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Government's Plan to Deal With HIV/Aids

Veronica Mohapeloa

The HIV/AIDS budget (excluding allocations from provincial equitable shares) is set to increase ten-fold from R342-million in 2001/02 to R3.6-billion in 2005/06.

To this end the conditional grant for HIV/AIDS to the provinces, including expanding VCT and the programme to prevent HIV transmission from mother-to-child, has been increased from R210-million in 2002/3 to R334-million in 2003/4.

Updating the nation on the implementation of the strategic plan against HIV/AIDS last week, Cabinet said the country had a plan to fight the life-threatening disease in terms of prevention, treatment, care and support, in the context of development and poverty eradication.

'There is a plan, a comprehensive national strategy, based on the premise that HIV causes AIDS,' Cabinet said.

With prevention critical in this regard because there was yet no known cure for AIDS, it said surveys confirmed a high level of awareness amongst South Africans and the young in particular.

'The Khomanani campaign, with R98-million of government funds, is reinforcing this.'

As part of the concerted efforts to prevent the spread of HIV/AIDS, government distributed 350 million condoms free of charge in 2002. This will increase to 400 million in 2003/04.

'We will increase the supply through non-traditional outlets - like clubs, shebeens and spaza shops - and double the number of sites where female condoms are available (the number of such sites has already increased from 27 in 2000 to just over 200 in 2002).

Voluntary HIV counselling and testing (VCT) was now available in nearly 1 000 public health sites and more funds had been allocated.

'By the end of 2002, VCT was available in 982 sites throughout the country, including the sites of the PMTCT programme (programme to prevent HIV transmission from mother-to-child). It is planned to have VCT services available in 80 percent of public health facilities by the end of the 2003/4 financial year.

By providing Nevirapine to mother and baby in the PMTCT programme, Cabinet said this had expanded and would continue to develop in 2003.

'Most provinces are now extending this comprehensive package to more facilities and at last count about 658 hospitals and clinics were providing the service.'

Provinces were also implementing the Constitutional Court ruling for all doctors working in public sector maternity services to offer Nevirapine to HIV-positive pregnant women, provided that adequate HIV testing and counselling facilities existed.

By the end of December 2002, Cabinet said over 101 202 women had visited the facilities attached to the 18 PMTCT research sites, with 63 217 accepting voluntary counselling and testing, 17 274 of whom tested HIV-positive.

'Nevirapine was dispensed, along with the package of support, to 10 043 women who accepted it and to 6 947 babies born to women in the programme.'

Regarding care to rape survivors, Cabinet said the decision it took last April to offer antiretrovirals (ARVs) to survivors of sexual assault as part of a comprehensive package of support was being implemented.

The post-exposure prophylaxis programme (PEP) includes counselling on the effectiveness and risks of using ARVs for this purpose.

On treating opportunistic infections, Cabinet said public health facilities had a responsibility to offer treatment for opportunistic infections. 'There can be no discrimination against anyone because of their HIV-status and nobody should be sent away untreated.'

'Treatment for TB is free and available in the public health sector. In addition antibiotics such as Bactrim are available at innovative joint HIV/AIDS, TB, management sites to prevent the onset of infection common in people infected with HIV.

However, it said there was a need to detect cases much earlier, as currently many TB patients report this when the illness was at an advanced stage.

Government was also working with pharmaceutical companies to lower the cost of drugs to treat such infections.

Government entered into the Diflucan Partnership Programme with Pfizer in 2000, to provide Diflucan, an anti-fungal, in the public health sector free of charge.

The drug is used to treat two of the most common opportunistic infections associated with HIV/AIDS - cryptococcal meningitis and oesophageal candidiasis, which affect the brain and the oesophagus respectively.

The partnership has since been extended indefinitely. In the first two years of the partnership 1.5-million doses of Diflucan were dispensed and 11 000 health workers trained in managing relevant conditions.

On strengthening the immune system to avert opportunistic infections, Cabinet said measures to alleviate poverty and improve nutrition were critically important to improve the quality of life of those infected with HIV or living with AIDS.

For this reason, government views its food security and poverty alleviation interventions as an intrinsic part of its response to HIV, AIDS and TB.

The importance of good nutrition for the health of people living with HIV an AIDS was stressed by the World Health Organisation (WHO).

For this reason, a number of measures aimed at enhancing nutrition were announced towards the end of last year.

'These included measures to counter the impact of high food prices, announced in October 2002, both short-term and medium term to long term, as well as a Department of Health programme for enhancing the cultivation and use of more nutritional food.'

It said close inter-sectoral co-operation would be pursued to ensure that such measures benefited families affected by HIV and AIDS or TB, with a significant emphasis placed on improving nutrition in 2003, for South Africans in general, as well as for people living with HIV/AIDS more specifically.

To provide ARVs to people infected with HIV, Cabinet said the team tasked with investigating resource implications of providing anti-AIDS drug to people living with HIV/AIDS in South Africa, was about to complete its work.

In April last year, government established a joint technical task team comprising the health department and Treasury, to look into these issues, including comprehensive costs and benefits of various AIDS treatment options.

Cabinet said it would consider the findings of the task team and any policy option that could have major costs ought to be thoroughly examined.

Regarding other work that had been done, it said there had been some other important developments to support the safe and effective use of ARVs in the country

For instance, the Medicines Control Council (MCC) in partnership with the Medical University of South Africa (Medunsa) had created a system to monitor the safety of antiretrovirals in use in the country.

The Medicines Control Amendment Act would also come into force this year to facilitate the purchase of medicines at cheaper prices.