TAC Welcomes Cabinet Statement on HIV/AIDS 18 April 2002 "Government calls on all South Africans to join hands in a campaign of hope: to mobilise our strength as a nation and as individuals to ensure that we are able to manage, reduce and, in the long-run, defeat this epidemic. We have it in our power to achieve this objective. What is critical is that we should work together as a united force to achieve the best interests of our society." Statement by the South African Cabinet, 17 April 2002 The Treatment Action Campaign (TAC) warmly welcomes the Statement of Cabinet on HIV/AIDS (17 April 2002). It has given us hope after months of despair. The Cabinet has agreed to make antiretrovirals available to rape survivors, rollout a mother-to-child transmission prevention programme, step up prevention efforts, improve the treatment of opportunistic infections, work to lower the cost of antiretroviral medicines, improve the working conditions of health-care employees, intensify poverty relief measures for families affected by the epidemic and access resources in the Global Trust Fund to fight HIV/AIDS, TB and Malaria. Furthermore, the Cabinet recognises that antiretrovirals can improve the conditions of people with HIV "if administered at certain stages ... in the progression of the condition, in accordance with international standards." It has acknowledged that Government should not be a protagonist in scientific debate, although it should "facilitate and benefit from [the] results of research." This appears to be a commitment by Government to fight the HIV epidemic together with civil society organisations and people living with HIV/AIDS incorporating both prevention and treatment strategies. Although, we continue to disagree with some aspects of the statement such as the continued delay on implementing the MTCT prevention programme and government's unnecessary appeal to the Constitutional Court, the TAC now has a basis for moving from a relationship with Government that has been conflictual over the last year to one based on co-operation. But, if the Minister of Health persists with the appeal, TAC will continue to vigorously defend its case because government has in the past made positive statements that it has reneged on. Until a position of full trust is re-established, the Constitution and the protection of the courts and public mobilisation are the only democratic instruments that we can rely on to enforce our rights. Despite this reservation, the Cabinet statement is cause for optimism because it allows us to rebuild the trust between government and civil society. We can now move past long-settled and time-wasting debates, such as whether HIV causes AIDS and whether antiretrovirals are effective, on to more pertinent matters such as working together to force the pharmaceutical industry to make all essential medicines more accessible and ensuring that the private sector, including medical schemes, insurance companies and large corporations, meet their treatment and prevention duties. We can build a health care system that will take care of all people equitably, especially poor and marginalised communities. By working with civil society, the most difficult struggle, which is to turn policy into reality, can be achieved. The TAC calls on the Cabinet to further demonstrate its commitment to defeating the HIV epidemic by * withdrawing its appeal to the Constitutional Court against the Pretoria High Court judgment on mother-to-child transmission prevention; * committing to the development of a comprehensive treatment and prevention plan in consultation with scientists, health-care workers, civil society and people with HIV, * stopping high-level public officials from pursuing the AIDS denialist agenda which only serves to confuse the public, anger, isolate and stigmatize people with HIV and encourage the spread of the disease. Although belated, this statement is particularly welcome on the eve of the first anniversary of the defeat of the drug companies in the South African courts. We congratulate the Department of Health for their commitment to prevention, treatment and care efforts based on a human rights and development framework. We are ready to join hands to implement the campaign outlined by Cabinet. *********************** The full Cabinet statement is available at http://www.gov.za/speeches/cabinetaids02.htm It is reprinted below: STATEMENT OF CABINET ON HIV/AIDS 17 April 2002 Cabinet today received a comprehensive briefing on the implementation of government policy on HIV/AIDS. The meeting reiterated government's commitment to the HIV/AIDS and STI Strategic plan for South Africa, 2000 - 2005. This comprehensive programme is backed up by a massive increase in resources. The total budget to be spent mainly through the Departments of Health, Social Development and Education was R350m in 2001/02; it has been increased to R1-billion in this financial year, and will go up to R1.8-billion in 04/05. Cabinet welcomed the progress that