Unity and Accountability? Let?s keep our promises

Key speakers at the Second SA AIDS Conference, held over four days in Durban during June this year, urged researchers, government, the media, business and social groups to push harder for close co-operation and openness in our struggle against HIV and AIDS. Dr Mamphele Ramphele - formerly World Bank Director of Social Development and Vice-Chancellor of the University of Cape Town ? said that ?HIV/AIDS is the mirror in South Africa?s face?, making us, as a nation, examine how inequality and discrimination continue to shape an uncaring response to the suffering of our fellow-citizens.

At a press conference held by national health officials, Health Minister Dr Manto Tshabalala-Msimang urged South Africans to pay attention to prevention, with abstinence, fidelity and condom use being critical while work is being done to develop microbicides and a therapeutic vaccine; she said that the value of African traditional medicines should be researched ? not as a cure for HIV or AIDS ? but to understand how they can help provide relief from symptoms. Prof Anthony Mbewu, President of the SA Medical Research Council, said that many poor people use traditional medicines before seeking ARV treatment, so more studies were needed on the effects of these combined remedies, and on the best treatment options for those HIV-positive people without adequate food supplies. The Minister could not provide journalists with accurate current figures on ARV treatment enrolment, drop-out, toxicity, side-effects or levels of adherence, but she said that funds were set aside for a sophisticated patient-information-system to gather these statistics. The Department was also investigating the use of cell-phone reminders to help patients in taking their full daily doses of ARV drugs.

Many of the presentations focused on building a sense of community to share burdens, and to uplift, respect and create hope for each other. Here are a few examples:
Research round-up

Microbicides (creams, gels, sponges and other types of application used by females to prevent HIV infection) - there has been real progress in making and testing these methods, and if the products can be proven in trials on humans and made available to the public, they could change the course of the HIV pandemic by giving women more control over their choices for safe sex. However, these tests and approvals could take a number of years.

AIDS and the Disability Grant in SA ? with the various impacts of the epidemic and the growing gap between those with and without money, there is a crisis of job provision, healthcare and welfare for working-age adults, and an urgent need for re-assessing the definition of ?disability? in this time of HIV/AIDS. At present, many people living with AIDS have to choose between money received through a disability grant and the opportunity for improved health through ARV treatment. This difficult choice arises because disability grants are being cancelled once the patient?s CD4 count rises above 200; this can leave the person and their household with no funds for nutritious food or for transport to and from clinics, and this raises the risk of patients being unable to adhere to their course of ARV medicines. This question of ?what is too sick?? is a challenge for us all, as HIV/AIDS demands social solidarity.

Thinking differently: the Broad Reach Programme to build capacity ? recognises the need to prevent new HIV infections, to test those who do not know their status, to treat millions of people already infected, and to support millions of ?well? people in the community. Broad Reach is a business-funded programme that takes specialist medical care to where people live. Home-based care volunteers and community health-workers are given training so as to encourage VCT, help patients in following their ARV schedules, and creating community-based support groups in which people can share their physical and emotional experiences of living with HIV/AIDS. The programme has shown good results in Uganda, Haiti, Botswana and now in South Africa. Ongoing work includes strengthening links between prevention and treatment, developing HIV testing kits for use at home and in the community, and finding ways of managing drug-resistance at district and clinic level.

A reason to live ? supporting and teaching each other: - a physician working in a provincial hospital in northern KwaZulu-Natal, Dr Okunga-Nambassi, stressed that caring for people living with HIV and AIDS involves more than anti-retroviral drugs ? it should include early treatment of AIDS-related illness (especially TB), ensuring adequate food security and nutrition, and a focus on prevention of new infections. In her view, information and education around social issues and goal-setting helps people through illness, abuse, poverty and deprivation, and that this knowledge can be built at schools, in families and neighbourhoods, and through the media. Dr Francois Venter from Wits University agreed that the government?s National Plan for HIV/AIDS Treatment and Support involves a ?complete care package? that balances the benefits of ARVs with nutrition and approved multi-vitamins to prolong life. He said that treatment programmes must focus equally on provision of drugs, on prevention, on healthy food intake and on treatment literacy.

Reaching forgotten people: Community Treatment Literacy ? the Treatment Action Campaign?s door-to-door community-based educational programme on HIV/ AIDS and anti-retroviral treatment offers an approach that provides the facts and discusses personal responses to them, so that people can take responsibility for informed decisions regarding their own health. By going to where people are, and providing them with information about the human body, the HI Virus, AIDS-related illnesses, nutrition, how ARVs work, sexual health, the national health system, social grants and statistics of the epidemic, this programme attempts to spread the light of knowledge to all citizens everywhere. Training is done in local languages, with booklets and posters given out to groups at community sessions: this stimulates openness and builds upon the work done by community volunteers and public health practitioners.

Business Responses to HIV/AIDS

Large companies attending the Conference presented a promising profile of workplace HIV/AIDS programmes ? most offering in-house peer education, and some including on-site VCT and provision of ARVs to employees and their family members. However, a survey of small and medium-sized businesses showed that this sub-sector is struggling to understand the impact of the epidemic. Very few of these smaller companies were willing to be interviewed about their HIV/AIDS service provision to employees; even those who, as corporate citizens, were actively concerned about HIV/AIDS, found the costs of programmes, lack of information and stigma-related fears to be serious barriers. Researcher Sydney Rosen remarked that companies - of any size - should not rely only on policies to address HIV/AIDS in their workplaces: ?Senior management must participate fully in these plans and face the facts about what AIDS can do to their workforce.?

All delegates and speakers agreed that stigma and discrimination around HIV and AIDS were the greatest obstacles to reducing its effects on individuals, their colleagues and families. In general, they shared the view that the majority of company managers either do not think the epidemic is a problem for their business or society as a whole, or they do not see that businesses should bear any responsibility for dealing with its impacts. Happily, those few owners and managers who were aware of HIV/AIDS as a social fact of life and the need for action around it, said that in helping their employees, compassion for fellow human-beings was a more important motivation for them than merely protecting future profits.

There was broad comment on the need for the private sector to tackle HIV/AIDS as a business challenge, to measure awareness and incidence of HIV among white-collar workers, and to consider that the spirit of volunteerism could not be sustained indefinitely. Large companies were urged to assist with providing resources for smaller businesses to set up and monitor HIV/AIDS workplace programmes. All agreed that a rights-based framework should be built to define a minimum response for small, medium and large businesses, with a dual focus of both creating and sustaining workplace HIV/AIDS support programmes; special leadership skills were needed and the media should be trained and deployed as an ally in the national struggle against HIV and AIDS.

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