Assessment of HIV/AIDS programmes in SA: public hearings for Inter-Parliamentary Union Advisory Committee on HIV/Aids

Meeting report

The Chairperson, Ms Henrietta Bogopane-Zulu, a member of both the South African Parliament and the Advisory Group, introduced the session as being part of an international oversight venture on HIV and AIDS issues.

In South Africa, members of parliament were being trained for involvement with such issues. Initiatives were launched to gain a sense of the situation in areas such as Kwazulu-Natal. Concern was being broadened to include a diversity of demographic groups. A report of these IPU hearings would be prepared for debate in the National Assembly.

Ms Bogopane-Zulu noted that members of the IPU from Uganda, India, Tanzania and Saudi Arabia served on the Advisory Committee.

In South Africa, the Department of Public Service and Administration, together with the Department of Health, represented a government response to AIDS.

South Africa indeed faced several types of AIDS epidemics. It was most prevalent in informal settlements, and the reduction of poverty remained a goal to be pursued to counter it. Another important area was child education. Job creation was salient. Programmes were envisaged for the prevention of gender based violence. Social cohesion in communities had to be strengthened.

Regarding prevention, sexual transmission had to be reduced. Discussion of HIV sex issues between parents and children had to be encouraged. Workplace prevention had to be instituted, with high risk occupational groups being identified. AIDS policies of departments such as the South African National Defence Force, had to be revised. The Defence Force was still refusing to deploy those infected with AIDS outside the country.

A circumcision expert group had been created to work with traditional leaders.

Research monitoring and surveillance was a priority, and technocrats were being trained, with the Justice Department leading the process.

Department of Health submission

Dr Yogan Pillay, Deputy Director General, Strategic Health Programmes, referred to its strategic plan launched during 2000 – 2005, to reduce infections and to provide care. Investment rose from R676 million in 2000 to 4.8 billion in 2008.

Care initiatives included Voluntary Counselling and Testing (VCT) and the syndromic management of Sexually Transmitted Infections (STIs). Youth programmes were launched. The focus was on multiple concurrent partners, intergenerational sex, and substance abuse. Laboratories were strengthened to conduct CD4, Viral Load and PCR tests.

The practice of granting stipends to community caregivers was instituted.

Other areas that received attention were human rights and research, for instance prevalence studies based on antenatal visits, and ethical research. Co-ordination of research was a priority, and reviewing of research for policy building, and building local capacity.

Although growth of the epidemic had slowed down, it was still in ascendancy.

There were problems of human resource shortcomings, finance restraints, and the cost of drugs.

Discussion
Mr Jesudas Seelam, IPU member (India), asked if there was special emphasis on youth, as had been the case in India. He wanted to know if community AIDS workers were volunteers or paid workers.

Dr Elioda Tumwesigye (Uganda) asked how the issue of multiple concurrent sex partners was addressed.

Dr Sipho Senabe, Chief Director: Department of Public Service and Administration, answered that an emphasis on youth took the form of mass media and community programmes, and peer education. Youth friendly clinic services had been established.

Regarding multiple concurrent sexual partners, he pointed out structural reasons underlying this. The migrant labour legacy exerted pressure towards engaging in sex relations with partners in men’s hostels away from home, for instance.

Dr Pillay also referred to youth friendly public health facilities, and facility based voluntary counselling and testing (VCT). Regarding multiple partners and intergenerational sex, he referred to the One Love campaign.

The situation concerning remuneration of community workers tended to be chaotic. Community health workers had initially been volunteers, but later became paid workers. NGOs were contracted by government grant stipends. The government initiated community development schemes with paid workers. But overall, the situation was that of multiple systems operating.

He pointed out that there were vibrant Information Education and Counselling (IEC) strategies co-ordinated by the South African National AIDS Council (SANAC).

Mr Seelam mentioned that in India, there was the problem of lack of trust between parliament and NGOs. What was the situation in South Africa? Concerning primary health infrastructure, he asked how antiretroviral (ARV) drugs were supplied to people, especially the poor.