is being made in ensuring that the South African public in general and the youth in particular are aware of the dangers of the epidemic. It called on all South Africans to take full responsibility and care for their lives. Government will intensify the awareness campaign, as part of its comprehensive strategy against HIV/AIDS. The challenge is to ensure that awareness continues to translate into a change in behaviour. In conducting this campaign, government's starting point is based on the premise that HIV causes AIDS. It is also critical for us, as a nation, to note that there is no cure for AIDS. In this regard, promoting awareness and life skills and HIV/AIDS education forms the core of our approach. A critical element of this strategy is the strengthening of partnerships among all South Africans and their organisations to fight this epidemic. Government commits itself to this objective, and will participate actively in the review of a SANAC currently underway, in order to strengthen the organisation. "Core SANAC ministers", now including the Minister in the presidency and the Minister of Arts, Culture, Science and Technology, will be constituted into a presidential Task Team on AIDS, headed by the Deputy president. Further, measures will be introduced to strengthen government structures dealing with this matter. On other issues of prevention, the meeting decided as follows: Research on the use of Nevirapine against mother-to-child transmission will continue; at the same time as government implements the temporary ruling of the Constitutional Court. In the meantime, the Department of Health is working on a Universal Roll-out plan to be completed as soon as possible, in preparation for the post-December 2002 period. Cabinet decided that, with regard to cases of sexual assault, government will endeavour to provide a comprehensive package of care for victims, including counselling, testing for HIV, pregnancy and STI's. In this regard, survivors will be counselled, including on the risks of using anti-retrovirals as preventative drugs, so they could make an informed choice. if they so choose (as is the case of needle-stick injuries), they will be provided with such drugs in public health institutions. A standardised national protocol in this regard will be finalised as soon as possible. With regard to treatment, Cabinet emphasised the commitment of government to treatment and management of opportunistic infections. No South African should be sent away and not treated irrespective of their HIV status. Given the critical importance of drugs dealing with infections such as meningitis, oral thrush, TB and pneumonia, Cabinet urged the public, especially People Living with AIDS, to assist government in monitoring their availability. On anti-retroviral treatments in general, Cabinet noted that they could help improve the conditions of PWA's if administered at certain stages of in the progression of the condition, in accordance with international standards. However, because these drugs are too costly for universal access and, because they can cause harm if incorrectly used and if the health systems are inadequate, government will continue to work for the lowering of the cost of these drugs, and intensify the campaign to ensure that patients observe treatment advice given to them by doctors. Further, alongside poverty alleviation and nutritional interventions, government will encourage investigation into alternative treatments, particularly on supplements and medication for boosting the immune system. Cabinet reiterated government's strong commitment to assist families affected by the HIV/AIDS epidemic. We are also improving the programme of home-based care and community-based care, for which allocation of R94.5-million have been made this year, and R138-million in 2004/05. Government calls on all South Africans to join hands in a campaign of hope: to mobilise our strength as a nation and as individuals to ensure that, we are able to manage, reduce and, in the long-run, defeat this epidemic. We have it in our power to achieve this objective. What is critical is that we should work together as a united force to achieve the best interests of our society. CONTINUITY AND CHANGE IN HIV/AIDS POLICY, 17 APRIL 2002 CONTINUITY - BROAD FRAMEWORK OF POLICY ON HIV/AIDS a.. The Partnership Against Aids, launched in October 1998 b.. The five-year "HIV/AIDS and STI (Sexually Transmitted Infections) Strategic Plan for South Africa 2000-2005". CHANGES - WHAT ARE THEY? COMPREHENSIVE PROGRAMME INTENSIFIED AND EXPANDED a.. Total budget through Health; Social Development and Education up (R350m 2001/02; R1bn 2002/03; R1,3bn 2003/04; R1,8bn 2004/5) PREVENTION a.. A new campaign phase from June, from awareness to lifestyle change b.. Big increase in budget for prevention (R340m last financial year; R460m this year, R515 in 2003/4 and over R630m in 2004/5) c.. Creation of special PMTCT Task Team will lessen delays in expansion to sites with capacity while ensuring