THE COJ RESPONSE TO HIV/AIDS

CITIES NETWORK MEETING

01 November 2004Meisie Lerutla & Khosi Mashego

Table of Contents

1. Background/Introduction2. HIV & AIDS Strategy – Workplace and

Community3. AIDS Plan – Goals:

3.1 Reducing New Infections3.2 Reducing the Impact of AIDS3.3 Organise the AIDS response

4. Partnership Against AIDS5. COJ – HIV & AIDS Plan 6. Factors Driving the Epidemic7. Progress to date8. Summary/Conclusion

1) Introduction/Background• AIDS Plan developed by

o Inter-sectoral Planning Teamo Regions/UAC’s/Departmentso Gauteng Health Department

• Plan addresses overall AIDS Plan for COJ and Civil Society sectors and the workers

• The AIDS Programme is located in 3 departmentso Health: community and clinicso Corporate: Workplace AIDS Programmeo Social Services: Welfare related issues

• Budget mainly drawn from COJ, GHD

2. Factors Driving the Epidemic

• Mainly heterosexual transmission

• Unemployment – 37% COJ residents

• High levels of Commercial Sex Workers (including child prostitution)

• Illiteracy – 7% COJ residents are completely illiterate, 29% of adults have matriculated

• Low status of women, women comprise 43% of the working population

• 42% of the population is under the age of 24

• High levels of STI’s

Factors Driving the Epidemic (cont..)

• Women infected at younger age than men (10 years earlier than men)

• Single sex hostels – 23

• 22% of Johannesburg residents stay in informal dwellings

• 65% of households are headed by one person

• There are only 35 cemeteries

3. HIV/AIDS StrategyMobilisation & Communication

PREVENTION

• Education• Services

CARE “COMPREHENSIVE CARE• Support of people with AIDS• Health Care Services• Affected families & Orphans• System for coordination &

referral

ORGANISATION OF THE AIDS PROGRAMME Workplace and communityAll departments & sectors

MUNICIPAL PROVINCIAL

HIV/AIDS Strategy(Cont…)

MOBILISATION & COMMUNICATION:

To mobilise involvement and increase understanding. Reaches workers and communities through training, cultural activities, campaigns, role-models, leadership and media. Communicates progress with the programme. The content reflects the key areas of the programme: Openness, Prevention and Care; The Partnership against AIDS.

HIV/AIDS Strategy (Cont….)

PREVENTION

Education – to change behavior:

• Youth Strategy: life skills in schools. Peer education for out of school youth and on campuses.

• Peer education for special risk settings (mining, hostels, sex-workers, prisons)

• Workplace Programmes - EAP

• Door to door education campaigns

• Prevention of substance abuse & sexual violence

Services – in support of behavior change

• STI management (syndromic management)

• Condom Supply (free male and female condoms)

• Voluntary testing with counseling (VCT)

• Reduce MTCT• PEP for needle-stick

and sexual assault

HIV/AIDS Strategy (Cont….)

Support of people with AIDS

• Community support (women, religious, civics, healers, workplace programmes)

• Support groups• Counseling and VCTHealth Care Services• Comprehensive care for

HIV/TB/AIDS- clinics & hospitals/OHASA

• PMTCT/ARV treatment • Palliative – Home Care &

Hospice Beds• Immune boosters

Affected workers/families & Orphans

• EAP/Social support• Orphan support -• Welfare grants & social

services• Indingency policy

water/housing services/food

• Poverty alleviation programmes

SYSTEMS FORCOORDINATION AND

REFERRAL

• CARE- “Comprehensive Care”

HIV/AIDS Strategy Organisation of the AIDS Programme (All departments & sectors)

MUNICIPAL• Mobilisation of workers

and communities• Coordinated plans• Monitoring of Services -

SDP• Data base of services• Tracking progress

PROVINCIAL• Leadership• Coordination• Capacity Building• Strategy• Provincial Plan• Policy• Guidelines• Research• Development• Monitoring & evaluation

ORGANISATION (roles & responsibilities)

4. Partnership Against AIDS•CCentre

PoliticalJAC

Official•HHealth•SSocial Services•CCorporate (OHASA)

•RRegions Ward Committees (Health)

Regional Coordinating Committees

Also:•H Health Precinct/COE (Hillbrow)•V Vusabantu (Mofolo)• Hostel Project (George Goch/Jeppe/Denver & MBA) – Private Hostels: LTA, Murray Roberts & SAP Hostels•D Domestic Workers

Wits/RHRU, GHDCity of ParisRHRU

CHB Perinatal Research Unit & SAMP (S.A. migration project)

Aims Aims

• To create a platform to review matters related to HIV/AIDS in the City of Johannesburg.

• To enjoin all the City’s inhabitants in the war against HIV/AIDS and to visibly demonstrate the City’s support for those infected and affected with HIV/AIDS.

• To actively review, monitor and evaluate the intersectoral response to HIV/AIDS in the City.

• To advise the City of Johannesburg on ways and means of improving impacts of the HIV/AIDS Programme.

