DURBAN, 13 June 2017 — Ahead of the 8th SA AIDS Conference, to be held in Durban, on 13-15 June, the South African National AIDS Council (SANAC) is calling on South Africans to support and implement the National Strategic Plan (NSP) for HIV, Tuberculosis (TB) and sexually transmitted infections (STIs). The NSP, a guide for the country’s response to these infections, seeks to reduce new HIV infections by 63% – from 270 000 in 2016 to less than 100 000 by 2022.
South Africa has made exceptional progress in tackling these infections, however HIV, TB and STIs remain national health, social and development priorities. 270 000 people became newly infected with HIV last year, 100 000 of whom were adolescent girls and young women and more than 3 million more people need to receive lifelong HIV treatment. TB is our leading cause of death and large numbers of South Africans have untreated, asymptomatic sexually transmitted infections (STIs).
“Successful implementation of the NSP is critical,” said Dr. Connie Kganakga Acting CEO of SANAC. “We are entering a make or break point that will determine whether we end HIV and TB or whether the epidemics will be prolonged indefinitely.”
The development of the Plan began with a national 18 sector civil society consultation in September 2016 and a 400 participant national multi-stakeholder consultation and it ended with the Plan’s endorsement by the national cabinet in March 2017. In between there was extensive further consultation to solicit the exceptional experience and insight of those living with these diseases, working in the field or researching it. There was also an open call for comments on drafts of the Plan.
The NSP wants 90% of all people living with HIV to know their HIV status, 90% diagnosed with HIV infection to get their antiretroviral treatment and 90% of them to have the virus suppressed. The NSP also aims to eliminate mother-to-child HIV transmission and reduce new TB infections.
The 2017-2022 Plan has adopted a “focus for impact” approach, which will see an intensified focus on districts and locations with high burdens of HIV, STIs and/or TB; on adolescent girls and young women and on tailoring interventions for the key and vulnerable populations so that nobody is left behind.
“The National Strategic Plan is a key anchor in our shared commitment to ending HIV, TB and STIs and needs the full backing of all South Africans,” said Kganakga.
For more information, please contact SANAC Communications Manager Kanya Ndaki 0832986100
Minister of Health, Dr Aaron Motsoaledi,
Deputy Minister of Mineral Resources, Mr Godfrey Oliphant
Deputy Minister of Health, Dr Joe Phaahla,
Deputy Minister of Social Development, Hendrietta Bogopane-Zulu,
UNAIDS Executive Director, Mr Michel Sidibé,
SANAC Deputy Chairperson, Ms Steve Letsike,
Acting Premier of the Free State, Mr Tate Makgoe,
MEC for Public Works and Infrastructure, Ms Dora Kotzee,
Executive Mayor of Mangaung, Cllr Olly Mlamleli,
Chargé d’Affaires of the US Embassy, Ms Jessye Lappen,
CEO of Sibanye Gold, Mr Neal Froneman,
Ladies and Gentlemen,
Dumelang! Sanibonani! Good Morning!
Today, we have come together as a nation to intensify the fight against HIV, TB and sexually-transmitted infections.
We are here to affirm that the dream of an AIDS-free generation is within our reach.
We are here to demonstrate our resolve to build a world free from the devastation of preventable and curable diseases like TB.
We know this is possible because South Africa is blessed with an abundance of leaders in every avenue of life, in every corner of the country.
Our leaders are young and not so young.
They are well known and unknown.
They are men, women and transgender people.
These are South African leaders in heterosexual and same-sex relationships.
They are found in places of worship and in the streets, in remote rural villages and in all spheres of government.
They are our influential sportsmen and sportswomen, artists, media personalities and leaders of youth organisations.
They are mothers, fathers, sisters and brothers.
They are the people who will provide the strong and inspirational leadership throughout society that we need to reduce the burden of disease and advance good health.
Through focused leadership and active citizenry, we have changed the narrative of fear, condemnation and death to a narrative of hope, opportunity and life.
Today, we know that to be infected with HIV and TB is not a death sentence.
We know that our best chance to defeat the co-infections of HIV and TB lies in behavioural change to stop the spread of infection.