Dr Pillay responded that a similar lack of trust did not exist in South Africa. The relationship between government and NGOs was satisfactory, and still improving. Government was represented by SANAC, donor funds were co-ordinated at the national level. He described primary health care as quite well developed. HIV care services could be said to be within reach of everyone, but ARVs were only available at public hospitals. Nurse driven administration of ARV was being launched.

Dr Tumwesigye enquired about the difference in AIDS prevalence between Kwazulu, where it was highest, and the Western Cape, where it was lowest. He asked if he was right in his assessment that VCT was viewed locally as a mere passage to care. If so, why was it not utilised as a major intervention strategy?

Dr Senabe responded that the lower incidence of AIDS in the Western Cape was on account of that province being wealthier, with a better infrastructure. Poverty in Kwazulu was widespread, coupled with large population figures. There were also cultural and social differences between the mostly Zulu population of Kwazulu, and the Coloured population which formed the largest population group in the Western Cape.

Dr Pillay did not agree that VCT was viewed only as a pathway to care. There was a programme, Knowing Your Status, that had more far-reaching aims.

Khomanani submission
Mr Cyril Sadiki noted that that Khomanani meant ‘caring together’. It constituted a government initiated mass media campaign, based on public issues around STIs. Its aim was to generate behaviour change. It focused on such matters as the impact of AIDS on the family, and increased education awareness. Communities were encouraged to accept critical messages.

Government alone could not change behaviour. Civil society and NGOs had to be involved. Prevention and treatment campaigns were prioritised, as well as nutrition and general health. The Department of Health was the custodian of the campaign. An effort was made to mobilise community support for child-headed families.

Campaigns were synchronised with calendar months, for example, TB month. IEC distribution occurred in 11 languages.

The Zithande campaign had been launched. Zithande means ‘love yourself’ so as to also be capable of loving others. The aim was to inculcate a positive attitude.

Five million people had been reached, with positive feedback from communities. Ninety thousand people were reached per week. Two million people have been reached from door to door.

South African National Aids Council (SANAC) submission
Mr Mark Heywood, SANAC Deputy Chairperson, expressed his approval that a report of these IPU proceedings would be debated in the National Assembly.

The question that had to be asked in the current context, was this: why were there so results so poor, with so much effort expended? Every day, 600 people died of AIDS in South Africa, and 1000 were infected. Eight government departments were co-operating on the AIDS project. Yet important voices were not heard, notably those of prisoners, sex workers, gays and lesbians.

On a positive note, civil society participated in the activities of SANAC. There was growing coherence and unity in South Africa about the epidemic. Different ministries were involved in SANAC, and civil society viewed it as an opportunity. There was an improvement in ARV treatment, although this was not sufficiently monitored.

But the overall need was not being met. Estimates ranged from 19 to 50%, when it came to reaching those affected.

He proceeded to identify challenges. There was a need for monitoring, evaluation and co-ordination. There was a plan, but not a system.

Financing was a problem. Civil society was starved of funds. A crisis with respect to government was looming. Mr Heywood read excerpts from a letter by a medical practitioner from the Free State, describing the virtual collapse of AIDS treatment and care in a region from that province. Drug readiness training had stopped, and medicines were running out.

Rapid response mechanisms were needed. 5.7 million were living with HIV. There were delays in key policy decisions between recommendations to implementation, that could last from a year to 18 months. Political will was needed. A link had to be forged between knowledge training and respect for human rights. Departments like the South African National Defence Force (SANDF) were still in contempt of AIDS testing, and would not deploy positively tested members outside of its national borders. Human rights violations had to be identified.

Discussion
Ms Bogopane-Zulu remarked that the country had nine provinces, all of which responded differently.

Mr Seelam asked for clarification of what Mr Heywood meant by ‘political will’. In a declining global economic situation, how did South Africa expect to fund AIDS programmes? The ARV supply was less than the demand. Was private sector sponsorship considered, and how was corporate and private sector funding managed?

