Live the Future Fact File March / April 2010

Live the Future Fact File June 09

• June 09 Live the Future Fact File
  
  

  What does the Autumn of Limited Opportunity mean for the future of HIV and AIDS?

  The season autumn has been used in the name of the scenario as it visually captures the essence of the scenario: in autumn the trees continue to grow taller, while the leaves die and are shed. In this scenario, sectors of the economy continue to grow and thrive, while other parts shrivel.

  The Autumn of Limited Opportunity looks at what our society and economy could look like in 2025 if all the role players (government, business, labour, communities and individuals) take, or fail to take, certain actions.

  Key characteristics

  • Leadership driven by growth
  • Exclusive partnerships
  • Significant income differentials
  • Treatment and care is available, prevention is lacking
  • Little behaviour change
  • Gender inequality and sexual violence
  • AIDS response intellectualised
  • Limited acceptance of HIV positive people
    
    

  The focus

  In the Autumn of Limited Opportunity the focus is on treatment and support to those who can afford it. The response to HIV is very much intellectualised and little benefit trickles down to those in need. Leadership is often self-serving and corrupt with the wealth and resultant power concentrated in a relatively small pocket of society. Exclusive partnerships are formed with strong individual agendas to address HIV and AIDS. Society is profit-driven with little focus on the spread of wealth. Business response to the epidemic is mostly profit-driven due to the reduction in HIV-related costs that come with an HIV workplace programme. Initiatives in the community are limited to urban areas and corporate social investment funding cycles are short. Civil society response under this Autumn scenario where there is high GDP growth and low social collaboration is limited. Donor programmes are short-sighted and work in isolation.

  Individual behaviour

  Awareness of HIV is quite high in the relatively wealthy first economy leading to a third of South Africans knowing their HIV status. Sexual violence is prevalent, and gender inequalities remain. There is limited acceptance of people with HIV and AIDS. More than 70% of the youth and around 40% of adults use condoms consistently. Those not in a long-term relationship change partners very frequently and risky sexual behaviour still remains a huge obstacle in the response to the epidemic.

  The new society

  This is a society with high economic growth that is very unevenly spread leading to a high increase in income inequality. Some provinces show a high GDP per capita and others remain at very low levels. The Human Development Index (HDI) differs widely between the first and the second economy. The HDI remains high in the first economy with good quality education and high life expectancy for those who can afford a good standard of living. Rural households and households in the second economy are severely affected by HIV and AIDS. Income reduction, increased borrowing, the sale of productive assets, illiteracy and malnutrition result in low GDP per capita, poor education and low life expectancy. The average person in the Autumn scenario is expected to live to age 55 by 2025. Business concentrates on capital-intensive industries and contract work becomes popular. The skills shortage worsens with the strong economic growth and skills are imported due to the lack of adequate skills development by the local education system. There is a booming market in the first economy with insurance remaining expensive but innovative.

  How will our responses shape the epidemic in the Autumn of Limited Opportunity?
  

  What does the HIV epidemic look like by 2025?

  The total number of people infected with HIV in 2025 will have reduced to 4.2 million. The estimated HIV prevalence rate for those between 20 and 64 will reduce to 13%. A total of 530 000 South Africans will be in the final stages of the disease and in need of antiretroviral treatment. AIDS deaths per annum would have reduced to around 303 000.

  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

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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

Research Fact File

• Oct 08 Research Fact File
  
  
  Corporate Responses to HIV/AIDS: Experience and Leadership from South Africa, Bolton PL, Business and Society Review 113:2 277-300
   “HIV/AIDS harms the viability and competitiveness of African businesses. As a consequence, companies increasingly subscribe to the view that taking a proactive role to combat HIV/AIDS is not simply a question of compassion and good corporate citizenship. Rather these firms see assertive action against HIV as critical to their long-term profitability, and some have concluded that it is cost-effective in the short-term. The article discusses how South African companies are taking action against HIV in ways that set new benchmarks, enhance the effectiveness of international AIDS advocacy efforts and spur business across Africa and beyond to strengthen their corporate responses to HIV/AIDS.”
  
