ADDRESS BY KZN PREMIER SIHLE ZIKALALA DURING WORLD AIDS DAY COMMEMORATION HELD AT HLABISA SPORTSFIELD, 01 DECEMBER 2019
Our Host, Umkhanyakude District Mayor, Cllr TS Mkhombo;
MECs present;
Chairperson of uMkhanyakude District House of Traditional Leaders, Inkosi ZT Gumede;
DAC Deputy Chairperson, Ms Makhosi Zondi;
Traditional Leaders, Religious Leaders, and Councillors Present;
Director-General of KwaZulu-Natal, Dr Nonhlanhla Mkhize;
HODs and Senior Government Officials;
Doctors, Nurses, and Community Health Workers;
Civil Society formations and other social partners;
The Community of Hlabisa and the entire uMkhanyakude District;
Members of the Media;
Distinguished Guests;
Ladies and Gentlemen;
INTRODUCTION: TRIBUTE TO ESHOWE
It is an immense honour to be with the people of Hlabisa and uMkhanyakude District on World AIDS Day.
This is a day that provides an opportunity for government, non-governmental organisations, churches, community organisations and individuals to stand together and recommit to actions that will end the AIDS epidemic.
It is also a day when we express public support for people living with HIV/AIDS and remember those who have passed away because of the disease.
Just over three decades ago, humanity came to know about the HIV virus. At the time, and for many years later, to be infected with HIV meant a slow, “shameful”, and a painful death sentence. Two decades later, the world has made great progress – AIDS-related deaths are down by half and there is more knowledge on it than ever before.
We gather each year on the 1st of December to recommit to a world where we have zero new HIV and TB infection, zero HIV and TB discrimination, and zero preventable HIV and TB deaths.
It is only by working together and relentlessly that we can end the co-infections of HIV and TV by 2030.
Today we know more than ever before that it will take the actions of communities themselves to end HIV – It is them who play a pivotal role in the fight against HIV.
It is for this reason that the international theme for WAD 2019 is Communities Make the Difference.
The theme recognises that communities are resilient and are contributing by leading in the response, supporting those infected and affected, and ensuring that the response remains rooted on the ground.
The theme recognises community driven programmes - that nothing about communities without communities - and that empowered communities are able to reach the Global target of 90/90/90.
As KwaZulu-Natal, the 2019 theme has a special relevance for which we take immense pride. The theme was influenced by the 2019 UNAIDS Global Report titled, “Communities at the Centre.” It is subtitled: “Defending Rights, Breaking Barriers, (and) Reaching People with HIV Services.” The report was influenced by the phenomenal success that KwaZulu-Natal has made at Eshowe and Mbongolwane.
The is a positive and encouraging story of community-based approach to HIV testing that links people to treatment and supports them to remain in care. UNAIDS reported that the community-centred approach has achieved the 90–90–90 targets in Eshowe town, rural Eshowe and Mbongolwane ahead of the 2020 deadline.
We applaud the community health workers there, the Doctors Without Borders, and our Department of Health for their successful collaboration which has given the world and KZN so much hope.
Recently in Secunda, Mpumalanga, Health Minister, Dr Zweli Mkhize made a profound statement. He said:
“If the world would defeat HIV and AIDS, that defeat will happen in South Africa. The world is watching South Africa. They expect leadership, determination, commitment and courage.”
And it is abundantly clear that if South Africa has to make AIDS history, our province must take a lead in prevention and stopping new infections since we have the biggest HIV burden in the country.
We need to replicate the success that we have seen at Eshowe and remind our people of the need to know their HIV status, of taking treatment, and preventing new infections.
We wish to encourage the people of KwaZulu-Natal to be proactive in the HIV, TB & STIs response. Let us all make our actions count and take personal and collective responsibility to prevent new HIV infections guided by the National Development Plan Vision 2030.
We cannot win if we do not put communities at the centre of our strategies. The UNAIDS Report shows for instance the crucial role that is being played by lay counsellors in Eshowe in prevention, testing and providing adherence support.
It reveals the difficulties the health care system faces in reaching young men with HIV testing and treatment services.
UNAIDS noted that:
“Lay counsellors, or community health workers, provide services across the cascade of care in both community settings and health-care facilities. They provide HIV counselling and testing, antiretroviral therapy initiation counselling, treatment planning, point-of-care CD4 monitoring and adherence counselling. Between 2012 and 2016, these lay cadres performed the majority of all HIV testing and counselling in the area covered by the project”
Indeed, a poverty stricken and under-resourced district municipality like Umkhanyakude and local municipality like Hlabisa need to take a leaf from the inspiring story of eShowe and its lay counsellors in their efforts to end the pandemic.
OVER 7 MILLION SOUTH AFRICANS ARE HIV+
Ladies and Gentlemen,
South Africa (SA) has the biggest HIV epidemic in the world, with 7.1 million people living with HIV. The country has made huge improvements in getting people to test for HIV in recent years and is now almost meeting the first of the 90-90-90 targets, with 87% of people aware of their status.
