North and South Coast Community Forum Series - May 2004

HIVAN hosts a quarterly Community Forum series in the North and South Coast areas, at the Verulam Child Welfare Society and at the Shallcross Community Hall. The topic for the May sessions was: ?“ARV roll-out - Where are we??”. Sindiswe Blose, the Assistant Co-ordinator of the Treatment Action Campaign (TAC) was the guest presenter.

Sindiswe began with a review of the TAC?’s lobbying process for Anti-retroviral (ARV) treatment for HIV-infected South Africans, which had proved to be very challenging for the organisation. In December 2003, TAC had held a public meeting, to which KZN Premier Dr Lionel Mtshali and KZN MEC for Health Dr Zweli Mkhize were invited, but they did not. The aim of this meeting was to put pressure on government to start rolling out the treatment services as had been promised. The Health Ministry?’s response was that quotations from drug companies were being awaited, and that no progress could be made the meantime. TAC suggested that they start providing the medication anyway, instead of allowing people?’s medical condition to deteriorate.

After much discussion and deliberation - and on the brink of the national elections - the Government made good on their word and began rolling out ARVs in during March and April of this year. The selected sites in the eThekweni area are: King Edward Hospital, Mahatma Ghandi Hospital and Addington Hospital; these sites have already started the programme, while Prince Mshiyeni Hospital and R K Khan Hospitals are scheduled to begin sometime in May. Dr Mkhize stated that all sites in the country should be offering the services by June 2004.

Sindiswe then explained the standard national procedure for the individual enrolment process. It takes six weeks overall to acquire the ARV drugs, during which the following steps are followed:

• A referral for Voluntary Counselling and Testing (VCT).
• If one tests positive, one would register for the ARV treatment programme (this being why the Identity Document is essential) and would be screened for opportunistic infections.
• One would be given training in the form of a two-week treatment literacy programme, which covers key issues such as adherence and resistance.
• Clinical assessments would then be run to record one?’s CD4 cell-count and viral load ?– only candidate patients with CD4 counts of 200 and below qualify for treatment, as this marks the stage of AIDS-defining illness.
• A pre-requisite for enrolment in the programme is that the patient must disclose one?’s HIV status to at least one family member, a friend or member of a support group.
• Compliance with the ?“Buddy System?” is also compulsory, involving the identification of a reliable ?“treatment partners?” who would accompany the patient to appointments, counselling sessions and issuing of the drugs. This not only ensures that the patient attends these meetings regularly, but also that the treatment partner can help the patient to adhere to the regime by reminding one to take the pills with food and water as required, to encourage a healthy lifestyle and to provide emotional support.
• There are currently three drug types being issued: D4T, 3TC and Nevirapine.


Audience questions included:

Is the government providing any nutritional support?The Provincial AIDS Action Unit is providing food parcels consisting of goods such as pap and nutrient-enriched food formula. Each site offers expert advice from a qualified dietician.

Is there any NGO (non-governmental organisation) involvement? Has the provincial Health Department searched HIVAN?’s database to find NGOs willing to assist?Management of hospitals hold meetings with NGOs from their area. The NGOs should contact the hospitals if they are interested in getting involved. As far as the provincial Health Department goes, they tend not to liaise closely with civil society.

Is there an ?“interruption period?’?” with these drug regimens?No. One must never stop taking the medication, unless one's doctor instructs otherwise.

The issue of ?‘traditional medicine?’ was also raised.Sindiswe explained that it is illegal to take, sell or dispense any medication, traditional or otherwise, unless it has been approved by the Medicines Control Council of South Africa. Traditional healers are currently working with the government and the Medical Research Council so as to bridge the gap between ?“African traditional?” and Western conventional?” medicine. In order to become accredited to administer any traditional medicine, traditional healers are required to register with the Traditional Healers Association of South Africa.

Sindiswe concluded her presentation by emphasising the importance of civil society?’s involvement in the roll-out of ARV treatment services. ?“We need to take an active role in the fight against HIV/AIDS if we want things to improve,?” she said.

At both venues, there was an excellent community response, both to the Forum content (which was described as highly informative) and to the platform provided for networking and sharing of experiences. The sessions certainly served the purpose of strengthening public awareness about the roll-out of anti-retroviral therapy for all those in need of this life-prolonging treatment.