  
• May - June 08 Research Fact File
  

  
  Corporate Responses to HIV/AIDS: Experience and Leadership from South Africa, Bolton PL, Business and Society Review 113:2 277-300
  “HIV/AIDS harms the viability and competitiveness of African businesses. As a consequence, companies increasingly subscribe to the view that taking a proactive role to combat HIV/AIDS is not simply a question of compassion and good corporate citizenship. Rather these firms see assertive action against HIV as critical to their long-term profitability, and some have concluded that it is cost-effective in the short-term. The article discusses how South African companies are taking action against HIV in ways that set new benchmarks, enhance the effectiveness of international AIDS advocacy efforts and spur business across Africa and beyond to strengthen their corporate responses to HIV/AIDS.”
  
  
• March - April 08 Research Fact File
  

  
  “Key priority area 2: Treatment, care and support

  Reduce the impact of HIV and AIDS on individuals, families, communities and society by expanding access to appropriate treatment, care and support to 80% of all HIV positive people and their families by 2011.

  5. Increase coverage to voluntary counselling and testing and promote regular HIV testing
  5.1 Increase access to VCT services that recognise diversity of needs.
  5.2 Increase uptake of VCT.

  6. Enable people living with HIV and AIDS to lead healthy and productive lives
  6.1 Scale up coverage of the comprehensive care and treatment package.
  6.2 Increase retention of children and adults on ART.
  6.3 Ensure effective management of TB/HIV co-infection.
  6.4 Improve quality of life for people with HIV and AIDS requiring terminal care.
  6.5 Strengthen the health system and remove barriers to access.

  7. Address the special needs of pregnant women and children
  7.1 Decrease HIV and AIDS related maternal mortality through women-specific programmes.
  7.2 Determine the HIV status of infants, children and adolescents as early as possible.
  7.3 Provide a comprehensive package of services that includes wellness care and ART to
       HIV-affected, -infected -and exposed children and adolescents.

  8. Mitigate the impacts of HIV and AIDS and create an enabling social environment for care,      
      treatment and support
  8.1 Strengthen the implementation of OVC policy and programmes.
  8.2 Expand and implement CHBC as part of EPWP.
  8.3 Strengthen the implementation of policies and services for marginalised communities affected by HIV and     
        AIDS.
  8.4 Ensure community AIDS competence in order to facilitate utilization of good quality services. Source: HIV
        & AIDS and STI Strategic Plan for South Africa: Department of Health
  
  
• Jan - Feb 08 Research Fact File
  

  
  EXTRACT FROM: National HIV Incidence measures - new insights into the South African epidemic by Thomas Rehle, Olive Shisana, et al. (S Afr Med J 2007; 97: 194-199)

  "HIV incidence in the study population aged 2 years and older was 1.4% per year, with 571 000 new HIV infections estimated for 2005. An HIV incidence rate of 2.4% was recorded for the age group 15 - 49 years. The incidence of HIV among females peaked in the 20 - 29-year age group at 5.6%, more than six times the incidence found in 20 - 29-year-old males (0.9%). Among youth aged 15 - 24 years, females account for 90% of the recent HIV infections. Non-condom use among youth, current pregnancy and widowhood were the socio-behavioural factors associated with the highest HIV incidence rates.

  Conclusions: The HIV incidence estimates reflect the underlying transmission dynamics that are currently at work in South Africa. The findings suggest that the current prevention campaigns are not having the desired impact, particularly among young women."

   

NSP Fact File

• May - June 08 NSP Fact File
  
  
  Extract from the Executive summary of the HIV & AIDS and STI Strategic Plan for South Africa 2007-2011 (NSP):
  
  “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% were from sub-Saharan Africa. In 2005 about 5.54 million people were estimated to be living with HIV in South Africa, with 18.8% of the adult population (15-49 years) and about 12% of the general population affected. Women are disproportionately affected, accounting for approximately 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 stabilizing, at about 16% for the past three years.”
  
  
• March - April 08 NSP Fact File
  

  
  Performance and capacity of second generation Comprehensive Care Management and Treatment (CCMT) sites in Gauteng province by Schneider, H, et al, CHP monograph no 93, January 2008.
  
