15 March 2007
South Africa is finalising an ambitious plan to spend as much as R44.9-billion on halving the rate of new HIV infections in the country by 2011 and providing treatment, care and support to at least 80% of people living with HIV/Aids and their families.
A draft of the new five-year National Strategic Aids Plan was discussed by government, business and civil society leaders at a consultative conference in Johannesburg on Wednesday.
The final document is expected to be adopted by the South African National Aids Council, which is headed by Deputy President Phumzile Mlambo-Ngcuka, by the end of March.
The new plan – drafted in close co-operation with some of the country’s top scientists, actuaries, clinicians, health economists and activists – marks a significant change in South African government policy on the epidemic.
The plan places a new emphasis on treatment and prevention, and makes no mention of the dietary recommendations previously cited by the health ministry as key to fighting Aids.
It also spells out clear, quantified targets, and places a high priority on monitoring and evaluation. Business Day reports that a special unit is to be set up in the health department to monitor the implementation of the plan, with a mid-term review scheduled for 2009.
“There is a new mood and energy in government,” Dr Nomonde Xundu, the department’s chief director for HIV/Aids, told Business Day.
Congress of SA Trade Unions general secretary Zwelinzima Vavi told Wednesday’s gathering that, if supported by business and civil society, the plan would be “the boldest, most comprehensive strategic plan on Aids in the world.”
According to Business Day, Treasury calculations contained in the draft plan put the costs at almost R45-billion – far exceeding the R14-billion the government has already allocated to Aids programmes over the next three years – with up to 40% of this earmarked for Aids drugs.
Xundu indicated to Business Day that the government was likely to increase its funding, but would also look to the private sector and foreign donors for assistance.
Speaking at Wednesday’s conference, Xundu emphasised that prevention remained key to South Africa’s fight against HIV/Aids.
“The intention of the plan is to ensure that the large majority of South Africans who are HIV-negative remain negative,” she said, adding that there was a strong focus on reducing the number of new infections among people in the 15- to 24-year age group.
Young people’s choices
“The future course of the HIV/Aids epidemic [in South Africa] hinges, in many respects, on the behaviour young people adopt and the contextual factors that affect those choices,” Xundu said.
The plan also aims to reduce the HIV infection rate among children under the age of five by expanding the prevention of mother-to-child transmission programme and providing antiretroviral therapy for pregnant women.
On treatment, the aim is to increase the reach of the country’s antiretroviral treatment programme from the current estimated one-quarter of HIV-positive people to at least 80% of people living with HIV/Aids as well as their families.
In order to lessen the impact of Aids on familes and communities, the plan also aims to expand community-home-based care and palliative care programmes, as well as social safety network programmes for orphans and vulnerable children.
‘Formidable partnership’ needed
“Nothing less than a formidable partnership between government and civil society can assist us to achieve our goal of reversing the tide of this pandemic,” Mlambo-Ngcuka said on the release of the first working draft of the plan on World Aids Day in December.
“Too many people have been infected and too many have died, but if we work together, Aids can be beaten.”
According to that draft of the document, HIV/Aids is one of the main challenges facing South Africa, which had an estimated 5.54-million people – 18.8% of the adult population – living with HIV in 2005.
“Although the rate of the increase in HIV prevalence has in past five years slowed down, the country is still to experience reversal of the trends,” the document stated. “There are still too many people living with HIV, too many still getting infected.”
According to the document, the “immediate determinant of the spread of HIV relates to behaviours such as unprotected sexual intercourse, multiple sexual partners and some biological factors such as sexually transmitted infections.”
However, the “fundamental drivers” of the epidemic in South Africa “are the more deep-rooted institutional problems of poverty, underdevelopment and the low status of women, including gender-based violence, in society.”