Broad Framework for HIV/AIDS and STI Strategic Plan for 2007-2011 South Africa

The HIV and AIDS and Sexually Transmitted Infections (STI) Strategic Plan for South Africa 2007-2011 flows from the National Strategic Plan (NSP) of 2000-2005 as well as the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment. It represents the country?’s multi-sectoral response to the challenge with HIV infection and the wide-ranging impacts of AIDS.

This NSP seeks to provide continued guidance to all government departments and sectors of civil society, building on work done in the past decade. It is informed by the nature, dynamics, character of the epidemic, as well as developments in medical and scientific knowledge. An assessment of the implementation of the NSP 2000-2005 has been useful in defining the capacities of the implementing agencies.

In May 2006, the South African National AIDS Council (SANAC), under the leadership of its chairperson, Deputy President Phumzile Mlambo-Ngcuka, mandated the Department of Health to lead a process of developing the NSP 2007-2011.

This process started with a rapid assessment of the implementation of the NSP 2000-2005. In September 2006, a report of the assessment highlighted the following findings:

• All stakeholders embraced the NSP 2000-2005 as a guiding framework.
• It served to broaden the involvement of agencies beyond the Department of Health and gave rise to establishing and expanding key programmes such as health education, voluntary counseling and testing (VCT), prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy (ART).
• However, stigma and discrimination remain unacceptably high and this has been a deterrent to the use of some of the services.
• Also, implementation of programmes tended to be vertical, with some serious capacity deficits, especially in the previously disadvantaged rural communities.
• The two major weaknesses of the NSP 2000-2005 were poor co-ordination at the level of SANAC, as well as lack of clear targets and a monitoring framework.


Some key recommendations were:
• A need for a revision of the behaviour change approaches
• Strengthen government implementation
• Consolidate and build existing partnerships
• Strengthen co-ordination, monitoring and evaluation at the level of SANAC
• Increase the contribution of the business sector, especially regarding small, medium and micro enterprises
• Make all interventions accessible to people with disabilities.
• HIV and AIDS is one of the main challenges facing South Africa today. It is estimated that of the 39,5 million people living with HIV worldwide in 2006, more than 63% are from sub-Saharan Africa. About 5,54 million people were estimated to be living with HIV in South Africa in 2005, with 18.8% of the adult population (15-49) affected. Women are disproportionately affected; accounting for about 55% of HIV-positive people. Women in the age group 25-29 are the worst affected with prevalence rates of up to 40%. For men the peak is reached at older ages, with an estimated 10% prevalence among men older than 50 years. HIV prevalence among younger women (<20 years) seems to be stabilising, at about 16% for the past three years.


There are geographic variations with some provinces more severely affected. These differences also reflect background socio-economic conditions as demonstrated by the district level HIV surveillance data in the Western Cape. In this province in 2005, the average was the lowest in the country at 15.7%, but two metropolitan health areas of Khayelitsha and Gugulethu/Nyanga registered prevalence rates of 33,0% and 29,0% respectively, high above the national average.

People living in rural and urban informal settlements seem to be at highest risk for HIV infection and AIDS.

Although the rate of the increase in HIV prevalence has in past five years slowed down, the country is still to experience reversal of the trends. There are still too many people living with HIV, too many still getting infected. The impact on individuals and households is enormous. AIDS has been cited as the major cause of premature deaths, with mortality rates increasing by about 79% in the period 1997-2004, with a much higher increase in women than in men. Children are a particularly vulnerable group with high rates of MTCT as well as the impacts of ill-health and death of parents, with AIDS contributing about 50% to the problem of orphans in the country. Household level impacts are the most devastating effects of HIV and AIDS in the country.

Increases in maternal and childhood mortality are some of the devastating impacts, threatening the country?’s ability to realise the millennium development goals targets of 2015.

The South African HIV and AIDS epidemic is defined as a generalised one, with ability to propagate on its own in the general population if unchecked. The vulnerable groups and the factors involved have been discussed, but some groups (commercial sex workers, men who have sex with men, commercial migrants, refugees, intravenous drug users and others), may be at higher risk than the general population.

While the immediate determinant of the spread of HIV relates to behaviours such as unprotected sexual intercourse, multiple sexual partners and some biological factors such as STIs, the fundamental drivers of this epidemic in South Africa are the more deep-rooted institutional problems of poverty, underdevelopment and the low status of women, including gender-based violence, in society.

Closely linked to HIV and AIDS is the Tuberculosis (TB) epidemic. The increase in the past few years of incidence and mortality from TB and recently the emergence of the extreme drug-resistant TB (XDR-TB) has been linked to a considerable extent to immune suppression caused by HIV and AIDS. Once more, poverty and an underdeveloped district health system are the other important factors in this regard. Double stigma associated with dual infection with TB and HIV has become a deterrent to health-seeking behaviours among many South Africans. The effective management of dual infections relies heavily on community-based interventions.

The reversal in the prevalence of syphilis among pregnant women in the past five years is an indication of the gains from the introduction of syndromic management of STIs in 1995 as well as the introduction of the primary healthcare system. The main hurdles with STI control relate to the management of 'partners?’, emergence of resistant strains of some bacteria, as well as the importance of viral STIs in the spread of HIV.

For the full document, please visit: http://www.doh.gov.za/docs/aids-f.html