The country has the largest ART programme in the world, which has undergone even more expansion in recent years with the implementation of ‘Universal Test & Treat’ guidelines. HIV prevalence among young women in South Africa is nearly four times greater than that of men their age.
Young women between the ages of 15 and 24 make up an estimated 37% of new infections in South Africa each year. HIV prevalence among young women in South Africa is nearly four times greater than that of men their age.
In an attempt not to leave anyone behind, here in KZN, communities are being mobilised through Operation Sukuma Sakhe (OSS). To succeed, leadership at all levels and shared accountability is promoted.
Our research tells us that in a rapidly changing environment, where young people are faced with peer pressure to engage in sex, the need for a new, innovative communication strategy that encourages safe sex is critical.
DISTRICT STATUS ON HIV/AIDS, STIs & TB IN UMKHANYAKUDE AND HLABISA
Ladies and Gentlemen, Umkhanyakude is known as one of the two most deprived districts in South Africa according to the District Health Barometer.
This deprivation derives from high unemployment rates, lack of access to piped water and electricity, many female-headed households with high numbers of children and low education levels.
From 2001 to 2011 the population of UMkhanyakude District increased by 0.9% to 625,846.
Currently, the population of Hlabisa is estimated to be about 38 000 and the unemployment rate is said to be as high as 86%.
Local SAPS also reports that there are about 11 unlicensed liquor outlets. 7 murder cases have been reported this year and only two arrests have been made. From the sexual assault and rape statistics, it is very clear that many of the perpetrators are living freely in the community.
Don’t look away. Silence is not always golden. Report women abusers and rapists before they harm the next person.
We have been appraised by the local leadership of the police about their resource constraints including human resource challenges and a police station that requires a lot of revamping. It is also a tragedy that there is no victim-friendly room to enable women not to suffer secondary trauma and victimisation when they report a crime like rape. Police here have to use their offices, which are also inadequate. This is a matter that the Office of the Premier will take up with the province and national leadership of SAPS.
Ladies and Gentlemen, in 20/19, 182 622 people in Umkhanyakude had HIV. And 25 133 were here in Big Five Hlabisa. In Q1 of 2020, Hlabisa, 6 221 were found to be infected. And in Q2, 2020, it was 6 438 people infected in this municipality.
In 2018/2019, 1 875 people were put on ART treatment. And in Q1 and Q2, 952 people were put on ART in Hlabisa.
Male condoms distributed at facilities during 2018/19 in Hlabisa were 115 020. Female condoms distributed were nearly half at 60 045.
We wish to acknowledge that our Province is experiencing challenges with condom distribution, as we are not meeting targets. This has warranted the formulation of a condom management plan that is being implemented throughout KZN. Development partners and Civil Society have a crucial role to play to ensure the success of this plan.
GBV IN HLABISA
Gender inequality and violence against women fuel the spread of HIV, AIDS, and STIs. It is important that communities come together to fight GBV.
Reported Sexual Assault cases in Hlabisa during 2018/19 were 86. In Q1 and 2 they were 18 and 28 respectively.
There are many cases of sexual assault including rape that remain unreported in communities like Hlabisa. The police report that they also experience challenges in enforcing the law when victims withdraw the cases.
We urge families and communities to support victims of GBV and to assist victims to report the crimes. Police also often struggle to piece the evidence together and to ensure speedy and successful prosecution if victims take long to report. The longer it takes, the greater the chance that evidence will be contaminated.
We must also fight against stigmatising women who suffer abuse, including rape. Police alone cannot win the fight if communities are not at the centre.
We implore councillors, traditional leaders, and religious leaders and youth leaders to work hard in stopping the prevalent myth that those who participate in community policing forums are informers. Unlike under apartheid, this is your government and you must rise to expose criminals in your communities. There is absolutely nothing to be proud about by protecting criminals.
BEHAVIOUR CHANGE PROGRAMMES ADDRESSING THE YOUTH
Ladies and Gentlemen, the district is implementing She Conquers and YOLO (You only live once) focusing on behaviour change for young people between the ages of 15-24 years focusing on:
• Playing it safe and making changes for a healthier lifestyle
• Self-Identity and GBV
• Building self-esteem and confidence
• Assertiveness and boundaries
• Healthy Sexuality and Good Attitudes about sex
• Blesser syndrome
• Safe termination of pregnancy
• Reproductive health
• Self defence
• Economic empowerment
• Styling – image makeover.
• The “My Life My Future Programme” is implemented in all High Schools within the District.
FROM RDP TO NHI
Last Thursday we made these observations in the KZN Legislature:
Since 1994, the ANC-led government has worked hard to transform the racially skewed health sector to benefit all South Africans.
In 1994, the health system was segregated and favouring a white minority, especially those in urban areas. The burden of disease and life expectancy mirrored racial and socio-economic inequalities.
