Pooling capacities against HIV/AIDS in Pietermaritzburg

Zanele Hlatshwayo, the Deputy Mayor of Pietermaritzburg, could well have spent her days attending meetings, making pleasant speeches and keeping the peace. This would have been easier than trying to turn the tide of HIV/AIDS, which, by conservative estimates, has infected more than 10 000 people living within a short distance of Hlatshwayo's grand brick Victorian offices.

Rather, she opted to lead platoons of people into a medical war-zone for first-hand observation, with the objective of bringing relief to the poorest in her constituency. The result is a networked strategy of cure, treatment and counselling that has attracted interest from international funding agencies and the United Nations.

On meeting Hlatshwayo, I could have quizzed her on how she dealt with the core problems of HIV/AIDS management without falling foul of censure from above. There was no need to. This handsome former Maritzburg College teacher, with a presence befitting Albert Luthuli - her grandfather - is so sure about the merits of her work and of that of her colleagues that defending her position would be, as she herself puts it, "frankly absurd".

"I knew what had to be done," said Hlatshwayo, who believes there's "too much talk" about HIV/AIDS and not enough action. "There were three choices: pretend HIV/AIDS was not a problem, ignore it and hope it would go away, or do something about it," she said. "I have people (working with me) who know exactly how to deal with this epidemic, with far more experience and knowledge than I have. My job is to support them in whatever they do."

Until last week, when the province's strategy was spelt out at a Provincial HIV/AIDS Action Unit meeting, neither Hlatshwayo nor her HIV/AIDS-fighting team in the city had said much publicly about "the doing" part - possibly for fear of government interference. Dr Julie Dyer, the Pietermaritzburg municipality's Chief Health Officer, believes that the secret of success has been the leadership from the top. "With a strong champion like our Deputy Mayor, someone who is not scared of making difficult decisions, commitment is so much easier," said Dyer on our look-and-see tour of the city.

"We've been going for only about six months, but in that time our networking programme has operated better than we could have imagined, and it hasn't cost the city millions," she said. The initial task was to bring on board the bulk of non-governmental agencies as partners. A mini-AIDS conference NGO forum was set up in the City Hall over two days, where each group explained its objectives.

"We had to dispel the image that shirts, caps and condoms were the only answer to beating AIDS," explained Dyer. "And the NGOs needed to know we were genuine about working hand-in-hand. They needed to know what everybody else was doing. In that way we could put in place a networking process and work for a common goal."

Dyer admitted there was the occasional flare-up. "We (the different stakeholders) are all strong people with our own ideas, equally passionate about what we want to do. So there are sensitivities about who owns which project. But we address those differences and move on."

Pietermaritzburg's 22 municipal clinics are a prime conduit for referrals and this is where the city's unique networking system comes into its own. "We realised that nurses simply don?’t have the time to address all the related problems of AIDS, be they treatment, nutrition or grants," said Dyer. "We needed a central referral system in order to keep patients in the loop and to avoid the feeling of desperation so many feel after their tests are positive."

International funders Oxfam agreed to donate R1,5 million and within a few months the funds were approved. Part of those funds are being used to train 12 Lifeline counsellors who will, from the beginning of September 2002, in a donated building in the city centre, assist and advise patients. At their disposal will be a computerised data system listing all NGOs in the network.

Said Nigel Taylor, Oxfam's programme representative in South Africa: "Pietermaritzburg is proving that synergy and good leadership work. It has also shown that a local authority can get things moving by building up pockets of good care. I see no reason why this same system could not be used by other local authorities."

"In all transactions, we keep the paperwork to a minimum," said Dyer. "If a bulk donation of Vaseline or clothing needs collecting then we'll use a municipal car. If we need a City Hall room for an urgent meeting, then the Deputy Mayor gives the OK. If you take away the red tape, it's amazing what can be done quickly." Rather like being on a war footing, I suggested. "I hadn't though of it that way," said Dyer, "But, yes."

How it works:

The Msunduzi Municipal AIDS Strategy (which includes the greater Pietermaritzburg region) is a co-ordinated partnership between the City Council, the Children in Distress Network (CINDI), Lifeline and more than 60 NGOs working in the area. To set the process in motion, a workshop was convened to identify what was needed to address the AIDS epidemic in the Pietermaritzburg area, where 100 000 people are infected, 250 deaths occur each month, and where 60% of hospital in-patients have AIDS-related conditions.

The categories include community empowerment, education awareness, a referral system, supporting the roll-out of treatment with Nevirapine, improving access to social grants, the welfare of orphans, and the sourcing of medicines.

Each element was spelt out with its objectives, activity, time-frame and partners and progress was monitored. Crucial to the success of the campaign was addressing the needs of the NGOs who, as a result of the Council's "open-door" policies, are able to raise issues at the highest level. For example, if an organisation dealing with the training of home-based care workers requires a building to operate from, the Council will try to identify suitable premises.

Said the municipality's Director of Health: "This scheme has had some positive benefits for the city. Historic buildings that were derelict have been restored by NGOs through their own funding." A disused government office near Edendale Hospital was made available to the CINDI Network. Here, care kits containing basic medicines and antiseptics are assembled and given to home-based care workers trained by CINDI partners.

Sister Eugenia Khumalo, who runs the Thapelo project, said: "Working together as a big networking family is giving us back the hope we thought we'd lost."