IKHALA TRUST

1
IKHALA TRUST

• A not-for-profit community micro fund operating
  in the Eastern Cape Province of South Africa

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HIV/Aids in South AfricaThe facts

• At least 5,5 million people living with HIV in SA
• Estimated 1000 deaths per day
• 1 in 5 people infected
• A staggering 71 of deaths between ages15-49
  caused by AIDS
• In parts of SA, cemeteries are running out of
  space for the dead
• In a recent survey it was found that S Africans
  spent more time at funerals, than they did having
  their hair cut, shopping or socialising

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HIV/Aids in South Africa

• Average life expectancy in SA 54 yrs
• Over half of 15 year olds are not expected to
  reach 60 yrs
• 2006 estimated that 21 of teachers were living
  with HIV

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History of HIV in SA

• 1982 1st recorded case of Aids
• 1992 Governments 1st significant response came
  when Nelson Mandela addressed the newly formed
  National Aids Convention of SA. A free national
  Aids helpline was founded

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History of HIV in South Africa

• 1995 The Ministry of Health announced that some
  850 000 people 2,1 of the total population
  were believed to be HIV positive
• 1998 Pressure Group Treatment Action Campaign
  (TAC) was founded. 1500 new HIV infections were
  occurring every day

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History of Aids in South Africa

• 2000 Dept of Health outlined 5 year plan to
  combat AIDS, HIV and STIs. A National Aids
  Council set up to oversee these developments.

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History of AIDS of South Africa

• 2002 South Africas High Court ordered the govt
  to make the drug nevirapine available to pregnant
  women
• 2003 November Govt finally approved a plan to
  make ARV treatment publicly available.
• 2004 Treatment program began taking effect in
  Johannesburg in March.

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History of Aids in South Africa

• 2005 At least 1 service point for AIDS related
  care and treatment had been established in all of
  the 53 districts
• 2006 Jacob Zuma, former SA Deputy-President,
  went on trial for allegedly raping an
  HIV-positive woman.
• Govt announced a draft framework. Civil society
  groups claimed that this marked a turning point
  in the Governments response

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Why did SAs AIDS epidemic go unchecked for so
long?

• Most rapid increase in SAs HIV prevalence took
  place between 1993 and 2000 during which time the
  country was distracted by major political changes
• South African people and the worlds media was
  focused on the political and social changes
  occurring in the country, HIV was rapidly
  becoming widespread.
• Results of these political changes were positive,
  the spread of virus not given attention it
  deserved, impact of the epidemic not acknowledged.

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HIV/AIDS Support Group

• People living with Aids (PWAs) groups are
  established and functioning in almost all
  communities

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HIV Treatment in South Africa

• SA government only started in 2004
• Around 33 of people in need receiving treatment
  at the end of 2006.
• Govt initially reluctant to provide drugs to
  prevent HIV-positive mothers
• Slow provision linked to unconventional views
  about HIV and AIDS
• Health Minister promoting nutrition rather than
  ARV drugs as a means of treating HIV.

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HIV Testing in South Africa

• Voluntary Counselling and Testing sites has
  increased significantly in recent years with 4172
  operational by November 2006 concerns regarding
  quality of services.
• Women accessing testing more readily than men in
  SA. Researchers believe that this is due to
  fears amongst men that their HIV positive status
  will be disclosed through testing and that
  stigmatization will follow. Surveys also suggest
  that some men see no value in knowing their
  status, viewing this as a burden

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HIV prevention campaigns in SA

• The issue of prevention in SA has attracted less
  controversy and debate than other aspects of the
  countrys response to AIDS. Some notable
  national efforts include-
• However the prevailing high rates of HIV found
  across SA suggest that either the message isnt
  getting through to many people, or that people
  are receiving information but not acting upon it.
• In December 2005 the Global Fund withdrew its
  funding from loveLife.

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HIV prevention campaigns in SA

• Difficult to carry out HIV prevention campaigns
  in SA
• Population is highly diverse and divided by
  deeply rooted social inequalities.
• SA has a mixture of ethnic backgrounds black
  people account for 75 of the population whites
  make up around 13 Asians make up about 3 and
  other people of mixed racial heritages account
  for 9.
• There are 11 official languages and many
  dialects around 86 of the population is
  literate
• Diversity has made it very difficult to carry out
  AIDS awareness campaigns that actually influence
  peoples behaviour