  “In terms of the norms set by the national CCMT Plan, three of the sites had staffing shortfalls. In all sites there had been turnover of doctors, and shortages of pharmacists, dieticians and social workers were reported. Nurses formed the stable core of the sites and were key to setting the “tone” of the service. Despite the shortages, the study found high levels of motivation and organisational loyalty among nursing staff working in the programme. This appeared to be related to good leadership and possibly the attention and prestige associated with the CCMT programme. Some staff however did indicate that they were burnt out and intended to leave.”
  
  
• Jan - Feb 08 NSP Fact File
  

  
  Key priority area 1: Prevention
  
  Reduce by 50% the rate of new HIV infections by 2011. The intention is to ensure that the large majority of South Africans who are HIV negative remain HIV negative.

  1.       Reduce vulnerability to HIV infection and the impacts of AIDS:

  o        Accelerate poverty reduction strategies and strengthen safety nets to mitigate the impact of poverty.

  o        Accelerate programmes to empower women and educate men and women, (including the boy and girl child), on human rights in general and women's rights in particular.

  o        Develop and implement strategies to address gender based violence.

  o        Create an enabling environment for HIV testing.

  o        Build and maintain leadership from all sectors of society to promote and support the NSP goals.

  o        Support national efforts to strengthen social cohesion in communities and to support the institution of the family.

  o        Build AIDS competent communities through tailored competency processes.
  
  

  2.       Reduce sexual transmission of HIV:

  o        Strengthen behaviour change programmes, interventions and curricula for the prevention of sexual transmission of HIV customised for different groups with a focus on those more vulnerable to and at higher risk of HIV infection.

  o        Implement interventions targeted at reducing HIV infection in young people, focusing on young women.

  o        Increase open discussion of HIV and sexuality between parents and children.

  o        Increase roll out of workplace prevention programmes.

  o        Increase roll out of prevention programmes for higher risk populations.

  o        Develop and integrate a package of sexual and reproductive health and HIV prevention services into all relevant health services.

  o        Develop a comprehensive package that promotes male sexual health.

  o        Develop and integrate interventions for reducing recreational drug use in young people with HIV prevention efforts.

  o        Increase the accessibility and availability of comprehensive sexual assault care including PEP and psychosocial support.

  o        Scale up prevention programmes for HIV positive people.
  
  

  3.       Reduce mother-to-child transmission of HIV

  o        Broaden existing mother to child transmission services to include other related services and target groups.

  o        Scale up coverage and improve quality of PMTCT to reduce MTCT to less than 5%.
  
  

  4.       Minimize the risk of HIV transmission through blood and blood products

  o        Minimize the risk of HIV transmission from occupational exposure among health care providers in the formal, informal and traditional settings through the use of infection control procedures.

  o        Minimize exposure to infected blood through procedures associated with traditional and complementary practices.

  o        Investigate the extent of HIV risk from Intravenous Drug Use (IDU's) and develop policy to minimize risk of HIV transmission through injecting drug use and unsafe sexual practices.

  o        Ensure safe supplies of blood and blood products (HIV screening tests for measuring both virus and antibodies)."

   

Prevention

Will the widespread availability of free condoms reduce the overall rate of new HIV infections?

Male condoms can reduce HIV incidence by 80%, however, they have to be used correctly and consistently.

Source: An overview of factors underlying future HIV & AIDS trends, March 2006

Will the widespread availabi-lity of Voluntary Counselling and Testing reduce the overall rate of new HIV infections?

A randomised control trail con¬ducted in Kenya, Tanzania and Trinidad demonstrated reduced risk behaviour in those undergoing VCT compared to general health education. Modelling based on HIV prevalence and risk behav¬iour calculated that for every 10 clients counselled, 1 HIV infection was averted.

Source: Efficacy of voluntary HIV-1 counselling and testing in individu¬als and couples in Kenya, Tanzania, and Trinidad: a randomised trial. The Voluntary HIV-1 Counselling and Testing Efficacy Study Group, Lancet. 2000 Jul 8;356(9224):103-12

Do you know how many South Africans do NOT know they are HIV positive?

You need to know your HIV status to access treatment.

A large number of South Africans (66%) do not perceive themselves to be at risk of HIV infection even though over half of them tested HIV-positive (HSRC Household Survey, Nov 2005). This is not only a huge barrier to prevention but also to accessing the necessary care and treatment should an individual test HIV-positive. People have to be encouraged to know their status and take the necessary steps as early as possible.

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