Agreement to Strengthen HIV and AIDS Programme

Tonight, we celebrate the grant given to the Western Cape Provincial Department of Health by the Global Fund to Fight AIDS, TB and Malaria for the first two-year phase of a five-year programme to strengthen and expand our already comprehensive HIV/AIDS programme, totals US$ 15.5 million (approximately R100 million) . We will also hand over cheques to 28 organisations helping us in this regard.

Since its creation in January 2002, the Global Fund has grown to become the world's largest funder of programmes to fight Aids, TB and Malaria which together kill more than 6 million people each year. The Fund is a public private partnership established under Swiss law, and governed by an international board of 23 members supported by an 80 person secretariat based in Geneva. I was privileged to meet Global Fund Executive Director, Professor Richard Feachem, during a visit to Britain earlier this year. The Manager of the Fund Portfolio in Africa is Mr. Duncan Earle.

By the end of 2003 the GF had approved 227 grants totaling US$ 2.1 billion in 124 countries of which 60% was earmarked for Aids programmes. Currently only two percent (2%) of its funds comes from the private sector and the remaining 98% from governments. A key principle of GF's approach to funding is "additionally" - meaning that its resources complement but never replace budgeted funding. In this regard, our Health Department budgeted R90 million for HIV and Aids programmes in the current financial year (this excludes monies budgeted for the care of patients in our hospitals).

The harsh reality is that we have yet to reach a turning point in the spread of HIV in our province The 2003 National and Provincial HIV Antenatal Survey in the Western Cape revealed an HIV prevalence of 13.1% among pregnant women attending public health antenatal clinics. This is up from 12.4% in 2002. While this is not a significant increase, we should be concerned.

District-level surveys showed that the HIV epidemic is spreading and maturing at various rates at local level. Overall the survey indicates sub-epidemics at various stages of development in the districts surveyed with the prevalence ranging from 1-28%. Districts with the highest HIV prevalence were Gugulethu/Nyanga (28.1%), Helderberg (19.1%), Khayelitsha (27.2%), Oostenberg (16.1%), Caledon Hermanus (14.2%) and the Knysna/Plettenberg Bay (15.6%) districts.

Other key findings were:

• In 2001, only 6 (24%) of the 25 health districts reported a prevalence of greater than or equal to 10%, whilst in 2003 , 13 (52%) of the 25 districts reported HIV prevalence of greater than or equal to 10%.
• A rapid rate of increase in urban settings, where over 65% of the population reside.
• The HIV prevalence in the under 20 age group (proxy for new infections) has increased consistently over the last eight years.
• The HIV prevalence is highest amongst younger women and continues to increase rapidly amongst 15-24 year old women.

It is clear from the evidence provided by this survey that by far the biggest risk group in our province is the under 20 age group. A finding, that supports what we are doing here tonight: putting more planning and resources into prevention and care programmes targeting the youth and women. It also confirms that we need to continue with intensive preventative strategies such as improving Sexually Transmitted Infections screening and management, particularly at family planning clinics, and promoting Voluntary Counseling and Testing uptake, particularly among the youth.

Currently, close to 5 000 people are receiving ARV treatment at 25 sites throughout our province. By early next year we will have 36 ARV sites accredited and operational in the Western Cape.

Clearly, the fight against HIV/AIDS is far from won. I believe that coalitions - such as the coalition that we represent here tonight, uniting government, the Global Fund, NGO's, public leadership and common purpose - are our best hope.

This grant by the Global Fund - my sources tell me it is the biggest single grant received by any department in the history of the Western Cape - represents an enormous step forward in the fight against HIV and Aids our province. For one thing, it will place us in a position to provide ARV treatment for everybody. It is only the beginning of a program that will see our Province delivering on more treatment, more care and more prevention in the fight against HIV and Aids. Approval by the Global Fund of the second three-year phase of the grant programme is dependent on the achievements of the Department and its programme partners during the first phase of the programme.   The total value of the five-year grant programme will come to US$ 66.5 million (approximately R430 million at the current exchange rate).

It is also a huge boost for South Africa, as the application for this grant was part of a national application approved by the South African National Aids Council and signed by Deputy President Jacob Zuma. All of us are in this battle together and we have the commitment, expertise, infrastructure and enthusiasm to ensure that the grant programme is successfully implemented.

Tonight, with the support of the Global Fund our Province are joining hands with 28 NGO's and CBO's to provide the knowledge and education that increase awareness and help reduce the fear of AIDS; the training and skills that slow its spread; the medicines to slow its development; the palliative care that is desperately needed and, most importantly, the financial support that underpin all of the above.

In this regard, the four major objectives of the grant programme that is being announced at this exceptional event tonight include:

• Strengthening the current HIV prevention effort by expanding a peer education programme among youth. The GF funding will allow us to take this programme to all 320 public secondary schools throughout our Province in the next year;
• Strengthening community based responses to the HIV/AIDS epidemic through community mobilisation and the development of local projects to promote awareness, reduce stigma and discrimination and address local effects of the epidemic such as care for orphans and food security;
• Strengthening an already comprehensive treatment programme through the expansion of the provision of antiretroviral treatment, providing funding for ARV treatment to an estimated one third of eligible patients in the province (ensuring treatment for all); and
• Strengthening palliative in-patient and home-based care services by expanding the already existing network of hospice facilities and their linked home-based care services (effectively doubling this service over the next two years).

Implementation of the grant programme is the collaborative responsibility of the Department and a large number of partners from provincial and local government and from the non-governmental sector.   The programme will provide a much-needed funding boost to the non-governmental sector in the Province.

• The Peer Education Programme will be implemented through the Provincial Education Department's HIV/AIDS Unit, working with 10 non-governmental organisations including Lovelife.   Virtually all of this programme's funding over the first two-year phase (R12.5 million) will be channelled to the non-governmental partner organisations.
• The Community Based Response Programme will be implemented through the Cape Town Municipality and the five District Municipalities in the province.   The programme will channel R11.6 million over the two-year period to community-based organisations for the implementation of local projects throughout the province.
• The Global Fund grant will be utilised to fund the antiretroviral treatment of patients at six of the province's treatment sites in the first two-year phase of the programme;
• The Site B, Nolungile and Michael Mapongwana clinics in Khayelitsha where the programme is implemented in collaboration with Medicins Sans Frontieres;
• The Gugulethu and Masiphumelele clinics where the programme is implemented in collaboration with the Desmond Tutu HIV Foundation; and
• The Crossroads clinic.
• The Palliative Care Programme will be implemented by 14 non-governmental organisations, supported by the Hospice Association of the Western Cape.   R17 million will be channelled to these non-governmental organisations over the two-year period.

In going forward, I believe an important message to all of us must be that in the fight against AIDS, there should be no competition. Organisations must share information and best practices so that the greatest benefits reach the greatest number of people. We must work proactively with our medical and healthcare professionals to develop strategies to prevent infection. We must educate our own people too. HIV and AIDS must not be allowed to become a tool of discrimination in our communities and work places.

The role and achievements of the Province in the fight against HIV and Aids have been recognised by the Global Fund in the confidence which they have placed in the Province to successfully further expand and strengthen our Programme. We are placing that same confidence in the organisations present tonight. Let us work together to make this province a HEALTHY HOME for all its people.

Contact: Pierre Uys   082 455 5144