rigour in assessing capacity d.. PMTCT Roll-out plan is being worked on to prepare for implementation post-December 2002 e.. Government to endeavour to provide a comprehensive package of care for survivors of sexual assault, including counseling, testing for HIV, pregnancy and STIs. They will be counseled on using anti-retrovirals so that they can make an informed choice, and if they so choose, will be provided with the drugs in accordance with guidelines and protocols TREATMENT, CARE AND SUPPORT a.. Assertion of right to be treated regardless of HIV status b.. Call on People Living With Aids to monitor availability of drugs to treat opportunistic infections (such as Diflucan for oral thrush and meningitis and medicine for TB or pneumonia) c.. Assertion of government commitment to work to lower cost of ARVs by working with producers of main drugs and investigating production of generics d.. Systematic campaign to promote compliance by patients with treatment regimes PARTNERSHIP AND STRUCTURES a.. Reinvigorating the partnership and review and strengthening of SANAC b.. Establishing a Presidential Task Team on AIDS consisting of Ministers under the leadership of the Deputy President ASPECTS OF POLICY AWARENESS, STI MGMNT, VACCINE INITIATIVE a.. Continue with and intensify the programmes and give them higher profile PMTCT a.. Continue with research on Nevirapine, and implement Constitutional Court decision b.. Extend sites where demands of research dictate and where there is capacity, in accordance with national guidelines and protocols c.. Decide in December using research results whether to introduce universal access to Nevirapine d.. Working on Universal Roll-out Plan in line with conditions above, as a matter of urgency ANTI-RETROVIRALS IN INSTANCES OF RAPE a.. Endeavour to provide a comprehensive package of support for survivors of sexual assault. They will be counselled, including on the risks, allowed to make an informed choice and provided with the drugs if it is their choice in accordance with guidelines and protocols (as with needle-stick injuries) b.. Continue to ensure that such drugs are administered in accordance with protocols c.. Promote further research into efficacy of this TREATMENT, CARE AND SUPPORT OPPORTUNISTIC INFECTIONS a.. Continue and intensify the programme, and give it higher profile b.. Publicise progress in availability of "specialised" drugs such as Diflucan, and drugs for TB and pneumonia, and encourage People Living with AIDS to partner government in monitoring availability in health institutions CARE AND SUPPORT INTERVENTIONS a.. Continue and intensify the programme, and give it higher profile ANTI-RETROVIRALS IN COMPREHENSIVE TREATMENT a.. Recognition that ARVs can help if administered at particular stages in the progression of AIDS and in accordance with international guidelines and protocols b.. Continue efforts to reduce costs of these drugs including discussions with producers of main drugs, access to the Global Fund and investigating production of generics c.. Campaign to improve compliance with treatment regimes for all drugs d.. Ensure private sector administers drugs in accordance with national guidelines e.. Encourage investigation into alternative treatments based, particularly, on supplements and medication to boost immune system DISCRIMINATION a.. Intensify campaign against discrimination b.. Continue with investigation on further legal avenues to protect the infected and affected BROAD SOCIAL ISSUES a.. Commitment to urgent action and caring b.. Appreciation of the need to deal with challenge of poverty as part of overall programme against HIV/AIDS c.. Openness in dealing with epidemic and development of policy issues MONITORING, RESEARCH AND SURVEILLANCE STATISTICAL SYSTEM a.. Continue improvement of methodologies and National Statistical System as a whole INTERNATIONAL AIDS PANEL a.. Work to continue, and government is not protagonist in scientific debate but seeks to facilitate and benefit from results of research BUILDING PARTNERSHIPS BROAD LOCAL PARTNERSHIPS a.. Renewal and strengthening of partnerships b.. Encourage all SANAC partners to act as primary voice of the campaign HEALTH PRACTITIONERS a.. Show sensitivity to their difficult situation, and work with them to improve working conditions INTERNATIONAL PARTNERSHIPS a.. Strengthen liaison with SADC, African and Developing countries to ensure common approaches on strategic issues STRUCTURES SOUTH AFRICAN NATIONAL AIDS COUNCIL a.. Improve structures and style of operation GOVERNMENT a.. Constitute "core SANAC" Ministers, including DACST and Presidency ministers into Presidential Task Team in AIDS b.. Strengthen government structures dealing with HIV/AIDS, led by Deputy President SUMMARY OF GOVERNMENT'S POSITION FOLLOWING CABINET'S DISCUSSION, 17 APRIL 2002 Intensifying our comprehensive programme against HIV/AIDS in partnership with all sectors Government is intensifying the campaign to prevent infection by the HIV and to