We know that prioritising investment in the wellbeing and capabilities of our people is not only morally and socially just – it is a development imperative.
As we launch the National Strategic Plan on HIV, TB and STIs 2017-2022, we ought to bear in mind that that this is a plan that belongs to all South Africans.
It is a plan that invites South African leaders from different walks of life to take action today to end the epidemics of TB, HIV and STIs.
Our new NSP emphasises the need for leadership participation and accountability at all levels to achieve the 90-90-90 targets.
We appeal to you, the champions of our people to make your voice heard and your actions count.
It was former President Nelson Mandela, a global champion of people living with HIV and TB, who said:
“Let us remind ourselves that our work is far from complete. Where there is poverty and sickness, including AIDS, where human beings are being oppressed, there is more work to be done. Our work is for freedom for all…”
Today, we say that for as long as babies and mothers die from preventable HIV transmission, for as long as young women remain vulnerable because they have no work or education, for as long as men are stripped of their dignity because they cannot provide for their families, our work to advance human freedom is far from complete.
Ladies and Gentlemen,
The launch of the National Strategic Plan 2017-2022 is a pivotal moment in South Africa’s response to the HIV, TB and STI epidemics.
It is pivotal because we have made significant progress in several areas.
New HIV infections are on the decline – from 360,000 in 2012 to 270,000 in 2016.
Mother-to-child HIV transmission rates at 6 weeks decreased from 3.6% in 2011 to 1.5% in 2016.
The number of people on antiretroviral therapy increased from 2.4 million in 2012 to 3.7 million people in 2016.
South Africans are living longer thanks to awareness campaigns and improved access to HIV, TB and STI treatment.
We have recorded a steady decline in new TB infections and TB cure rates have increased.
Deaths from TB declined from 41,000 in 2013 to 33,000 in 2015.
This is a pivotal moment in our fight against the epidemics because, despite our successes, we need to significantly expand and accelerate our efforts if we are to make meaningful progress.
We still have a large number of new HIV infections.
About 2,000 adolescent girls and young women are infected weekly.
Tuberculosis remains the leading cause of death in the country.
A large number of South Africans have TB, but are not in the health system.
Ladies and Gentlemen,
To improve outcomes, the NSP calls for a new approach to HIV, TB and STIs.
It directs our efforts and resources to geographic areas and populations most severely affected by the epidemics.
It adopts a combination of interventions that deliver high impact.
It has a strong focus on improving the prevention of HIV infection among adolescent girls and young women because of their extremely high rate of infection.
This effort will undoubtedly be helped by the new treatment regimen for Multi-Drug Resistant TB that was launched earlier today.
This new regimen will reduce treatment time from the current 18-24 months to only 9 months, and is expected to significantly improve the cure rate.
The NSP is premised around eight interrelated strategic goals:
Goal One is to accelerate prevention to reduce new HIV, TB and STI infections.
Goal Two is to reduce morbidity and mortality by providing HIV, TB and STIs treatment, care and adherence support for all.
Goal Three is to reach all key and vulnerable populations with customised and targeted interventions.
Goal Four is to address the social and structural drivers of HIV, TB and STI infections.
Goal Five is to ground the response to HIV, TB and STIs in human rights principles and approaches.
Goal Six is to promote leadership and shared accountability for a sustainable response to HIV, TB and STIs.
Goal Seven is to mobilise resources to support the achievement of NSP goals and ensure a sustainable response.
Goal Eight is to strengthen strategic information to drive progress towards achievement of NSP goals.
The NSP is closely aligned with the National Development Plan, locating the struggle against HIV, TB and STIs within the broader struggle for economic and social development.
These are mutually reinforcing efforts: progress in reducing the burden of disease contributes to development, while faster development improves our ability to address the social and structural drivers of HIV, TB and STIs.
Working together, we seek to reduce TB incidence by at least 30%, from 450,000 to 315,000.
We want 90% of all people living with HIV to know their HIV status, 90% diagnosed with HIV infection to get antiretroviral treatment and 90% of them to have the virus suppressed.
Working with you, we must drastically reduce new infections of HIV by 60% from 270,000 in 2016 to less than 100,000 by 2022.
We want to eliminate mother-to-child HIV transmission.