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STIGMA AND DISCRIMINATION IN SOUTH AFRICA

• The prevalence of misinformation about AIDS in SA
  hampered efforts to increase access to treatment,
  but has also creates climate of confusion in
  which prejudice towards people living with HIV
  thrives. HIV is sometimes seen as a disease of
  the poor.
• In SA, there is some correlation between extreme
  poverty and high HIV prevalence, although HIV is
  prevalent in all sectors of society.
• By 1998, although people from more affluent,
  largely white society were starting to come out
  as being HIV-positive, stigmatization of the
  condition remained deeply rooted in township
  areas.
• In October 1998, the then Deputy President Thabo
  Mbeki made the Declaration of Partnership Against
  AIDS, in which he called for an end to
  discrimination against people living with HIV.
• Less than 2 months later, Gugu Dlamini an AIDS
  activist in Durban, was beaten to death by her
  neighbours after declaring that she was HIV
  positive on World Aids Day.

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STIGMA AND DISCRIMINATION IN SOUTH AFRICA

• In 2000, Justice Edwin Cameron of the SA court
  announced in a speech that he was HIV-positive
  public largely supportive
• A study in 2002 revealed that only 1/3 of
  respondents who revealed their HIV-positive
  status were met with a positive response in their
  communities 1 in 10 met with outright hostility
  and rejection
• When Nelson Mandelas son died in 2005 the
  publicized the cause of death in an effort to
  challenge the stigma that surrounds HIV
  infection.

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GENDER EQUALITY AND SEXUAL ABUSE IN SOUTH AFRICA

• Women and girls in SA are often unable to
  negotiate safer sex and are frequently involved
  with men who have several sexual partners.
• They are particularly vulnerable to sexual abuse
  and rape and are economically and socially
  subordinate to men.
• Police reports in 2004-2005 suggest that there
  were at least 55,114 cases of rape in SA
• In a 2006 study of 1 370 SA men, nearly 1/5
  revealed that they had raped a woman
• Rape plays a significant role in the high
  prevalence of HIV among women in SA.

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GENDER INEQUALITY AND SEXUAL ABUSE IN SA

• Women often face more discrimination than men if
  they are known to be HIV-positive
• Since antenatal testing gives them a greater
  chance of being identified as HIV positive, women
  are sometimes branded as spreaders of the
  infection
• Govt acknowledged that women face triple
  oppression in South African society oppression
  on the grounds of race, class and gender and
  has been making efforts to address the problem
  through education and skills development schemes.
• In September 2007, rape laws were strengthened to
  stop judges and magistrates taking into account
  factors such as a rape victims sexual history,
  their apparent lack of physical injury, or the
  relationship between the victim and the
  perpetrator, when deciding on the length of the
  perpetrators sentence.

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CHILDREN, HIV AND AIDS IN SOUTH AFRICA

• Antenatal surveys revealed around 260 000
  children aged below 15 living with HIV in South
  Africa in 2006
• Pediatric ARV treatment still a shortage in SA
• UNAIDS estimates that at the end of 2005,
  children accounted for 8 of those receiving ARV
  drugs in SA
• UNAIDS estimated that there were 1.2 million SA
  children orphaned by AIDS in 2006 compared to 780
  000 in 2003.

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Treatment in South Africa

• Aspen Pharmacare main factory in my city of Port
  Elizabeth biggest pharmaceutical manufacturer
  in the southern hemisphere and the only generic
  company currently manufacturing and supplying ARV
  drugs to the SA state hospitals and clinics
• Received licences from 3 multi-nationals viz
  Bristol Myers, Boehringer Ingelheim and GSK
  companies hold patent but rights and licence
  given to Aspen to manufacture.

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Treatment in South Africa

• Situation changing has Indian players now tapping
  into SA markets due to licences granted and are
  more competitive than local manufacturers
• Locally produced drugs will prevent bureaucratic
  delays and cases were Aids drugs are expiring on
  shelves due to poor co-ordination between aid
  agencies and governments.

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The way forward for South Africa

• The high level of new infections occurring in SA
  reflects failure of prevention and education
  strategies.
• The high number of AIDS deaths occurring in the
  country reflects the continuing lack of ARV
  treatment available
• The future of the epidemic at least partly
  depends on the direction of the governments HIV
  and AIDS policies.
• New national framework to guide a national
  response to AIDS from 2007 2011 suggests that
  Government is now more committed to improving the
  situation. The question for many is a not a
  little too late for so many thousands who are
  already sick and infected

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Eastern Cape Context

• Population of 6,4 million
• 64 of population live below a dollar a day
• Unemployment at around 49
• 96 000 people requiring treatment
• 110 000 receiving treatment in S.A.

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Ikhala Trust

• Thank you for the attention and for listening to
  our story