JOHANNESBURG AIDS COUNCIL

FUNCTIONSFUNCTIONS• To assume an advocacy role that will highlight

(continuously) issues related to prevention and care of those infected and affected by HIV/AIDS.

• To support communication efforts around all issues related to HIV/AIDS that are disseminated by the HIV/AIDS and STI Programme around prevention and awareness.

• To contribute materially towards the training of “AIDS Activists”, Home based care initiatives and other outreach campaigns.

• To jointly plan and conduct major campaigns in a calendar year such as – valentine’s; candlelight; World AIDS Day, etc.

• To coordinate and strengthen the partnership with the Gauteng AIDS Council and the National AIDS Council.

JOHANNESBURG AIDS COUNCIL (Cont..)

5. COJ – PlanObjectives for 04 / 05

• To increase availability & accessibility of condoms community/workers

• To increase condom usage targeting vulnerable groups & areas

• To capacitate health professionals in the COJ so as to provide an effective HIV/AIDS & STI service

• To capacitate workers to deal with the epidemic/peer education & support

• To capacitate CBO’s, NGO’s in the COJ to support the implementation of the HIV/AIDS programme

• To promote & increase access to VCT on site testing• To promote effective coordination of HIV/AIDS activities• To create awareness & increase level of understanding in

the community• To mobilise the community involvement & strengthen

partnerships against HIV/AIDS & STI• To provide Regions with uniform policies, SOP’s & guidelines• To develop an effective, efficient monitoring & evaluation

strategy of the HIV/AIDS & STI programme

6. Progress to date

• Preventative Serviceso + 3 million free male condoms suppliedo STI services in 95% of clinics (syndromic

management)o PMTCT services all hospital and health centers

(large clinics)o PEP for victims of sexual assault in specialised

services (CHB;JHB; Hillbrow)o VCT services at 23 COJ clinics

• Workplace programme• Health care

o 90% of clinics have infrastructure to provide care for HIV infected persons

o Need to improve clinical training of PHC nurses and doctors in treatment of AIDS

o TB cure rates in COJ improving slowly but still high average (+56% cure rate)

Progress to date (cont…)

• Social impact of AIDSo Growing more problemso COJ has approximately ?20-25000/50,000 orphans

o Access to grants still a problemo Burials have increased o Hunger, poverty, abandonment, difficulties with

burials, social distress, school attendance Note: food parcels, free uniforms, school

nutrition programme (Provincial Govt)

7. ARV’s therapy in the management

of HIVCapacity needed

• Intensive training of health professionals (58) • Doctor support inadequate– prescription of drugs• Laboratory to monitor CD4 and viral loads• Pharmacy - reliable drug supplies, safe storage • Community education – public awareness,

understanding, compliance

NB. COE – An opportunity for training of staff

8. Review of the AIDS Strategy

• Well developed but needs proper, effective implementation with monitoring, evaluation and relevant research

• Institutional capacity in department, NGO’s and communities need to be developed rapidly

• COJ have large scale implementation programmes with GHD – but needs stronger, better coordination and communication of the AIDS effort across and within department

9. AIDS Plan 2004-2006

• Reduce new HIV infections & the overall HIV infection rate

• Reduce the impact of AIDS on people living with HIV, their families & society as a whole

• Organise an effective AIDS response involving all government departments & civil society sectors

AIDS Plan 2004-2006 (cont…)

• Reduce the impact of AIDS on people living with HIV, their families (and society)

• Increase openness on AIDS• Provide access to

comprehensive TB/HIV/AIDS care in 100% of local areas

• Strengthen health systems management

• Assess the feasibility of adding ARV treatment to the package of AIDS care

• Extend access to comprehensive orphan support services to 100% of local areas

• Increase access to poverty relief

• Develop methodology for monitoring & evaluation of comprehensive care

AIDS Plan 2004-2006 (cont…)

• Organise an effective AIDS response involving all government departments & civil society sectors

• Organise all departments & sectors in a Partnership against AIDS

• Monitor & evaluate implementation of the AIDS strategy

• Strengthen capacity of departments & society sectors. Strengthen Workplace AIDS programme

• Establish local Inter-Sectoral AIDS programmes

• Coordinate & communicate the AIDS programme

AIDS Plan 2004-2006 (Cont...)GOALS• Reduce new HIV

infections & the overall HIV rate

OBJECTIVE• Improve understanding of

HIV risk, transmission & prevention amongst youth & general public & workers

• Reduce risk behaviour through implementing effective educational programmes for specific groups:o Youth o People in special risk

settingso Workplace AIDS

Programmes• Provide accessible, effective

serviceso Free male condoms/some

female condomso An STI service

10) Conclusion• Workplace Programme- All departments (and UAC’s) have HIV/AIDS

“champion”- Intensive programme in all Council Departments (and

UAC’s) familiar with workplace policy- Anonymous (voluntary) testing programme to all

Council employees (politicians and workers)- Availability of ARV’s to staff memebrs who disclose

(note confidentiality issue!)- Develop/strengthen EAP (employment Assistance

Programme) in COJ• Social Development- Strategic Plan for COJ to address issue of orphans,

(orphanages) child headed household- Improve community programme