We are determined to cut new infections among adolescent girls and young women from 2,000 each week to less than 800.
The She Conquers campaign and other similar programmes are already being implemented as part of the effort to reduce HIV transmission and its impact.
She Conquers is focused on decreasing HIV infections, reducing teen pregnancy, keeping young people in school, ending sexual and gender based violence and creating economic opportunities for young people.
We applaud the involvement of the business community in this campaign.
We invite business leaders to work with government and civil society to empower their employees and their families and communities that live in the vicinity of their business operations.
Ladies and Gentlemen,
All sectors of society must contribute to the effort to eliminate AIDS and TB as public health threats.
Our individual and collective actions must count.
If you are sexually active, protect yourself and your sexual partners by consistently using a condom.
Check your HIV status regularly and seek care and support to remain healthy.
Cover your mouth when you cough and get screened for TB if you have a persistent cough.
If you have TB, make sure that you finish your treatment so that you can be cured.
Play your part in ending stigma and discrimination against people with HIV or TB and protect their human rights.
Let us act against patriarchy, gender based violence and alcohol abuse.
Our young people must stay away from drugs and avoid the abuse of alcohol.
We have to use our limited resources wisely and more prudently.
And as we take personal and collective responsibility for our health and the health of our loved ones, we should all be accountable and measure our progress in eliminating these diseases.
We should, at minimum, reach the 90-90-90 targets for HIV and TB by 2020.
This must be the commitment of government, business, labour and every formation within civil society.
The National Strategic Plan that we are launching today recognises that these epidemics are not simply about viruses, bacteria and medicine, but about the society in which we live, the relationships we form, the work we do, the places in which we live, the way we treat each other, the way we treat ourselves, and the aspirations we have for our children and their children.
This National Strategic Plan is about life, how we protect it, how we prolong it, how we value it and how we improve it.
We have it within our means to eliminate AIDS and TB as public health threats.
This was originally published in the January edition of the SANAC newsletter.
How far are we with the finalisation of the new NSP?
It was initially supposed to have been launched on World AIDS Day (December 1, 2016) however, a request was tabled to launch it on World TB Day since TB is the leading cause of death to people living with HIV. Our Health Minister, Dr Aaron Motsoaledi has been instrumental in shining the spotlight on TB at UN level. So, on World AIDS Day we launched a document tabling the Goals and Objectives of the new NSP with the theme, ‘Let Our Actions Count’. This document reflects the lessons learnt from the ending NSP and what helped shape the objectives of the new one. The steering committee is now finalising the objectives of each goal of the NSP 2017-2022.
What were some of the challenges during the development process?
We wanted to be as thorough as we possibly can non the new NSP and so we wanted to interrogate everything and properly scrutinize the current data. We also wanted to ensure that everyone is heard. As you can imagine, consolidating input from all stakeholders was a bit of a challenge. Also, we’re currently operating under trying economic times and considerable financial constraints so things haven’t been easy. There were also a few technical challenges which posed the questions such as, ‘Do we know enough? Are we going to adequately address all the issues before us and, how far can the NSP go’, because it is affected by many other challenges in our society. For example, we advise young girls against “blessers” but, is the environment in which they live in favour that? We need to be cognisant of what drives them to blessers in the first place and deal with those issues.
What were the highlights?
The consultations held in September last year were very helpful, especially the 2-day civil society consultation which was well attended. We held successful engagements that really helped inform a lot of decisions going forward. I really appreciated the willingness in people to engage. The community voices were incredibly interesting. We also learnt a lot about what people are doing out there in response to HIV, TB and STIs.
What excited you the most in the process?
The emphasis on impact! What are the best choices to make that will yield the desired outcomes?! What does the data and evidence we have taught us going forward and, how will that help us reach our targets?! The interesting discussions we held with civil society and the important role they play.
The National Strategic Plan (NSP) outlines the strategic framework for a multi-sector partnership to accelerate progress in reducing the morbidity (illness) and mortality (death) associated with HIV, TB and STIs.
The NSP 2017-2022 – which leverages lessons learned from public health gains made under the NSP 2012-2016 – is the product of an extensive collaboration involving national, provincial and local governments; civil society; the private sector; academic experts; multilateral institutions; development partners and other stakeholders.
