Positive. That’€™s the only way to describe the attitude of Dr Liz Floyd, Gauteng’€™s head of HIV/AIDS, to the province’€™s campaign against the disease over the past year.

“There’€™s a new seriousness amongst people at every level about AIDS,” says Floyd, as she zips through the year’€™s highlights.

Social mobilisation is one of her favourites, which has involved building a mass movement around AIDS in the past few years, drawing in an impressive range of people from hostel dwellers and traditional healers to church leaders, ANC branches and sports associations.

“Last year, in the run-up to AIDS Day our 7 000 volunteers reached 2.2 million people in their homes,” she says. “This year we have 10 000 volunteers who have been out in the field since 18 November in the campaign called Sikhulekil’ekhaya. The aim is to reach three million people,” she added.

“Reaching” means more than just distributing pamphlets. Volunteers have been trained on AIDS prevention and positive living for those already infected and are able to educate, answer questions and distribute condoms. Best of all, they are also able to refer those who need care to service providers in a unique demonstration of bringing governance to the people.

Health MEC, Dr Gwen Ramakgopa, says the volunteers have been spreading the message that “HIV can be prevented, we can deal with the consequences of AIDS and every little bit counts and is it up to everyone to make a small contribution in the battle against the disease”.

“Last year, our volunteers found 23 165 people in their homes who needed help, including home-based care, and were able to refer them on,” says Floyd.

Massive expansion of the prevention of mother-to-child HIV infection programme, better medical care for those with HIV and improved home-based and orphan care are other successes.

Floyd believes the success of the campaign is reflected by last year’€™s antenatal survey, which showed a minimal increase in HIV infection in Gauteng from 29,4% to 29,8%. This is despite the fact that new people flock to the country’€™s powerhouse province every day.

“Gauteng is acknowledged to be ahead of the game. It is widely acknowledged as the leading province in the HIV/AIDS campaign,” says Dr Dave McCoy of Health Systems Trust, who co-ordinated a team of healthcare experts to evaluate the provincial department of health’€™s response to HIV/AIDS a year ago.
“They were exceptionally brave to open their doors to outsiders and ask us to conduct an external review. This was really excellent because it means they were looking for deficiencies to be highlighted so that these could be addressed,” he added.

As to be expected, many of the deficiencies lay in implementation at a local level.

“There is a good HIV-specific campaign with a well thought-out strategy but this was undermined by the day to day problems of the primary healthcare system,” says McCoy. “The lack of a basic primary healthcare system is bringing down a lot of the good work.

“Restructuring of the department to bring it in line with local government had disrupted management and leadership at the district and regional level,” says McCoy. “The review also highlighted the need to strengthen clinical leadership at these levels, as well as the high degree of ignorance, fear, stigma and denial amongst nursing and medical staff.”

Floyd believes that the AIDS campaign has been strengthened at local level since the review.

“About 80% of our 480 clinics now offer basic HIV/AIDS care, counselling and HIV tests,” she says. “TB treatment and treatment for sexually transmitted infections (STIs) is available at 90% of the clinics.”

TB is the most common opportunistic infection suffered by people with HIV. The TB cure rate in Gauteng in 2001 was 71%, an improvement of 5% on 2000. The recent Health Summit has asked the health department to investigate offering TB prophylaxis (drugs to prevent TB) for HIV positive patients.

STIs, particularly those that result in sores or lesions, massively increase the risk of HIV infection and the good news is that the syphilis rate is down to 2,7%, which represents an 83% reduction over three years.

Nevirapine is available for pregnant HIV positive women who want to reduce the risk of transmitting HIV to their babies at all hospitals and 70% of large community healthcare centres. By June 34 000 women had been offered the PMTCT service.

Ramakgopa says local AIDS programmes are now being driven by the mayors in most cities and towns, thus mirroring the provincial inter-sectoral AIDS structure headed Premier Mbhazima Shilowa.

For Ramakgopa, a highlight of the past year is the way in which home-based care (HBC) has taken off locally. From five pilot programmes in 1998, there are now close to 60 HBC organisations that cover 80% of local districts.

“If there is one programme I am passionate about, it is home-based care,” says the MEC. “It is so local and accessible. The HBC workers are available to support the infected and affected in every way. If the person needs food, access to care for opportunistic infections, or children are having problems at school, the carer can help.

“They also in a position to de-stigmatise the disease because they deal not only with the sick, but help people with HIV to live healthily,” he said.

Orphan care over the past year has improved dramatically, with 22 new orphan services having been set up in the 2001/2 financial year and a further 13 planned in the next year.

The mining town of Carletonville is a model in HIV/AIDS prevention, says Floyd. It’€™s HBC organisation, Heartbeat, has been supporting 105 orphans many of which live in child-headed households and 98% of orphans have been absorbed by the community.

Thanks to daily visits by caregivers, all the orphans passed their grades and there were no school dropouts.

Looking to the future, Ramakgopa believes that Gauteng needs to start engaging with anti-retroviral therapy.

“We need more refined research in terms of cost implications, and we need to keep track of best practice and monitor the trends elsewhere,” says Ramakgopa, indicating that the province has applied to the Global Fund to Fight AIDS, TB and Malaria to help fund such research.