 Letter from the editor
Welcome to the first AAAO edition of 2009
Summer for all people
When
Metropolitan launched its Live the
Future scenarios in 2006, the business leaders suggested that we were
heading for the ‘Autumn of limited opportunities’. This scenario is
characterised by high economic growth but little social collaboration,
resulting in a limited reduction in HIV prevalence rates by 2025. As we face
a global economic slowdown, the scenarios of low economic growth are
becoming more probable. But still, we would like to strive towards a “Summer
for all people” where prevention, economic growth and social collaboration
form the cornerstone of a successful strategy to address HIV and Aids.
AAAO January/February 2009
focuses on prevention
This
is the first priority area of the Strategic Plan on HIV& Aids and STI, 2007
- 2011. The Stellenbosch
community identified the need for a strong focus on prevention during a
Live the Future workshop in 2006,
which brought together business, community and healthcare leaders from the
area. As a palliative care specialist, Dr Lize Hellstrom became aware of the
unnecessary deaths due to the late diagnosis of HIV and TB. In order to make
HIV and TB testing more accessible, afterhours clinics were identified as
key projects to drive prevention.
We
are delighted to bring you the results of this great prevention initiative,
spearheaded by a remarkably skilled and compassionate woman. Read more on
why the Stellenbosch and Mbekweni Afterhours clinics have been so successful
in providing a unique service to the community.
We’ve
also included the steps to a “Summer for All People” in the
Live the Future Fact File. If you want to read more, visit our
website: www.livethefuture.co.za.
Nathea
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specialises in HIV - and
which is friendly, confidential and professional - opens up
possibilities for those for whom these options are inconvenient or
impossible. In addition, to make the service truly accessible, HIV
testing and support has to be made available after working hours.
The Stellenbosch and Mbekweni afterhours clinics run one
evening a week
The Stellenbosch clinic opened in February 2007, initially in
Stellenbosch hospital. It has now moved to Victoria Street in the
town centre closer to a shopping centre and to evening commuters
catching public transport. The Mbekweni clinic opened in October
2007 at an independent HIV research site, Be Part Yoluntu Centre, on
the edge of a residential area outside Paarl. While supported by Be
Part’s facilities and resources, the Stellenbosch site is
complemented by the Stellenbosch Hospice.
One of the motivations was to attract men to test for HIV
While all working people find it awkward to access clinics during
weekdays, 70% of patients at HIV clinics are women and many state
clinics are reputed to appear unfriendly to men’s needs. In
addition, men who are HIV positive tend to present late for
treatment.
Both men and women are attending the afterhours clinics where they
are served without an appointment. Clients are largely working
people and, particularly in Stellenbosch, are students. In Mbekweni,
predominantly young men (56%) aged 18-25 have accessed VCT, while
the Stellenbosch clinic saw more women (60%) although of a similar
age group.
We are also very pleased to be attracting health workers to whom we
hope to provide a less visible space to access VCT and HIV-related
care than in the state services where they work.
Word about the clinics is spreading fast and attitudes are
changing
We have averaged 70 and 100 clients a month at Stellenbosch and
Mbekweni respectively. The Mbekweni Clinic has already identified
the need to provide VCT services on an additional evening to avoid
turning clients away.
The HIV-prevalence at the Stellenbosch clinic has been 9% and 10.7%
at the Mbekweni facility. People who are found to be HIV positive
can have their CD4 counts assessed and, if they choose, a care plan
can be drawn up and monitored..
Following regular data collection, word-of-mouth has been the
greatest source of promotion of the clincs, emphasising the
importance of a consistent reputation for accessible and good
service. Fliers and newspaper notices were also used to attract
clients.
An additional and significant effect of the Mbekweni clinic has been
its contribution to tackling stigmas and denial towards the disease.
In a recent internal review, a nurse noted that ‘People in
Mbekweni do watch each other, but it doesn’t stop them being tested.
People here have come to terms with HIV/Aids. At some funerals, Aids
is acknowledged as the cause of death’ - while another sister
reported that ‘Some clients have asked for T-shirts to show they
have tested and know their status'.
Suitable premises and quality staff continue to address
challenges
The winter weather and transport routes provided significant
challenges to the Stellenbosch clinic in its first year but moving
to a more accessible site on commuter routes and engaging in
assertive marketing has helped. While operating in significantly
different environments, the clinics have learnt from each other,
with the increased uptake in Stellenbosch partly resulting from
adopting active recruitment strategies at the community-based
Mbekweni site.
It is clear that suitable premises with welcoming and professional
staff who provide counselling and excellent care, efficient hands-on
co-ordination and upbeat assertive marketing are central to the
success of these kind of initiatives.
Corporate sponsorship and government support key to success
The co-operation of the West Coast Winelands region of the
Department of Health has been central to these clinics in the form
of materials, primary health care staff and the services of the
infections diseases clinic and laboratories.
