‘€œOver 350 000 people in Gauteng have been tested for HIV. And out of those we have close to 60 000 now who are on treatment,’€ says Health MEC Brian Hlongwa.

‘€œWe can’€™t expand much faster than we are. We have a very intensive programme and face limitations of staff and space,’€ adds Dr Liz Floyd, head of the provincial multi-sectoral AIDS unit.

Two and a half years ago, the province only had 2 400 patients on ARVs ‘€“ and the massive expansion in numbers has put strain on the health system.

Patient numbers are gathered by data capturers working on records at each treatment site, checked against pharmacy registers and sent via the districts to the province, says Dr Madi Moloi, director of the HIV/AIDS, STI and TB programme.

Despite the fact that Gauteng is one of the best resourced province, it has one of the lowest nurse-patient ratios in the country and its health facilities are overburdened with patients.

‘€œAntiretroviral treatment is very labour-intensive and patients need a lot of support, especially in the first three months,’€ says Floyd. ‘€œToo many people are only seeking treatment when they are very sick. We have to stabilise their medical condition before starting them on ARVs.’€

In many ways, Gauteng is a text-book example of best practice in a country where such examples are scarce in the government sector. It has strong leadership, extensive partnerships and plenty of resources.

Gauteng was the first ANC province to provide nevirapine for all pregnant HIV positive mothers in 2002, something that earned Premier Mbhazima Shilowa a public tongue-lashing from the health minister.

But Shilowa stood firm and has continued to speak out about HIV/AIDS and push the province’€™s HIV/AIDS programme.

Hlongwa, appointed six months ago, has also energized the HIV/AIDS programme, declaring the disease ‘€œthe biggest health challenge the world has ever faced’€.

In the past year, the provincial HIV/AIDS budget has increased by 48% to R514-million.

‘€œWe are happy as a province that we think we are leading in the country in terms of planning and preparing personnel to deal with the burden of disease,’€ says Hlongwa.

The province’€™s biggest breakthrough in the past year is to get that all faith-based organisations  ‘€“ from Apostolics to Zionists ‘€“ involved in a partnership against HIV.

In addition, the department funds some 250 organisations to reach people the officials cannot ‘€“ ranging from the home-based carers working for hospices to those working with prisoners.

From tomorrow (27 Nov) until AIDS Day on Friday, the province has organized 12 000 volunteers ‘€“ many from religious organizations ‘€“ to go door-to-door to speak to people about HIV.

‘€œOne thing that organisations working in HIV have learnt is that face-to-face communication works best. It gives people a chance to ask questions,’€ says Floyd.

‘€œAs a country we have about 12 million people who are functionally illiterate. So, it’€™s not just a question of producing pamphlets. If people can’€™t read, they won’€™t get the message. The spoken word is a very powerful way,’€ adds Hlongwa.

Treatment Action Campaign secretary Sipho Mthati says her organisation has found those in charge of implementing Gauteng’€™s HIV/AIDS programme to be ‘€œhighly motivated and ready to engage’€.

‘€œThey are quite different from many other provinces,’€ she added. ‘€œThey have always co-operated with us. They have decentralised the ARV rollout and have strong political support and leadership.’€

But despite the province’€™s huge output, its impact on bringing down new HIV infections is still disappointing.

Young men under the age of 24, who report high condom use, are the only group to show any significant decrease in HIV infection.

Getting people to change their sexual behaviour is a complicated process.

‘€œUnfortunately, the HIV epidemic shows little signs of abating and it is not clear that the large investments in prevention to date are achieving more than marginal changes in behaviour,’€ say researchers Professor Helen Schneider, Dr Peter Barron and Professor Sharon Fonn.

Communication alone does not prevent HIV, agrees Floyd and says Gauteng has invested heavily in educational interventions including life skills training at schools and peer educators in prisons and hostels.

‘€œWe are also trying to address the social factors that drive AIDS,’€ says Floyd. ‘€œUp to 30% of people don’€™t control the conditions under which they have sex. We have to address factors of economic inequality, gender inequality, alcohol and drug abuse and sexual violence.’€

But Hlongwa emphasizes that ordinary people also need to stand up and take responsibility for themselves.

‘€œWe need to get individuals to be empowered and educated to take responsibility for their health and to promote healthy lifestyles. This idea that the Department of Health can look after you and give you a [hospital] bed is a fallacy. It doesn’€™t exist anywhere in the world,’€ he stresses.