Anti-Aids activists claim the Health Department has good policies – on paper – but is falling down on implementation.Jim Day reports
ONLY about half of R65-million budgeted for HIV education, prevention and care has yet been used -even while the virus continues to spread alarmingly.
The money, from the Reconstruction and Development Programme (RDP), is a major portion of funds made available to fight HIV. Other finance comes from the European Union and the Health Department’s budget.
Figures from the national and provincial offices of the department’s HIV directorate reveal the reality of what many activists have long claimed: that while programmes and policies now on paper could reduce the spread of the epidemic, the pace of implementation is agonisingly slow.
The R65-million was allocated by the RDP for HIV/Aids programmes in the budget year that ended in March. Of this, R18-million earmarked for strengthening counselling, outreach and community-care services was promised to the provinces, but is still going through bureaucratic processes.
None of the R4,4-million meant for research into care and support has been spent. Only half the R8-million for bringing government departments into the fight has been used.
Rose Smart, head of the Aids directorate, said this week that she expected all the RDP funds to be spent and there was no danger of losing them. She added she was aware that her directorate and many of the provinces were unable to push through HIV programmes as quickly as she would like.
“We’re definitely making progress, but often things take time,” she said, emphasising the need to lay the institutional groundwork before programmes can begin. “These things can’t be rushed.”
Even as directorate officials struggle to strengthen existing programmes and bring new ones on line, Aids activists say other departments and the public remain largely indifferent to the epidemic that figures released last week show is expanding at a horrifying rate.
HIV infection among pregnant women increased 35% last year, to reach 14%. Health officials believe the annual survey of women attending antenatal clinics is an accurate benchmark to study the spread of HIV-infection.
About 2,4-million South Africans are now HIV-positive, up from 1,8 million last year, a one-year increase of 33%. Some 1 500 South Africans become infected each day: 90 000 people are expected to develop full-blown Aids this year.
Although the figures came as no surprise to the experts tracking the epidemic, one official described the numbers as “mind- boggling”.
The latest figures show that efforts to stem the tide in South Africa have simply not been effective, said Kevin Osborne of the National Association of People Living with HIV/Aids.
“Obviously, not enough is being done,” he said. “They’ve got the money to spend, the programmes are designed, and then they get sent to the provinces and nothing happens.”
The Sarafina II and Virodene “debacles” drained time and energy from efforts to implement HIV programmes, he said. Delays had also been caused by the turnover in the directorate’s leadership.
Directorate officials blame delays on late approval of last year’s RDP budget for anti-Aids programmes, “time-consuming tendering processes”, and restructuring of departments.
Officials and activists repeatedly bring up the model of Uganda, which has shown that high-level political commitment to combat the disease can bring down infection rates. That level of commitment is not seen in South Africa, they say.
Phone calls to several organisations and departments that could play a key role in fighting the spread of the disease indicate such a lack of commitment.
The National Union of Mineworkers, for example, does not have an HIV-education programme in place for its members, nor any condom-distribution programme. NUM, described as a relatively progressive union on HIV issues, has no schedule to put any programmes in place, according to Welcome Mboniso, the union’s health and safety coordinator.
Training for high school teachers in anti- HIV education is due to begin this month. They will then launch a nationwide education programme for schoolchildren.
The Welfare Department is only expected to begin evaluating what it can do about the HIV epidemic this month.
The nation’s prison system has been praised for improving its HIV policies in the past year, but questions remain about relatively simple issues like how condoms should be distributed. Presently, prisoners must often ask officials for a condom, a system which discourages their use.
With HIV infection already so high in South Africa, some activists say “we missed the boat” on prevention, and that resources should now be focused on providing the best possible care. Although that view is a matter of hot debate, it is clear that, whatever is done, there will be no quick reversal of the epidemic.
On trial for sleeping with more than 100 women, PAGE 17