Dr Thumwesigye asked how the South African political structure could be utilised to good effect. Was there interaction with parliament? In Uganda the attitude existed that saving a life was the highest achievement. He suggested that in South Africa the question be asked: was saving life a problem of resources or logistics? Could parliament in any way expedite the supply of medicines?

Mr Heywood responded that political will was certainly present at the national level of the President and Ministers. But what did that translate into? It would be good policy to supply every member of the ruling party with a list of what to do at the community level.

AIDS was linked to poverty and education. In rural communities, AIDS was still stigmatised. Rights were linked to resources in South Africa. One had to ask what other resources besides government existed. Every month, 16 000 new people were involved in treatment. The private sector had to be engaged. In South Africa the public and private sectors were unequal.

SANAC was not a statutory body with executive powers. Its power rested on trust.

He continued that problems experienced were of resources and logistics, both. There were problems of co-ordination in Mpumalanga, for instance. Monitoring and evaluation were essential.

What was needed was a functional professional secretariat.

Ms Bogopane-Zulu suggested that members of parliament could build such functions into their constituency work.

Dr Pillay remarked that the scale of ARV uptake of ARV had become greater than had been budgeted for. As testing increased, the demand increased. He agreed with Mr Heywood that the public and private sector were unequal. A national health insurance system was needed.

Public health was under-funded. Health expenditure in the private sector per year in medical aid schemes amounted to R8000 per member. In the public sector, it was only R1000 per individual.

Dr Thumwesigye suggested that SANAC be converted into a statutory body.

Mr Bassam Al Arifi (Saudi Arabia) remarked that a more extensive database could help solve the problem of reaching larger numbers.

Ms Lediana Mng’ong’o (Tanzania) asked about strategies to co-ordinate departments, for the same reason.

Dr Pillay responded that South Africa had a federal system, which made monitoring hard. The aim was to institute electronic patient records, that could follow patients, but it was costly. Every province had its own registry.

SANAC Religious Sector submission
Rev Desmond Lambrechts explained that in Sanac there was co-operation between faith based organisations and public health agencies. Faith based organisations provided care.

There were Christian, Jewish, Muslim and Hindu conservative and progressive ideological positions. Networking occurred at the grassroots level. Funding had been secured.

Mr Charl Fredericks referred to behaviour change that had been effected through youth programmes, especially concerning the issue of multiple concurrent sex partners.

Efforts were made to create caring communities. Orphaned and vulnerable children received attention. Religious leaders had volunteered for VCT. Research monitoring and surveillance was underway, and the cultivation of treatment literacy. The sanctity of human life was a rallying point.

Discussion
Dr Tumwesigye asked if there were religious views that were opposed to the use of condoms. Was there a spiritual help programme for suffering? How was fidelity encouraged?

Mr Al Arifi enquired if counselling took a medical or religious form, and about religious values, spiritual warning, and infertility.

Rev Lambrecht replied that different faiths had different views on condom use. Concerning spiritual values, he noted that there was recourse to Kairos, an identification with unconditional love and compassion. Values centering on fidelity were promoted on a weekly basis during marriage preparation and Sunday schools, for instance.

SANAC Higher Education Sector submission
Dr Shaidah Asmall pointed out that the higher education sector was not part of government. Institutional autonomy had been granted to 21 institutions. There was only collaboration with the Department of Education.

Beneficiaries of Aids programmes were students, higher education staff and society. Access to ARVs was available on campus, and wellness programmes had been instituted.

New knowledge was generated by research, but HIV remained a non-funded mandate. A policy framework had been adopted. Academics had to promote debate. University work remained evidence based, and donor funded. Professional competence was aspired to.

Discussion
Dr Tumwesingye ventured that the submission lacked explicit reference to AIDS, and concrete measures to address the problem. He asked what was meant by professional competence.

Dr Asmal replied that a sector response to AIDS was co-ordinated. Students were indeed equipped to address the AIDS problem, through modules on the subject that were included across the board in training. Higher education institutions were involved concretely by working with traditional leaders, for instance.

