV/AIDS is recognised by the NACP. In this respect, all projects should be gender-sensitive, and special gender programmes will be introduced throughout the country.

3.3 Capacity Building

The government is committed to human resource development within the public service and the NGO/CBO sector. In particular, training will be provided to improve counselling services. Capacity building will be undertaken in the following areas: ensuring safe blood supplies, health promotion, and monitoring and evaluation. Further, protocols to reduce occupational exposure to HIV will be developed, and HIV/AIDS surveillance mechanisms will be strengthened.

4. Indicators of success

The following will be indicators of a successful implementation of the NACP:

• increased number of children/teenagers receiving STD/HIV education
• reduced incidence of STDs
• reduced incidence of HIV
• increased number of, and greater area in which, condoms are distributed
• increased STD clinic attendance rates
• increased number of health facilities where voluntary testing and counselling is available
• increased number of individuals receiving voluntary HIV testing and counselling.

5. Some issues raised by the Chapter

• The implementation of the NACP within the new health care system is not discussed. How are provinces going to be supported in implementing their programmes? Will home-based and hospice care be supported and promoted? What are the strategies envisaged to support Community Health Workers?
• Statistics indicate that HIV/AIDS affects the active workforce. What strategies are envisaged to deal with the economic and social impact of the disease? What strategies are envisaged to deal with orphans?
• Given the vulnerability of women to HIV/AIDS, should there be a specific Gender Policy?
• Protecting the rights of people living with HIV/AIDS cannot be accomplished through legal reforms alone. Are there any specific strategies envisaged to raise awareness around this issue: for example, educational campaigns, or a charter of rights?
• The lack of a government plan is worrisome. Although, the use of NACOSA’s framework is welcomed in terms of its involvement of Civil Society in national policy, should the Department not take ownership of it’s own plan?
• The indicators are not very specific. Should specific targets be set to facilitate monitoring and evaluation of the NACP?

For more information, please contact Jane Mathieson or Bea Abrahams by telephone @ 021 - 6964954 or by fax @ 021 - 6969308 or by e-mail at philaw@wn.apc.org . The PHILA programme is funded by a grant from the Henry J. Kaiser Family Foundation.

Please send comments or suggestions about this site.