deal with its consequences. In that regard our starting point is the premise that HIV causes AIDS. HIV/AIDS is a challenge for all of us. Defeating it depends on strengthening the Partnership Against AIDS launched in October 1998, in which all sectors society work with government to implement a comprehensive programme. Together we can overcome the disease. The policy framework which government is following is set out in the "HIV/AIDS and STI (Sexually Transmitted Infections) Strategic Plan for South Africa 2000-2005". It is in line with international trends, and it is in fact among the best in the world. As we continue to work within that broad framework, we are intensifying and expanding the programme; addressing problems of implementation; and improving our approach in line with changing circumstances. (Total funding in 2002/2003 is over one billion rand, three times more than the year before.) Why does the programme put so much emphasis on prevention? Because there is no cure for AIDS, preventing infection by the HIV is critical. Each of us must exercise our individual and collective responsibility to take care of our own lives. Promoting public awareness and the life skills and HIV/AIDS education programme are the core of the efforts to prevent transmission of HIV. The latter is now a compulsory part of the school curriculum and full implementation is expected by the end of 2003. Though we have achieved a high level of awareness - over 90% - which is beginning to have an impact especially amongst the young, we are intensifying the work so that more people translate awareness into change of lifestyles. A new phase of the campaign by the agencies contracted by government, working with partners such as Lovelife, will start in June 2002. The effective management of Sexually Transmitted Infections (STIs), which render people more vulnerable to the HIV, plays a critical role in reducing the risk of HIV transmission. This programme, which has so far ensured that there are trained healthcare workers in 80% of our public sector clinics, is being extended. Amongst other things there has been a steady decline in the prevalence of syphilis amongst pregnant women attending public health sector clinics, and antenatal surveys show that that the rate of HIV infection is levelling off. In the South African AIDS Vaccine Initiative scientists are working with government support and funding to develop a vaccine that will make people immune to HIV infection. It is important however to remember that success will not be quick and is not guaranteed - so prevention through awareness remains the key message. What progress are we making on preventing mother-to-child transmission? The Prevention of Mother-to-Child Transmission of HIV (PMTCT) is being run through 18 research sites accessed through over 230 hospitals and clinics. Over 38,000 mothers have gone through the programme. At the sites women are offered voluntary counselling and testing for HIV. Those who are HIV-positive are offered Nevirapine for themselves and their babies, vitamins to improve their health during pregnancy and after; preventive measures and prompt treatment of infections and formula-feed if they choose not to breast-feed. Babies are also given multivitamins and prophylaxis for opportunistic infections. Where there is capacity to provide the package of care that is needed, and where the demands of research dictate, sites are being extended. Towards the end of the year, tests will be done on the babies and mothers being monitored, for us to then consider moving to universal access of Nevirapine. A Universal Roll-out Plan in this regard is being worked on and will be released in due course. In the meantime, government is implementing the temporary Constitutional Court order; and we have provided guidelines to hospitals on the package of care they need, to be able to administer Nevirapine against mother-to-child transmission beyond the research sites. A special Task Team set up by the Health Minister in consultation with MECs will assist hospitals in this. Regarding use of antiretroviral drugs following cases of sexual assault, government will endeavour to provide a comprehensive package of care for survivors, including counselling, testing for HIV, pregnancy, STIs. Survivors will be counselled, including on the risks, so that can make an informed choice, and will be provided with the drugs if they so choose in accordance with guidelines and protocols(as is done in the case of needlestick injuries) What does government's programme offer in the way treatment? The quality of life of those infected by HIV is a major concern of government. Their health can be improved greatly through the effective treatment and management of opportunistic infections. It is important for those with recurrent opportunistic infections to know their HIV status. The programme to provide voluntary HIV counselling and testing (VCT) was started in 2000 - at the moment 359 VCT sites are operational out of 495 