The clinics have had two funders: the South African corporate,
Metropolitan who provided the initial funding and enabled this
project to start, and PEPFAR/USAID through the PHRU (Perinatal HIV
Research Unit) which currently provides ongoing maintenance funding.
While the costs are kept as low as possible – for example, by using
rent-free sites – this external funding is crucial to continuing
this service.
The new site in Stellenbosch was opened by the captain of the South
African Netball team, Bronwyn Bock, who challenged all Stellenbosch
sportsmen and sportswomen to be tested for HIV and, if infected,
undergo treatment.
Dr Lize Hellström is currently the project leader of the
After Hours Clinics and Stellenbosch Hospice Farm Projects, both supported
by PHRU.
Dr Hellstrom is also the principal investigator for Be
Part Yoluntu Centre in Mbekweni , part-time Palliative Care consultant at
Stellenbosch Hospice and
lecturer and The Department of Family Medicine,
Medical School, University of Stellenbosch.
She holds a MB Ch B degree from
the University of
Stellenbosch
as well as a Masters degree in Palliative Care from the
University of
Cape Town.
Dr Hellstrom has also completed diplomas in Obstetrics, Anaesthetics and HIV
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In this issue
Live the Future fact file
What are the Live the Future scenarios?
The key question we asked when developing the scenarios was: ‘How will HIV and
Aids, and our response, shape the future of South Africa by 2025?’
The key strength of future scenarios is that they reveal to us what might
happen, rather than what we want the future to be – they help us to move beyond
our own mental maps, to think the unthinkable, and to plan accordingly. In
short, scenario-building implies choice – and therefore hope.
The project has resulted in four distinctly separate scenarios that reflect on
the interrelationship between a wide range of aspects including socio-economic,
psychosocial, legal, environmental and political issues. These scenarios
describe how South Africa could look in 2025.
The Live the Future scenarios suggest that unless we aim to prevent new
infections, collaborate and adopt a holistic and integrated approach, we will
make little progress in stemming the tide; ‘we will continue mopping up the
water while the tap is still running’.
Extract from:
D.Daniels, Metropolitan Holdings Ltd (June 2006). Live the Future – A Model to
Respond to the Challenges of HIV and Aids in South Africa on
www.livethefuture.co.za
What community level action does the Live the Future project suggest for
a ‘Summer for all people’?
Action for All
Non-governmental organisations (NGOs) and community-based organisations (CBOs)
to work in partnership and support local healthcare facilities to:
- Make male and female condoms available
- Provide syndromic management for sexually transmitted
infections
- Provide Voluntary Counselling and Testing (VCT)
- Implement prevention of mother-to-child HIV transmission
(PMTCT) programmes that are efficient and friendly so as to encourage uptake
- Provide post-exposure prophylaxis (PEP) for survivors of
sexual assault
- Provide post-exposure prophylaxis for healthcare staff
who have been exposed to HIV through needle stick injuries etc
- Ensure there are clear guidelines in place to protect
staff from occupational exposure and enforce these guidelines
- Provide adolescent-friendly clinics
- Develop food gardens at the clinics
- Extend the clinic hours to make it more accessible for
people who work during the day
- Extend the clinic facilities to include income generation
projects so that people are able to work and earn a small income to support
themselves and their families
- Ensure services are properly monitored and evaluated
- Identify and use existing resources and expertise to
support prevention programmes
Challenges
Many healthcare institutions are understaffed and therefore do
not have time to focus their attention on prevention.
Many healthcare institutions offer vertical programmes - patients are not
assessed as a whole and given a comprehensive service through one consultation.
Stigma may prevent people form accessing services.
People may not access services because they do not know they are available.
Extract from: Metropolitan Holdings Ltd (June 2006). Live the Future –
A Model to Respond to the Challenges of HIV and Aids in South Africa on
www.livethefuture.co.za
HIV and AIDS Vital Statistics for South Africa in 2009
| AIDS deaths per day | 1000 |
| New HIV infections per day | 1400 |
| People living with HIV | 5,7 million |
| Total AIDS deaths | 380 000 |
| Total new HIV infections | 501 000 |
| Total AIDS sick | 676 000* |
| Adults with AIDS, not on ART |
470 000 |
| Children with AIDS, not on ART | 26 000 |
| Adults on ART |
583 000 |
| Children on ART |
69 000 |
*Note: This includes people who have
not started ART and those who have started ART, but have since
discontinued treatment.
Source: Metropolitan AIDS Risk
Consulting from ASSA 2003 (Full) AIDS and Demographic model
Contact info:
Published by
Metropolitan Holdings
Editorial Board
Tersia Mdunge
(021) 940 6121
tmdunge@metropolitan.co.za
Nathea Nicolay
(021) 917 3090
nnicolay@metropolitan.co.za
Nosipiwo Ngxabazi
(021) 940 5150
nngxabazi@metropolitan.co.za
Tjaart Esterhuyse
(021) 940 4950
testerhuyse@metropolitan.co.za
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