Stuart Hess
The new head of the Department of Health’s HIV/Aids/sexually-transmitted diseases (STD) directorate has vowed to kickstart the organisation’s stumbling campaign, pursuing a strategy based on greater co-operation within the government.
Rosemary Smart, a 48-year old former nurse, was appointed to the post on December 12 ‘ some six months after her predecessor Quarraisha Abdool Karim resigned.
The directorate has been stung by criticism that it lacks leadership and drive. Morale among staff has been drained by the Sarafina II episode.
Groups involved in the fight against the Aids virus have also accused the directorate of straying on to their turf, while failing to provide a clear lead.
In an interview this week Smart said she planned to close the door on the mistakes of the past. ‘Sarafina II has been damaging to the Aids programme, but I believe that there is sufficient goodwill to put it behind us and move forward on the important issue of tackling the epidemic,’ she said.
Sarafina II, she added, could have been avoided had the directorate followed the correct procedure and ‘not tried to rush the ‘R14,2-million project.
The programme in 1997 will concentrate on all stakeholders developing a common understanding of the national Aids plan. This will seek to overturn the idea of an ‘alleged’ lack of political will behind the campaign.
Directorate figures show the number of people in South Africa infected with HIV rose to 2,2-million this year from 1,8-million in 1995. Heterosexual transmissions account for an increase of 1 000 new infections daily.
‘It would be naive to believe that the epidemic can be halted in its tracks or even appreciably slowed down in the short term,’ she said.
‘There is a growing realisation that Aids is not a health issue, but has ‘the potential to impact on all sectors of society. As ownership of the ‘problem increases there will be ‘an associated increase in support from political and other leaders.’
An inter-departmental committee will meet early next year to provide a forum to create a ‘united response by government to the epidemic’, Smart said.
Among the major issues the directorate will seek to tackle is that of confidentiality. Department of Health director general Olive Shisana, who oversees the directorate, has already opened the debate, arguing earlier this month that the question of confidentiality should be reviewed if the fight against the spread of the virus was to be stepped up. Her comments earned a sharp rebuke from the African National Congress and Aids activists.
Smart said the issue was one area where policy development was needed.
Confidentiality was also one of the key factors affecting the treatment offered to pregnant mothers who are HIV-positive. She believed that by testing in order to protect the baby, doctors may come into conflict with the mothers’ right to privacy.
Administering infected mothers with the drug AZT during pregnancy and to infants immediately after birth can reduce the transmission of the virus by 70%.
‘However, the department recognises certain policy and ethical problems with the provision of AZT because the use of this treatment requires that pregnant women be tested for HIV,’ said Smart.
The efficiency of AZT when administered with a drug called 3TC is being tested at Baragwanath Hospital. ‘Until conclusive results are known, making this combination available will not be considered by the department,’ she said.
Smart said the Health Department was ruling out, for now, subsidising such combination treatment, given the cost of ‘R70 000 to R95 000 a year per patient.
Future plans to subsidise treatment will be guided by research currently under way across the world.
‘The results of the research will have to be interpreted and implemented within the context of the available health budget,’ said Smart. ‘Demands for such treatments will have to compete with other health issues.’