Since 1994, we have been working on achieving a unified, inclusive National Health System drawing from both the public and private sectors. The cornerstone of the RDP vision was a well-functioning Primary Health Care (PCH) functioning at national, provincial, district and community level.
Given our interventions, access to PHC services for all South Africans increased from some 67 million in 1998 to close to 120 million annually by March 2019.The proportion of households who reported using public sector clinics increased from 44.7% in 2004 to 71.5% in 2018.
As a country, we are making good progress with the implementation of universal access to healthcare through the introduction of the National Health Insurance (NHI).
The NHI is a health financing system that will make sure that all citizens of South Africa (and legal long-term residents) are provided with essential healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.
It pools funds to provide access to quality health services for all South Africans based on their health needs and irrespective of their socio-economic status.
The National Health Insurance will go far in transforming the inefficient and inequitable SA health sector to ensure that by 2030, we have attained the UN SDG goal 3 of quality health care for all people.
PROGRESS MADE IN IMPROVING ACCESS TO ANTI-RETROVIRAL TREATMENT AND COMBATING THE SPREAD OF HIV/AIDS
Ladies and Gentlemen,
According to a 2018 HSRC survey, KZN remains at the epicentre of HIV and AIDS epidemic with a prevalence of 27% Despite the Province being the second populous Province in the country, we are making remarkable strides in mitigating the scourge of HIV/AIDS.
Today, South Africa has the biggest HIV treatment programme in the world. More than 1,4 million people on treatment are here in KZN, and we remain committed to end the twin co-infections of HIV and TB by 2030.
Thanks to the success of our HIV-AIDS programme, people are living longer. Mother To Child Transmission (MTCT) of HIV has been reduced, ensuring that we significantly improve child health while reducing infant mortality and under five mortality rates.
ANTI-RETROVIRAL TREATMENT (ART)
Treatment for HIV is available in all our facilities. In cases where there is a shortage, an alternative is offered. The Department of Health in KZN uses an effective stock visibility solution to monitor stock levels. The Pharmacy Directorate issues a list of alternative drugs in case of shortages.
MEDICAL MALE CIRCUMCISION (MMC)
We again wish to thank iSilo for the leadership that he provides in the fight against HIV and AIDS. We applaud him for leading the campaign to have the men of the province circumcised. Circumcisions reduces the risk of HIV infection.
The Department of Health has circumcised more than one million males young and old since April 2010 until March 2019 (1 179 027), with achievement of 215 248 (146%) circumcisions done in 2018/19 against a target of 147 414. This achievement is attributed to the use of the General Practitioner model, MMC implementation partners, and engagement platforms through iSibaya Samadoda in taxi ranks, hostels, Institutions of Higher Learning, and the private sector.
CONDOM DISTRIBUTION:
During the 2018/19 financial year, 111 028 599 male condoms were distributed against a target of 210 000 000; and 3 397 759 female condoms against a target of 6 141 077, which equates to 53% and 55% respectively.
The Province is experiencing challenges with condom distribution, as we are not meeting targets. This has warranted the formulation of a condom management plan that is being implemented throughout KZN. Development partners and Civil Society have a crucial role to play to ensure the success of this plan.
PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV:
The Anti-Retroviral Treatment coverage for pregnant women has improved from 18.7% in 2009 to 98.9% in 2018/19. The Elimination of Mother to Child Transmission (EMTCT) Last Mile Plan target is 99%, which has been achieved.
TB PREVENTION AND CONTROL:
There is a general increase of 81,3% in the TB treatment success rate, while the rate of deaths due to TB have declined over the last financial year, from to 6.7% to 5,4%.
Amajuba, Harry Gwala, UMzinyathi and Zululand districts have consistently reported a high death rate of above eight percent (8%) as a result of late patient presentation to healthcare facilities.
Community TB awareness activities in hot spots were conducted across the all districts, educating communities about TB to increase awareness while championing the importance of lifestyle changes (health promotion and disease prevention) to ensure early diagnosis and treatment.
CONCLUSION
As we conclude, we wish to extend our deepest gratitude to all our stakeholders in the health sector who are working tirelessly to end HIV and AIDS. We also thank the donor community for the important investments that it is making in the fight against HIV and TB.
Much research has been done and we remain hopeful for a cure or vaccine for HIV.
This World Aids Day is occurring a few days after Dr Zweli Mkhizwe launched a new HIV treatment through the new drug, TLV. This is the era of one pill, once a day. The drug has been found to have a rapid, high viral suppression rate, and has fewer side effects.
This will surely improve adherence to treatment.
But it is in the area of changing sexual behaviour that we need to do more to stop new infections. We call on everyone – including our media – to work with government in promoting messages on safe sex.
We again call on all communities to come to the centre in the battle against HIV and AIDS.
Eshowe has shown that it is possible and that it is indeed in our hands to end AIDS by 2030.
Play your part.
Cheka Impilo. Test. Condomise. And protect yourself and your loved ones.
And Let Us Grow South Africa Together!
I thank You!