This is a public working draft of the NSP for HIV, TB and STIs 2017-2022 for comment. It has been developed under the guidance of the NSP Steering Committee taking into consideration all the inputs from the sectoral and national Stakeholder Consultations.
SANAC Chairperson Deputy President Cyril Ramaphosa has called on all South Africans to make their views heard on the new National Strategic Plan (NSP) on HIV, TB and STIs. Ramaphosa was speaking at the SANAC plenary held in Pretoria on 11 November.
The NSP is the strategic guide for the country’s comprehensive response to HIV, tuberculosis and sexually transmitted infections. It is revised every five years. With the current NSP on HIV, TB and STIs (2012-2016) coming to an end in December, the focus has been on the development of the NSP for the next five years – covering the period 1 April 2017 to 31 March 2022.
The new NSP is set to be launched on World TB Day (24 March), since TB is the leading cause of death in people living with HIV.
“I urge all of you to take part in the NSP development processes. Let us ensure that the various constituencies that we represent also contribute their ideas to the NSP. Working together, we will end AIDS by 2030.” – SANAC Chair & Dep. President Cyril Ramaphosa
Legalising sex work and protecting adolescent girls and young women also took centre stage at the plenary.
It was unanimously agreed that sex work needs to be redefined in order to address the intersectional challenges it presents against HIV response efforts. “We need to redefine sex work to include those who are not selling sex on the streets per se but are still having sex for money,” said Vuyokazi Gonyela of Section 27.
The increase in new infections among adolescent girls and young women means that the country needs a smarter HIV prevention approach. Statistics indicate that 2000 adolescent girls and young women are infected with HIV per week. Current popular trends among young women such as having “blessers” and “sugar-daddies” remain a contentious issue.
“We need to address the issue of blessers in this discussion (about the upcoming NSP 2017-2022),” said one delegate at the plenary.
Lessons from AIDS 2016
Ramaphosa said hosting the International AIDS conference in July this year, left South Africa better equipped to respond to HIV and TB.
“As a country, we emerged from the conference inspired, empowered and far better equipped to confront the many challenges we face. We had much to share and learn about policy, programmes, science, research, funding and social mobilization. Many of the lessons from AIDS 2016 are being incorporated in our new National Strategic Plan (2017-2022),” said the Deputy President.
Opening the conference on the birthday of the late former president Nelson Mandela, was a significant moment, Ramaphosa noted. “Inspired by Madiba’s moral and political leadership, we were united in our message that it is in our hands to end AIDS in our generation.” Thus the theme for this this year’s World AIDS Day, ‘It is in our Hands to end HIV and TB’.
The plenary was also attended by civil society representatives, researchers as well as Minister of Women Susan Shabangu and Minister of Health Dr. Aaron Motsoaledi.
SPEECH BY DR GWEN RAMOKGOPA, CHAIRPERSON OF THE SANAC TRUST, AT THE NATIONAL NSP STAKEHOLDER CONSULTATION 29 SEPTEMBER 2016
The Minister of Health, Dr Aaron Motsoaledi
The Deputy Chair of SANAC and Chairperson of the Civil Society Forum
Fellow Trustees of the SANAC Trust
Ladies and gentlemen
The development of the National Strategic Plan for HIV, TB and STIs for the period 2017 to 2022 is one of the most important tasks of the SANAC Trust and it needs to be done in a way that ensures all stakeholders agree with the goals and objectives stated in the Plan and develop a sense of ownership for this Plan for the next five years.
It is important to reflect on the history of the HIV response in this country as in doing so it becomes abundantly clear how important it is to have a National Plan that is owned and supported by all stakeholders.
The miraculous turnaround of the AIDS response that we have seen over the last decade is undoubtedly linked to the last two national strategic plans. The breathtaking rollout of antiretroviral treatment can be traced back to the second NSP that covered the period 2007 – 2011. This NSP called for the national scale up of antiretroviral treatment as it main goal. The Plan would not have succeeded if it were not for the extensive consultation and negotiation that took place within the SANAC structures during 2006. If the Plan was supported only by government and not by civil society then it would not have made as much progress as it did over those five years.