SANAC Health Professionals Sector submission
Dr Kgosi Letlape, chairperson of the South African Medical Association (SAMA), expressed concern at shortcomings in training that created a human resources problem. There were not enough medical schools, and education was unaffordable. Medical workers often left the country after completion of training. There were not enough jobs for everyone, and work was often poorly paid. Working conditions were often appalling. Safety and remuneration of health services urgently needed attention.

He pointed out public/private discrepancies. Doctors attended to the needs of the privileged, whereas nurses attended to the poor. Task shifting had to occur, with equitability as the yardstick.
HIV/AIDS treatment could promote treatment protocols.

It was paramount that available resources had to be shared equitably.

Discussion
Dr Tumwesigye enquired about wellness programmes and counselling services for health professionals. He was concerned about the occurrence of burnout, to which health workers generally were prone.

Dr Letlape replied that there were wellness managers in the field, but that health workers showed a marked tendency to avoid seeking help at the places where they work. In addition, they were generally reluctant to disclose, being generally more concerned about the health of others.

Burnout did occur, especially because of understaffing, and impossible work loads. More human resources had become available, but there were still problems. Off-site counselling facilities were needed. These were resisted on-site, due to stigma. Re-education was needed among health workers to eliminate discrimination. Some health workers were reluctant to work with AIDS cases, because of stigmatisation.

SANAC Traditional Leaders Sector submission
Hosi Peter Kutama noted that traditional leaders were the youngest institution in terms of legislation and political representation, and yet it was a very old social institution. Traditional leadership had had to struggle to attain its current state of recognition.

He stated that Parliament was not doing enough. AIDS was causing death and destitution.

Traditional leaders needed a mandate that included resources. No clear role had been spelt out for them. They could not plan together with traditional healers. He urged that they be capacitated. A suggestion was for them to be partnered with the Medical Research Council. The issue of circumcision schools had to be regulated. There were illegal circumcision schools operating that contributed to AIDS vulnerability.

Discussion
Dr Tumwesigye referred to programmes in Uganda that promoted virginity, and asked if there were such in South Africa. Were there efforts to promote a culture favourable to responsible sex relations?

Mr Seelam asked if it was possible to comment on what people felt at ground level, about unprotected sex.

The presenter replied that initiation was geared towards the production of worthy adult members of society. Virginity testing was not allowed. Traditional culture discouraged youthful sex. It was, however, impossible to monitor sexual safety.

SANAC Organised Labour submission
Ms Edna Bokaba (FEDUSA) noted that organised labour was represented by FEDUSA, COSATU and NACTU.

There was concern to mitigate the impact of AIDS on workers, and to protect them. Workers had to be sensitised and educated about the issue. Organised labour campaigned and lobbied for better treatment, and negotiated at NEDLAC. The VCT ‘Know Your Status’ campaign was of crucial importance. Every effort was made to secure treatment, care and support for workers.

Human and legal rights were a focal concern. Stigma around AIDS had to be addressed. People were dying silently. Input in Parliament remained a problem. There were many aspects to the AIDS problem that were simply not captured by statistics. A willingness existed to learn from other countries.

Discussion
Mr Al Arifi enquired about the impact of a lack of resources.

Ms Bokaba replied that labour was lobbying for human resources in the public sector.

SANAC Research Sector submission
Dr Olive Shisana identified priorities as being research co-ordination and technical support. The primary aim was to ensure that gathered evidence got translated into programmes. A clearly defined research plan existed, but there was a lack of funding.

Information on biomedical prevention was forwarded to SANAC and the public. Studies indicated that male circumcision could contribute to prevent transmission. Social and behavioural intervention was needed. This included the surveillance, monitoring and evaluation of VCT programmes. Workshops were conducted on human resources for health.

Discussion
Dr Tumwesigye enquired about an institutional framework, how the Research Sector related to the MRC, for instance? What role could this Sector play in co-ordinated research in the Sub-Saharan countries severely affected by AIDS? Could SANAC commit itself to take a lead in research and help other countries, also to produce treatment drugs?

