Prevention/Treatment

How is the South African Government dealing with the aids epidemic?

In 1987, the apartheid government recognized that HIV and AIDS had the potential to become ‘a major problem’, even though there were few reported infections.

The first antenatal survey, conducted in 1990, found that only 0.7% of pregnant women were infected. Yet, in the same year, ANC leader Chris Hani, speaking from exile, warned: Existing statistics indicate that we are still at the beginning of the AIDS epidemic in our country. Unattended, however, this will result in untold damage and suffering by the end of the century.”

This warning was not heeded, either by the outgoing regime or by the incoming democratic government as it faced the huge challenge of taking over political control of a divided country.

During the first decade of democracy in South Africa, the energies of civil society organisations in the HIV and AIDS sector ­ led by the Treatment Action Campaign (TAC) were largely focused on challenging the government to recognise the scale and depth of the emerging epidemic.

Former President Nelson Mandela acknowledged after leaving office that his government had not acted swiftly or decisively enough to address the crisis. His successor, Thabo Mbeki, far from redressing this failure, compounded it with a deadly denialism parading as intellectual inquiry. Under his presidency, more than 5 million people were living – and increasingly dying – with HIV. Yet Mbeki questioned the link between HIV and AIDS and said he had never met anyone with the disease.

Mbeki’s Minister of Health, Manto Tshabalala-Msimang, fought growing national and international appeals for a public treatment programme to save lives, all the way to the highest court in the land. Prevention, nutrition, traditional medicine and a ‘positive attitude’ were the Minister’s prescription. These were touted as an alternative to anti-retroviral treatment, rather than as important components of a comprehensive treatment and support programme. The body that was supposed to drive the national response to HIV and AIDS, the South African National AIDS Council (SANAC), chaired by then Deputy President Jacob Zuma, was dysfunctional and ineffective in the absence of political will. It was only in 2003 that the government finally decided to provide free ARV treatment to patients in some public hospitals. The government produced an Operational Plan for the rollout of ARV treatment but lack of leadership and severe capacity problems in the health sector inhibited its implementation.

After Zuma was fired as Deputy President in 2005, SANAC was reconstituted under his replacement, Phumzile Mlambo-Ngcuka. As Minister Tshabalala-Msimang’s influence began to wane, reason began to prevail in the response to HIV and AIDS. Mbeki desisted from public contestation of HIV/AIDS science and, in 2007, government and representatives of labour, civil society and the private sector, through SANAC, finalised a new Strategic Plan for HIV and AIDS and STIs in South Africa, for 2007 to 2011.

When Mbeki fell from office in 2008, a new Health Minister, Barbara Hogan, was appointed, who immediately committed government to a concerted and decisive response to the epidemic. A new spirit of trust and cooperation between government and civil society bode well but the legacy of poor leadership and cooperation was daunting. New infections were still occurring at a rate of about 1500 a day and 1000 deaths per day were attributed to AIDS.

This text is an extract taken from http://www.aids.org.za/ - please visit this site for more information.

While the government response is a matter of national policy and has always been framed as a ‘partnership’, clearly the role of individual leaders is critical. Strong, visionary leadership is needed in all sectors to defeat an epidemic that is affecting all sectors. This is the context in which AFSA is supporting initiatives aimed at taking control of the HIV and AIDS epidemic from household to international level. Hopeful signs of a determined and comprehensive response to the HIV and AIDS pandemic in South Africa emerged during 2008. After years of denialism and mixed messages from the Presidency and the Ministry of Health, there was the prospect of committed leadership and an effective response. The appointment of a new Minister of Health, the functioning of the reconstituted South African National AIDS Council (SANAC) and the promotion of a National Strategic Plan (NSP), with clear targets for prevention, care and treatment, all pointed towards a new era of joint action to save lives.

Education

Prevention of HIV transmission in South Africa has focused primarily on interventions to promote behaviour change.

One of the main strategies was to inform people about the existence of HIV, the means of transmission and the consequences of infections. It was believed that this would prompt peopled to abstain from sex, use condoms during every act of sexual intercourse, and move from high-risk to low-risk sexual activities, such as having fewer sexual partners.

However, it became clear, through the increase in infection rates, that knowledge of HIV has not led people to change their attitudes or behaviour. One factor is that prevention campaigns have not taken account of the dynamics of the epidemic in South African society. These include deep-rooted inequalities, which mean that girls and women, who are physiologically more susceptible to HIV infection, may be unable to negotiate safe sex, are vulnerable to rape and are often in relationships with men with multiple partners. The fact that most South Africans do not know their HIV status and the perception – fuelled by the slow pace of roll-out of ARVs – that a diagnosis of HIV/AIDS is a death sentence have also contributed to a high level of denial.

