Country situational analysis

South Africa has the largest number of people living with HIV in the world. According to the 2010 UNAIDS Report on global AIDS epidemic, there were 5.6 million people living with HIV in the country at the end of 2009. This corresponds to 17.8% HIV prevalence. South Africa’s 2008 Antenatal survey report was released in July 2009. The overall national HIV prevalence among antenatal women aged 15-49 years is 29.3%6.

In 2006 and 2007, the HIV prevalence was 29.0% and 29.4% respectively. The findings suggest that HIV prevalence over the last three surveys has stabilized around this level. There have been some variations in the HIV prevalence rates in the provinces. The Western Cape reported the lowest estimate of 16.1% while KwaZulu-Natal had the highest HIV prevalence in the country at 38.7%. Mpumalanga has shown an increase in HIV infection from 32.1% in 2006 and to 34.6% in 2007 to 35.5% in 2008. The survey also reported a decline in HIV prevalence among youth 15-24 from 10.3% in 2005 to 8.6% in 2008.

However, prevalence remains disproportionately high for females overall in comparison to males. HIV prevalence is highest among the 25-29 years age group, where one in three women were found to be HIV positive. HIV prevalence among males is highest among the 30-34 year age group where 25.8% of men were found to be HIV positive in 2008. Women continue to be worst affected by the HIV epidemic in South Africa.

According to UNAIDS, there were 971,556 people on antiretroviral treatment at the end of 2009, which corresponds to 59% coverage of all people in need. The percentage of HIV positive pregnant women receiving anti-retroviral therapy to prevent mother-to-child transmission of HIV was 88% in the same time period.

Key elements of the national response 

The government has since 2000 developed many policies and programmatic responses to ensure that there is a multisectoral response to HIV/AIDS. This is driven by the five-year National Strategic Plans (the current one is for the period 2007-2011), but supplemented by a variety of complementary policies and guidelines, such as:

• Revised policy and guidelines for the implementation of the PMTCT programme;
• Integrated Nutrition Programme Infant and Young Child Feeding Policy;
• A policy on quality health care for South Africa;
• School Health Policy for South Africa;
• Policy guidelines for Youth and Adolescent;
• Health Policy Framework for Orphans and other Children made Vulnerable by HIV & AIDS;
• National Action Plan for Orphans and other Children made vulnerable by HIV and AIDS;
• Home and Community-Based Care Policy Framework;

Under the National AIDS Council leadership, South Africa developed a National Strategic Plan for 2007-2011. This sets out the road map for Universal Access to prevention, treatment, care and support. The plan was developed through a consultative and inclusive process, ensuring national consensus on priorities to address the epidemic. The plan has linkages with other national programmes addressing the drivers, manifestation and impact of the epidemic.

In a landmark speech in October 2009, South African President Jacob Zuma heralded the beginning of a new movement to accelerate South Africa’s universal access to HIV prevention, treatment, care and support. An ambitious national HIV counselling and testing campaign was launched in Apricl 2010 with the aim to test 15 million people by June 2010.

Central to prevention activities are media campaigns and related programmes, focused on behaviour change. Khomanani is the official government communications campaign loveLife is a prevention programme operating in public schools, clinics and community-based organisations aimed at youth aged 12-17 years as well as out of school children with specific focus on farming communities and informal settlements; Soul City is a national prevention campaign through edutainment, offering a television drama series Soul City, and Soul Buddyz, a radio/television component for 6-12 year olds; and the Department of Education’s life skills programme.

Other media initiatives include local productions such as Siyanqoba Beat it!, 46664 (Nelson Mandela Foundation), Tsha Tsha and Scrutinize (Johns Hopkins University Health and Education South Africa). There is a large free condom distribution programme, providing approximately 400 million male condoms annually. This will expand to 2.5 billion male condoms in 2010.

Key achievements 

In 1992, the National AIDS Coordinating Committee of South Africa (NACOSA) was launched with a mandate to develop a national strategy on HIV and AIDS. The Government’s Cabinet endorsed this strategy in 1994. A review conducted in 1997, in line with the goals of the NACOSA plan, highlighted the strengths and weaknesses of a health sector which tended to have a disease-specific approach to HIV and AIDS. Some of the recommendations included capacity building for implementing agencies, increasing political commitment, increased involvement of people living with HIV and strengthening integration. Several policies and guidelines have been developed in order to support the implementation of HIV strategies in South Africa.

This work began in 1994 with the finalisation of the Reconstruction and Development Programme document from which most of the other policies flowed. Some examples are:

• Maternal, Child and Women’s Health;
• Development of the District Health System;
• Patients’ Rights Charter;
• White Paper on Transformation of the Health System in South Africa;
• Workplace policies in all government departments and the Integrated Nutrition Programme.

Other important milestones were: the National Operational Plan for Comprehensive HIV and AIDS Management, Treatment, Care, and Support (The Comprehensive Plan) in November 2003; the National Policy Framework for Orphan and Vulnerable Children (OVC) in 2005 and the National Action Plan for OVCs for the period 2006 – 2008.

In 1999 the National Strategic Plan (NSP 2000-2005) was developed and an assessment was carried out through a consultative process with stakeholders. Its findings and recommendations have been used to inform the NSP 2007-2011. The two primary aims of the NSP 2007 – 2011 are:

1. Reduce the rate of new HIV infections by 50% by 2011 and
2. 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.

The plan has identified 19 goals that are needed to reach the NSP’s aims and these are structured under four key priority areas (Prevention; Treatment, Care and Support; Research, Monitoring and Surveillance; and Human Rights and Access to Justice).

In the last five years South Africa has established the largest antiretroviral treatment programme in the world, with around 1 million people on antiretroviral treatmet by the end of 2009. This has been provided in around 500 public sector health facilities, mainly hospitals, but also some community health centres and clinics.

PMTCT scale up and uptake has increased since initiation of the program in 2004. PMTCT is now almost universally available in public primary health facilities having achieved the NSP target of 95% coverage in public sector antenatal service sites in 2008.

Key challenges

National Commitment and Policy, and Monitoring and Evaluation

• The lack of two out of three of the UNAIDS “Three Ones”
• Weak management and coordination efforts across sectors
• The lack of streamlined and clear indicators supported by appropriate data management systems

Programme implementation

• Lack of a unified, national prevention strategy
• Uncoordinated implementation among agencies involved in Impact Mitigation, Human Rights and Access to Justice Health system constraints
• Limited programming for “traditional” populations most at risk of HIV infection

Useful links 

• National Strategic Plan
• South African National AIDS Council (SANAC)
• PMTCT and Paediatric Care and Treatment Fact Sheet
• 2010 UNGASS Report

Contacts

UNAIDS Country Office 

Pretoria 0001
Tel: +27 12 3548490
Fax: +27 12 3548491

National HIV & AIDS and STIs Directorate (National AIDS Programme)
Dr Nomonde Xundu
Cluster Manager – HIV and AIDS, TB and STI
Tel: +27 12 312-0121
Email: xundun@health.gov.za
Email: http://www.doh.gov.za/aids/index.html

South African National AIDS Council (SANAC)
Phumzile Mlambo Ngcuka- Chairperson
1267 Hadefields, Pretoria Street
Block G, ground floor
Tel: +27 12 342 9660
Fax: +27 12 342 9670

Networks of people living with HIV

NAPWA (National Association of People Living with HIV and AIDS)
NAPWA House
2 Oak Street
Boksburg
1460
Tel: 011 892 0773, 011 892 0615
Fax: 011 892 0771
Email: director@napwa.org.za