Mr Al Arifi joined him in emphasising the need for inter-country collaboration, to find common ground on challenges.

Dr Shisana noted that there were initiatives to co-ordinate research with the HSRC and MRC. Research information could also be shared with other countries. How were other countries handling orphans, for instance? Inter-country research on treatment drugs could yield positive results.

NAPWA (National Association for People with HIV and Aids) submission
Mr Nkululeko Nxesi defined the objectives of NAPWA as being mobilisation, care, capacity building and prevention. Opposing discrimination, as in the Celebrate Your Life campaign, was another pursued aim.

Care, support and group counselling support were promoted. Efforts were made to educate parents to provide guidance to families. Home visits were conducted, and improved access to treatment was worked towards. Men In Partnership Against HIV/AIDS was another established initiative.

A circumcision summit had been held. A lack of coherent knowledge concerning circumcision practices could reverse gains made in other areas. There was already an assumption gaining prevalence among young boys that once circumcised, they would not run the risk of AIDS infection.

NAPWA worked together with all sectors in SANAC, but Mr Nxesi perceived a tendency towards SANAC closing the space of other organisations, though this was not done consciously and deliberately.

Ms Bogopane-Zulu suggested that the presentation be discussed together with the one following.

Treatment Action Campaign submission
Mr Ntatho Mokoena noted that TAC was committed to a mother to child transfer prevention plan.
A diagnosis, treatment and care programme had been launched. Dissemination of relevant information was a key objective. The same applied to promoting increased awareness, comprehensive testing and condom access.

TAC was also committed to alleviation of the refugee crisis, and to address health issues affecting Zimbabweans.

Discussion
Ms Mng’ong’o asked if NAPWA caretakers received the kind of help that they were rendering to families.

Mr Nxesi replied that caretakers received debriefing.

Mr Seelam asked if NAPWA and TAC interacted with Parliament.

Dr Tumwesigye remarked that stigma was effectively counteracted when public figures and celebrities in Uganda began to openly admit their AIDS status.

Mr Nxesi responded that the relationship between NAPWA and Parliament stood in need of improvement. He found media reporting on AIDS to reflect stigma. The media could change its perspective.

Mr Mokoena pointed out that the political will to respond, for government and civil society to stand together, had taken a long time to be established. Interventions and campaigns became effective when it happened at door to door level. Mobile services had to be brought to communities. Leaders had to be persuaded to speak out, to disclose their status if need be, to break the stigma.

Afternoon session

SANAC Women’s Sector submission
Ms Nomfundo Eland presented on this topic. On her ‘women’s sector progress report’ she highlighted the issue of HIV as a feminized disease that affected and infected women far more than men due to societal inequalities. Women however take a large part in community programmes and are more likely to test for HIV. Women are strong advocates for change through their work monitoring policy implementation and taking part and supporting the four pillars of the HIV/AIDS National Strategic Plan.

She then explained the sector’s objectives, focusing on the role of the NSP in helping overcome the challenges of the sector which included gender-based violence, hate crimes (especially lesbian women being targeted), a rise in maternal death due to complications at birth, lack of the availability of female condoms and the lack of services available for rural women.

During their summit in 2008 the sector identified various priorities. There was focus on maternal health and equal parenthood, looking at fatherhood and the role fathers can play in the lives of their families instead, and not excluding them from participating in their welfare.

She spoke about the high prevalence of cervical cancer especially among HIV positive women, who are more prone to being infected by their partners. GBV (Gender-based violence) is another issue they spoke about. They felt the rape policy is not working and being far too slowly implemented, especially PEP (Post-exposure Prophylaxis) which was not being administered to rape survivors.

She then spoke about their website and newsletter which they will use to communicate to the community. They have already been liaising with the men’s sector. World AIDS day was very successful last year and they had used it to highlight women’s role in preventing and treating HIV and ensuring their voices are heard through SANAC.

However, the sector felt that there was a lot of ignorance about the NSP. It was subsequently explained to the women and they hope the implementation of the NSP will be better in future.