People will only change their behaviour or attitudes when they feel that they have a vested interest in change. That is, people must believe that their lives will improve as a result of knowing and being able to manage their HIV status.

Successful interventions show that a peer educator approach is most appropriate to convey the AIDS message to the target group. Since more than 60% of new HIV infections occur among young people aged 15 to 25, with adolescent girls and young women of childbearing age most affected, interventions that will reduce the vulnerability of these groups are needed.

Does education about AIDS make young people more sexually active?

“My HIV status is going to let me live longer than I would have lived normally, because I've got a challenge, because I know that I have a duty to the people out there to inspire them that 'Folks, the fight is on! Let's hold hands. Let's not hide.” - Top SA playwright, Gibson Kente, news24

Some people believe that talking to young people about sex will encourage its practice. Such anxieties prevent many teachers, youth workers and parents from talking about sexual matters. Alternatively, they may encourage and over-emphasis on the negative aspects of sex - unwanted pregnancy, sexually transmitted illnesses, AIDS - rather than focus positive aspects such as intimacy, sexual love and pleasure.

What type of education works best for young people?

There are several components including factual information about biology, sexual development, and sexual and drug-related risks; a concern with personal relationships, feelings and values; an emphasis on the acquisition of relevant negotiation skills (including but not restricted to how to say 'no'); and a consideration of wider social pressures, cultural expectations and sex education.

What is sex education?

Sex education, which is sometimes called sexuality education or sex and relationships education, is the process of acquiring information and forming attitudes and beliefs about sexual practices, sexual identity, relationships and intimacy. It is also about developing young people's skills so that they make informed choices about their behavior, and feel confident and competent about acting on these choices.

Medication

“Young AIDS sufferers don't know how to deal with it (HIV/AIDS). They can't tell their parents and they think It is useless to fight. If you are HIV positive, you must know that there is no escape.” - Former ANC Youth League chairman, Peter Mokaba (Born 7 January 1959 and died June 9 2002)

There is no cure for AIDS. Scientific research is producing new information about the virus and disease progression all the time but no one can predict when a cure will be found. However, antiretrovirals (ARVs) can be taken, they are not a cure but they are agents that suppress the activity or replication of retroviruses such as HIV, therefore ARVs reduce morbidity levels and defer premature death (stop people from becoming ill for many years). The treatment consists of drugs that have to be taken every day for the rest of someone's life.

One of the problems is that ARVs are not always readily available in South Africa and are expensive”. Read more

An opportunistic infection is an illness caused by an organism that usually does not cause disease in a person with a normal immune system. People with advanced HIV infection suffer opportunistic infections of the lungs, brain, eyes and other organs.

A list of common opportunistic infections:

  • Tuberculosis (TB): TB is highly contagious and can be spread through coughing or sneezing.
    Symptoms: include fatigue, fever, night sweats, weight loss, and a cough producing mucus and sometimes blood.
  • Hepatitis: Hepatitis is an inflammation of the liver. The three types are Hepatitis A, B, and C. Hepatitis A can be spread through unsanitary living conditions, sex or contaminated food. Hepatitis B is spread through infected blood and through sexual contact and hepatitis C is spread by blood transfusion and injection drug use . A vaccination is available to prevent Hepatitis B.
    Symptoms: include fever, abdominal pain, and a yellow discoloration of the skin and eyes (jaundice).
  • Candidiasis: Candidiasis is a form of yeast infections and are of three types: oral (thrush), esophageal, and vaginal.
    Symptoms: of oral thrush are the presence of white patches inside the mouth, on the tongue and upper throat. A Sore throat and a change in taste can also occur. Chest pain and difficulty swallowing characterize Esophageal thrush. Vaginal itching, burning, and thick white vaginal discharge characterize recurrent vaginal candidiasis.
  • Anemia: Anemia is a condition that occurs when your body does not have enough red blood cells. The red blood cells carry oxygen to your body's organs.
    Symptoms: extreme weakness and fatigue, shortness of breath, dizziness, fainting, trouble concentrating, rapid heart beat, chest pains, trouble sleeping, loss of sex drive, pale skin and headache.

Several HIV-related infections can be prevented. Following successful treatment, prophylaxis (prevention of disease) can also prevent disease recurrence (TB, salmonella, cryptococcus). Although the variety of HIV-related illnesses, for example in Africa, differs from that in industrialized countries, several of the most common opportunistic infections are open to prevention through antibiotic prophylaxis.

Providing prevention of opportunistic infections and HIV-associated diseases can”

  • Reduce the suffering of people living with HIV/AIDS and improve their quality of life and the quality of life for their families.
  • Allow people with HIV/AIDS to continue as contributing members of their families and communities for as long as possible.
  • Prevent the further spread of TB and other transmittable opportunistic infections to other members of the family.