The NSP 2007 – 2011 also saw the massive HCT campaign during which more than 15 million South Africans tested for HIV. This led to a massive surge in the number of PLHIV initiating treatment. A clear articulation of the goals of the NSP led to all partners, including the massive PEPFAR programme, supporting government’s rollout of antiretroviral treatment.
The same can be said for the 3rd NSP covering the period 2012 – 2016 which set ambitious goals for treatment and PMTCT but also set goals for prevention of HIV and a fifty percent reduction in TB incidence and mortality. Both these plans led to a substantial increase in domestic funding for HIV and TB responses.
In development the next five-year plan it is important to build on the successes of the past and to improve upon those areas where progress was slow.
The Enhanced Progress Report published by the M&E Unit of the SANAC Secretariat in May this year provides a clear analysis of what has worked and where we need to do more over the next five years. The report shows that we have more than 3 million people of antiretroviral treatment and the MTCT rate is well below the 2% target set in the NSP. The government and especially the Department of Health must be congratulated for that. So must all the NGOs who have been supporting the rollout at clinic and hospital level.
The report points out that we did not reach the target to reduce new infections by 50%. This is extremely concerning for all of us and it is widely recognised that much more needs to be done to reduce the number of new infections especially in young women where incidence is higher than 3% in most high burden communities. I would like to emphasise that whilst we focus on young women and certain key populations, new HIV infections are high across the board and no target group can be considered to be low risk. Therefore, prevention must be across the board.
Although we did not meet the very ambitious targets set for TB there are definite signs of progress and there has been a complete revolution with the use of geneXpert in the diagnosis of drug resistant TB.
One of the most neglected areas of the NSP has been the diagnosis and treatment of STIs. The SANAC Trust has discussed this and identified the need to invest greater resources in the management of STIs. The zero draft of the NSP that is under discussion at this stakeholder consultation has clearly identified the need to address all aspects of HIV prevention and treatment as well as TB and STIs. The challenge will be in the selection of priorities for programmes across the three epidemics. There is only a limited amount of resources available and whilst the plan needs to be aspirational it also needs to be realistic and implementable. It is important that we draw on the tools that we have such as the Investment Case to guide the choices we make and that we should make together.
Consensus building is a difficult goal to achieve but it is essential that we invest the time and resources to create the opportunity for all voices to be heard in a meaningful way. The Secretariat has been systematic in putting together the consultation process and the evidence of this consultation.
One of the major roles of SANAC is to build consensus as I have stated before and the consultation about the development of the NSP is one of the most important processes on the SANAC calendar. It happens every five years and the Trust is committed to raising the resources needed for this consultation process. The Trust has raised R8.9 million for the consultation process so far and has received support from the WHO, Gates Foundation, UNFPA and GIZ. As Chairperson of the Trust I would like to thank these partners for their support.
So far there have been major consultations with civil society, government, the private sector, development partners and public health specialists. We understand that civil society sectors and the government sector have requested further consultations. The Trust is working with the Secretariat to raise the additional funds required for these further consultations. I would like to thank Steve Letsike, Dr Nono Simelela and Dr Yogan Pillay for their assistance in raising additional funds. I also met with the Deputy President who has assured me of his support for raising additional resources.
I look forward to consultation that will take place over the next two days. It is important that the discussion is robust and open and that all stakeholder views are expressed in a constructive manner and in a way that is objective. It is important to choose priorities and to ensure that our inputs are grounded in the evidence and that recommendations are practical and realistic.
We have made great progress to date and what we decide to include in the next NSP will give us the results we need to be able to control the three epidemics in the next five years.
The zero draft of South Africa’s next National Strategic Plan on HIV, TB, STIs is being shared for review and comment in the midst of ongoing national consultations and consideration by technical working groups. This version is informed by consultation and research to date, while remaining open to forthcoming inputs. The content is not comprehensive nor is it finalised; key targets and priority actions are still being discussed. This is a strategic document, with detailed thematic monographs which accompany the final product. Operational and implementation plans will be developed at a later stage. The NSP development team welcomes feedback of any kind on the zero draft at this stage.