Discussion
Mr Bassam Al Arifi (Saudi Arabia) asked whether femidoms could be made cheaper and whether it was cost that hindered use or was the use of femidoms not popular?

Ms Eland replied that accessibility to the female condom was not very high as it was expensive. Recently a better designed condom has been introduced which might encourage broader use, but at the moment the Department of Health found the cost too high.

Mr Jesudas Seelam (India) enquired that, while reading some literature on the ethical issues surrounding HIV, he read about the Mental Health Act. However, he was wondering about the religious principles and ethical principles and why there was not a larger discussion on these issues.

Ms Eland replied that they were looking at behavioural change which they hoped was going to be dealt with this year

Mr Jesudas Seelam then asked what programmes were available for girls.

The reply was that issues dealing with girl children were usually referred to the children’s sector

SANAC Disability Sector submission
Ms Gillian Burrows said the Disability sector undertook a study in 2007 in conjunction with SANAC and the United Nations which came out in 2008. The study looked at the challenges this sector faces with regard to HIV infection and treatment.

Through proactive involvement with the government, the sector had ensured that when SA signed the Human Rights Charter on Disabled Persons, they had gained certain rights. The perception that disabled persons were asexual had affected them and had helped spread HIV/AIDS through lack of education. 12% of South Africans were disabled but the extent of HIV in this sector was unknown due to no research being conducted in the sector. As HIV was spread mostly through sexual contact, disabled persons had not really been included. In the National Strategic Plan of 2007 this had changed as it recognised that there was HIV in this community

Many disabled persons live in poverty which was why it was such a large challenge to reach them. There was also a low literacy rate, lack of knowledge about HIV/AIDS and they were not treated with respect when they went to get treated or tested at a VCT drive.

There was a need to include disabled persons in the national plan and to ensure mainstream education included them to ensure especially rural disabled persons got education about HIV

Discussion
There was a comment from the Communication Sector of SANAC that there was AIDS information that had been translated into other languages in audio-visual form which may assist in allowing better communication with disabled persons.

SANAC Traditional Healers submission
Ms Veronica Motlogeloa explained the role of traditional healers in the prevention and treatment of HIV. Act 35 of 2004 established a directorate on traditional healers. Provincial co-ordinators ensure that traditional healers were co-ordinated. The committee reported on the traditional healers, however these meetings had been cancelled and now only the co-ordinators met without any traditional healers.

The sector, however, did meet but the Department of Health could not give them funding and so there was not very much training available for them. When there was training, the problem was that it was conducted in English whereas many traditional healers spoke no English. Soul City and Khomanani programmes and material were helpful because they had pictures.

The healers did not test for HIV but refer the persons to nurses. Some persons did not use ART because they believed in African medicine, but she did believe that traditional healers had a strong role to play in HIV prevention.

Discussion
Mr Elioda Tumwesigye (Uganda) asked whether there was a policy framework for traditional healers.

Ms Letlape spoke about the legislation and the related regulations (delegated legislation) passed by the Department at which point they lose control over the actual implementation of their delegated responsibility. There was the Traditional Health Practitioners Act, No 35 of 2004, that had been delayed as it had been returned to Parliament because of inadequate public comment. There was supposed to be a council and a policy framework through that Act. This would allow the healers to have standards.

Dr Pillay spoke about the Act saying that there was now a new directorate at the Department of Health which was working with the Medicines Control Council (MCC) to register traditional and homeopathic medicines. Traditional practices such as faith healing was not included in the legislation. The implementation of the Act was still happening and there was no sanction against a person who prescribed a traditional medicine with negative effects.

Mr Jesudas Seelam asked whether a traditional healer’s medicines were clinically tested.

It was stated that the healers were unwilling to get their medicine tested due to the issues surrounding their use.

SANAC Children's Sector submission
Dr Ashraf Coovadia explained what the sector did. It was a highly networked sector, with paediatric care, palliative care, justice and other people involved. Their goal was to implement the HIV/AIDS National Strategic Plan (NSP). Through their CATCH Children’s Right Programme they ensure that children receive treatment and try to engage with many other children’s organisations into working with CATCH. They do a lot of monitoring.

