Compiled by: Eddy Moyambo (Clinic‒Laboratory Interface Co-ordinator: HST), Joslyn Walker (HSS Programme Manager), and Judith King (HSS Copy and Content Editor)
South Africa implements the largest HIV treatment programme in the world. This is an enormous achievement, made possible by collaboration and partnerships at all levels of the health system.
Noting that we have such a successful programme, it is important to recognise that we still have a very long way to go in terms of epidemic control, which entails ensuring that 95% of people living with HIV know their status, 95% of those who know their status are on treatment, and 95% of those on treatment are virally suppressed. This will dramatically reduce new infections and will enable us to achieve the UNAIDS targets.
Every year, we mark World AIDS Day with mixed feelings, because we understand the magnitude of what is still required. We celebrate how far we have come from the unfortunate times when we lost so many lives to HIV and AIDS before the range of antiretroviral drugs became available: we remember our mother activist Gugu Dlamini, the brave Nkosi Johnson, and many more. Sadly, we have still not overcome HIV-related prejudice, stigma and discrimination, which is pulling us back in terms of treatment accessibility. We also pay tribute to healthcare workers, political leaders and civil society for their efforts to ensure that patient rights and access to treatment, prevention and education remains front of mind.
This year was no different, and each of the four HST-supported districts hosted events with and in communities to mark this auspicious day. The National Department of Health (NDoH) commemoration on 1 December was hosted in KwaZulu-Natal (KZN) this year, at the Ngcedomhlophe Sportsground in Mandeni, Zululand.
The Health Systems Trust (HST) supported this event in the interests of education and treatment literacy. Our teams provided testing support, briefed leaders on our strategies and progress, and mobilised with communities for health education at all events.
HST's Outreach Team members at the WAD 2023 event in Mandeni, Zululand
The proceedings were co-chaired by KZN Premier Nomagugu Simelane Dube, and Patrick Mdletshe, Chairperson of the KZN Civil Society Forum and Deputy General Secretary of the Treatment Action Campaign (TAC). Speakers included the Minister of Health, Dr Joe Phaahla, Deputy President Mr Paul Mashatile, and U.S. Ambassador Reuben Brigety.
It was noted that KZN has reached the first UNAIDS 95 target for HIV epidemic control, however, we remain short of the second 95, with the shortfall reflecting gaps in leadership action to implement agreed strategies and innovations.
The speakers voiced the need to embody the theme 'Let communities lead' in all our strategies and approaches. In order for us to climb the last hill, our communities must lead, and through working together and embracing Ubuntu, our villages will and can 'raise a child'.
At this year's commemoration, the South African Charter of the Global Alliance to End HIV/AIDS by 2030 highlighted political willingness and decisive leadership, representing a strong step towards government ownership and sustainability. The Deputy Minister emphasised the objectives of focus, i.e.:
We know that epidemics and disasters happen and will continue to do so despite good preparation and prevention strategies. What we have learnt from the COVID-19 pandemic is that we need an adaptive response strategy, and to keep vigilant, with warning systems in place.
The COVID-19 experience has shown us that combatting diseases must start with letting communities lead.
As HST, we pride ourselves in ensuring that we integrate all activities designed to support HIV control and accessibility of care for a range of illnesses. We collaborate and co-ordinate at community level up to provincial level, maintaining grassroots availability and visibility through our Outreach Teams' services which respond to community needs and synergise action with community partners.
This is reflected in direct services that HST provided at the WAD 2023 event Mandeni. Two Outreach Teams mobilised 167 people for HIV literacy, tested 67 people for HIV, and identified three people who were HIV-positive and did not know their status, as well as 13 people who knew their HIV status. At a WAD 2023 event held on 10 December in Klaarwater, eThekwini, a further 49 people were tested and two new patients were diagnosed.
All diagnosed clients received counselling and treatment literacy information, were initiated on treatment, and were directly linked to a facility convenient to them for lifelong care. The teams also provided TB education and prescribing of TB preventative therapies, along with health education about sexually transmitted infections and non-communicable diseases.
HST's Outreach Team provided health services at the Klaarwater event in Pinetown.
This comprehensive care package is regularly provided by our Outreach Teams, but commemorative events are valuable opportunities to magnify the scope and availability of the services to the general public.
Continuous coal-face visibility ensures that demand creation is available and healthcare services are accessible. Training support, new information and data trends dictate that healthcare workers keep learning in order to hone their skills for provision of quality health care, and ongoing skills audits allow for critical in-service trainings to take place.
HST's partnerships at district and sub-district levels ensure that performance on agreed indicators is monitored, reviews are conducted, and shortcomings are redressed through quality-improvement interventions. Layering of services with the Department of Health (DoH) is conducted with the aim of sharing knowledge and transferring skills from Implementing Partners to DoH staff through mentoring and coaching, with the clear objective of promoting ownership and sustainability.
HST research experience influences policy, and this knowledge is disseminated through reviews on a quarterly basis. We also participate in periodic amendments and updates for NDoH guidelines, which enable tailor-made solutions for an effective HIV response.
As a supporting partner, we see ourselves as central in this last push to reach and exceed the 95-95-95 targets, and remain positive that our experience will contribute to the formulation of adaptive response strategies. Our efforts are increasingly focused on the community, working together with civil society organisations to strengthen our support and fulfil government commitments to ending HIV and AIDS.
As our Campaign Agent, Mr Lungelo Joka, advised eThekwini Mayor Mxolisi Kaunda, we work with the DoH and communities to increase knowledge about HIV and how to prevent it, and provide lifesaving treatment in communities and facilities.
The eThekwini Outreach Team
Tracing people who miss appointments and providing people-centred services rests on Community Health Workers (CHWs), who are often the face of health care in the community. They see the daily struggles that patients face in accessing and adhering to treatment, and their struggle with stigma and discrimination. The CHWs also see the triumphs of treatment adherence and treatment as prevention.
While these commemorative days are important to communicate our messages and elevate them into the media and public consciousness, we are reminded that HIV is with us every day, not only on 1 December every year. Together, we must support communities to lead us to an AIDS-free generation.
HST extends special thanks to Lungelo Joka for providing a voice for healthcare workers to His Excellency the Mayor, and for presenting the great work of CHWs in mobilising for improved adherence and retention. We are also grateful to our Outreach Teams for their hard work at the events in KwaDabeka, Tongaat and Klaarwater.
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