identified by provinces. However, no one should be sent away and not treated, whatever their HIV status. Therefore treatment of opportunistic infections is available at public health care facilities irrespective of HIV status. Government will continue working with pharmaceutical companies to lower the cost of drugs to treat these infections. As part of this programme Government signed an agreement with the pharmaceutical company Pfizer in December 2000 for the provision of Fluconazole (Diflucan) to the public health sector for two years. The agreement includes funding for the training of healthcare workers in the diagnosis and management of oral thrush and cryptococcal meningitis. So far 20,000 patients have benefited from the programme. We call on the public, especially People Living with AIDS, to help us in monitoring the availability of such drugs; so that we can work together to improve treatment for the infected, and public health care in general. Government recognises that anti-retroviral drugs can improve the quality of life of People Living with AIDS, if administered at certain stages in the progression of the condition and in accordance with international guidelines and protocols. Because these drugs are costly and can cause harm if incorrectly used or if health systems are inadequate, we will: a.. continue working to lower the cost of anti-retrovirals, including through discussions with the producers of the main drugs, and investigation into possible production of generic drugs; b.. work through the Global Fund to fight HIV/AIDS, TB and Malaria to access resources for the overall campaign against the spread of HIV, TB and Malaria; c.. intensify the campaign to ensure that patients generally, and those infected with TB, thrush, meningitis and HIV in particular, observe the treatment advice given to them by doctors. Though antiretrovirals are not generally available through the public health sector, guidelines for their use in the private sector have already been developed and research on their targeted use will continue. A further initiative arises out of the fact that conditions of poverty lower the body's natural immune system making it more susceptible to infection, and more vulnerable to its effects. Alongside poverty alleviation and nutritional interventions government will encourage investigation into alternative treatments, particularly on supplements and medication for boosting the immune system. What about care and support? Government is deeply concerned about the conditions of families affected by the HIV/AIDS epidemic. We are intensifying the campaign to assist these families, including foster care grants, assistance to child-headed households, food parcels and so on. We are also improving the programme of home-based care. In this regard the budget allocation for home-based care and community-based care increases from R25,5 million in 2001/02 to R94,5 million this fiscal year, to R138 million in 2004/5. What can be done about discrimination against pople with HIV/AIDS? This is a very important matter. Negative attitudes in our society can result in people being denied the treatment, care and support they need. They discourage people from being tested to find out their status or from declaring the cause illness or death in their family. Amongst other things this leaves us without vital information our country needs to know the extent of the disease and its patterns. Government will intensify its campaign and awareness programme against discrimination and continue investigating further legal avenues to the affected and infected. What does partnership mean in practice? Because of the scale of the disease, because it affects every aspect of our society, and because of the need for awareness, care and support, defeating it depends on a partnership of all sectors of society with government to implement a comprehensive campaign. In the beginning the response to HIV/AIDS came just from the Health sector. The launch of the Partnership Against Aids in 1998 by then Deputy President Mbeki brought other government departments and key sectors of society together in a broad-based and multi-sectoral fight against the disease. In January 2000 the partnership was formalised in SANAC, the South African National Aids Council under the leadership of Deputy President Jacob Zuma. SANAC has been reviewing its two-years of work and is preparing to strengthen itself to play the key co-ordinating role in our national effort against HIV/AIDS. Government will strengthen its own contribution to the partnership, establishing a Presidential Task Team on AIDS consisting of Ministers led by the Deputy President. As government focuses its efforts and resources ever more intensively on the public policy challenges of HV/AIDS, it will draw whatever it can from science to use in this fight. As in all areas of science research and debate will continue, but government is not a protagonist in those debates. Issued by: Government Communications (GCIS)