Their achievements so far were having better child-specific interventions and goals. They have mobilised the provinces, spread literacy and communicated with various other sectors.

SANAC NGO Sector submission
Ms Denise Hunt said that the goal of the NGO sector was to implement the NSP and to build capacity to help communities, ensuring there was collaboration and contribution to all other sectors. Building capacity was important as there were many people who were working in communities who were not benefiting from good education. There was also a need to bring policies to grass-roots level.

They got funding and then identified strong NGOs to represent provinces. A core working group of 35 NGOs had identified the problem of where many NGOs competed for limited funding. Now they have developed a core plan to work together and had published a newsletter. They also met with over 400 NGOs to ensure they reached as many organisations as possible.

In 2009, they wanted to consolidate their strategy and implement this, unifying and growing the sector. They had monthly themes for the meeting and a campaign with Constitutional Court Justice Edwin Cameron participating.

There were several problems: funding was not getting to the organisations and there was a lack of capacity.

Discussion
Mr Elioda Tumwesigye (Uganda) asked how one registered as an NGO or CBO in South Africa.

The response was that it was not difficult to register a NGO through the Department of Social Development. Most organisations need to be registered before they receive funding.

SANAC Men’s Sector submission
Mr Rabichanda Gobind focused on the role of men in communities and their role in spreading the disease. At their summit, SANAC made some objectives: mobilize men, involve boy-children, mainstream male reproductive health, address the issue of gender-based violence and poverty. The men’s programme had been implemented in some municipalities. However, there was a need for men to be involved in communities

The challenges they faced were lack of funding and capacity and inadequate communication with governmental structures. Lack of community involvement and networking was also a problem. Lack of engagement with and partnering up with other organisations had also been a problem. However, they had now become involved with organisations such as the John Hopkins University.

There was a need for education on the NSP and a need to lobby and engage with politicians to ensure that the NSP was implemented. There was a need for the men’s sector to have more partnerships. There was need for an international organisation promoting men’s interests to protect women from HIV/AIDS.

Communications submission
The representative said that organisations such as Love Life, Soul City and Khomanani had campaigns focusing on changing an individual’s approach to the disease. Using treatment literature as a prevention strategy was usually focused on HIV-negative people, but it now needed to be integrated with treatment campaigns.

While there was a stabilization of HIV at lower age levels, higher age groups were engaging in riskier behaviour and there was a high level of denial in HIV persons. The challenge in the sector was to integrate the prevention campaigns and treatment campaign. High levels of unemployment and large informal settlements were serious socio-economic problems and this was the major issue for this sector which needed to become pro-poor.

Art of Living submission
This volunteer service was used to help young people through a leadership training programme which used social upliftment and spiritual growth.

SANAC Youth Sector submission
Dr Nomonde Mqhayi of the South African Youth Council representative spoke about their summit. They reviewed their progress in 2008. A challenge was the reaffirmation of the ABC method and to encourage behavioural change through use of schools and parents too.

Access to testing, treatment and care and information dissemination was an issue, especially in rural areas. Rolling out of ART treatment and the change of the approach of a medical centres to HIV positive persons and their stigma.

Impact studies need to be conducted and there needs to be youth-centred research. Access, lack of skills, poor resources and poverty were the main issues. Individual responsibility for their own health was the most important functions.

Discussion
Mr Elioda Tumwesigye (Uganda) asked why the health department considered young persons as being between the ages of 15-24 but their constitution considered 14-25 years old as young persons.

There was a bit of confusion over what ages were representative of this sector for proper research of this sector.

Mr Bassam Al Arifi asked what the prevalence rates among the youth were.

The response was that it was mostly higher among females and then this changed as the age increased.

Closing
The IPU thanked the Chair and Parliament and Government of South Africa.

[Note: This international public hearing was hosted by Parliament but PMG has filed this meeting report under the Portfolio Committee of Health]