SYNOPSIS OF THE ACCELERATED PREVENTION STRATEGY

							                  SYNOPSIS OF THE ACCELERATED PREVENTION STRATEGY


Introduction:
South Africa has a generalised epidemic which predominately affects young sexually active adults with a
reported 30.5% HIV prevalence amongst women attending HIV antenatal clinics in 2005. The Western Cape
antenatal HIV prevalence at 15.7% is relatively lower compared to the rest of the country. This implies that
the province has a window of opportunity to intervene and turn the course of the epidemic around through
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swift and intensive prevention strategies. The 55 session of the WHO-AFRO Regional Committee that was
held in Maputo in August 2005 declared 2006 a “year of Accelerated HIV Prevention in the African Region”.
The National commitment to work across all sectors to develop a joint strategic plan (HIV & AIDS and STI
Strategic Plan for South Africa, 2007-2011) provides a solid platform to implement an accelerated and
comprehensive response to HIV and AIDS, in this province.


The Western Cape Department of Health has put into place various programmes and interventions. For the
period April 2006 to Sep 2006, 160 000 people were tested through the Voluntary Counselling & Testing
(VCT) programme, the transmission rate from mother to baby in the prevention of Mother to Child (PMTCT)
programme has decreased to 5.9% and 22 million male condoms and 194 000 female condoms were
distributed in the Western Cape. The Peer Education programme had 6 848 badged peer educators in place
at 194 high schools in the province by June 2006. The Department acknowledges that more should be done
to prevent new infections in the years ahead, especially in light of the escalating need to provide ART to
those in need, and the global consensus that prevention and treatment are interdependent.


One of the key elements needed to turn the epidemic is modifying sexual behaviour. Numerous studies have
consistently shown that having adequate and appropriate knowledge does not translate to behaviour
change. The key challenge across all sectors is to better understand what interventions, at individual level,
are likely to lead to sustained behaviour change, especially in the 15 to 24 yr old age group. International
best practice illustrates the following key principles for effective prevention programmes: i) promotion,
protection and respect of human rights; ii) all programmes should be differentiated and locally adapted; iii)
prevention actions should be evidence-informed; iv) all prevention programmes should be comprehensive in
their scope; v) HIV prevention actions should be implemented as long-term strategies; vi) programmes
should be implemented at large scale, coverage and intensity; vii) the intended beneficiaries of HIV
prevention should participate at community level for optimal impact. (Adapted from UNAIDS 2005,
intensifying HIV prevention)


To a large extent the success or failure of this accelerated HIV prevention strategy will depend on credible
„champions‟. The voices of credible leaders are going to be crucial. This comprehensive strategy requires
that all sector leaders promote its various components to their various audiences. A comprehensive HIV
prevention strategy has to acknowledge and address gender inequality. Empowering women in the response
to the HIV & AIDS epidemic has to include changing gender norms and relations, including a campaign
against gender-based violence. An important element of expanding access to HIV prevention is
communication with the general public. All those who need accurate information on HIV & AIDS should get it
in appropriate ways so that individuals and groups can act on it.
Strategic Objectives & targets for HIV prevention, treatment, care and support:
i)    Reduce HIV prevalence in young people between 15 and 24 years, by at least 25% by 2010;
ii)   Reduce the transmission of HIV from mother to baby to < 5% by 2 yrs in all HIV +ve mothers, in by 2010;
iii) Provide anti-retroviral treatment to >80% of those needing treatment in the Western Cape by 2010;
iv) Provide 80% of orphans and vulnerable children with access to basic services by 2010;
v) Provide access to home community based care to >80% of those in need of care by 2010.

Supportive Objectives for the Prevention Strategy:
i)    Achieve annual VCT coverage of 15% of adults >15 yrs of age by 2010.
ii)   Provide access to accurate HIV & AIDS information to 90% of youth aged 15 – 24 yrs by 2010.
iii) Delay age of sexual debut by 1 year amongst Western Cape youth by 2010.
iv) Increase annual male condom uptake to 100 condoms per adult male >15 yrs of age by 2010.
v) Increase annual female condom uptake to 10 condoms per adult female >15 years of age by 2010.
vi) Increase STI partner treatment rate to 50% by 2010.
vii) Provide 80% of new sexual assault victims with full course of PEP by 2010.
viii) Provide access to pMTCT service to 100% pregnant women by 2010.
ix) Provide >90% uptake of anti-retroviral regimen in HIV +ve mother/infant pairs.
x) Reduce HIV transmission from mother to infant to <3 % by 6 weeks post-partum.
xi) Reduce mixed feeding to <10% in HIV +ve mother/infant pairs by 2010.

Western Cape Plan:

a) Communication:
It is recognized that a comprehensive communication strategy is essential in order for the whole prevention
strategy to succeed. This should include information about the comprehensive HIV & AIDS strategy in this
province and information about availability of services across the various sectors. Particular attention should
be paid to the following specific prevention messages: i) reducing the number of concurrent partners; ii)
reducing the exploitation of younger women by older men; iii) increase age of sexual debut; iv) increasing the
use of condoms.
b) Targeted interventions:
There will be additional concentration upon achieving behaviour change amongst specific high-risk groups in
the Western Cape. Specifically these groups will be: i) younger women and older men; ii) men having sex
with men (MSM), iii) commercial sex workers, and iv) injecting drug users (IDU).
c) Peer Education in schools:
With a view to scaling up prevention activities for school-going youth, the Departments of Health and
Education have contracted 15 locally based NGOs with experience in the field to implement a standardised
peer education programme in schools. The programme‟s aim is to delay sexual debut, decrease partners,
increase condom, encourage abstinence and to encourage early sexual health seeking behaviour (as
appropriate). The Province is committed to expand the school-based interventions.
d) HIV Treatment and Prevention:
ARV treatment can generate great benefits for individuals, but it may also generate considerable community
benefit by reducing secondary HIV transmission. Antiretroviral treatment lowers the plasma viral load and the
amount of virus in the genital tract; as a result it should decrease the probability of further, secondary,
transmission. On the other hand any increase in unprotected sex among the HIV-positive population
following the introduction of HAART may have unintentional consequences on the HIV/AIDS epidemics if not
appropriately addressed through targeted and continuous risk reduction campaigns. Integrating prevention
actions into the treatment programme presents an important opportunity to work with those affected by the
virus.
e) Counselling and Testing:
VCT has been shown to be effective in HIV prevention by decreasing risk behaviours as people increase
condom use and decrease the number of partners. It is also estimated that for every 10 people accessing
VCT, 1 HIV infection is prevented. VCT may contribute to decreasing stigma as more people know their HIV
status and it is an entry point into care and support. Shortened testing and counselling will be introduced in
health-care facilities. The process must remain voluntary and emphasize consent, confidentiality, counselling
and information. In addition to increasing client and provider initiated testing in health facilities, the Western
Cape will also continue to increase the number of non-medical testing sites. Options of expanding non-
medical sites include: public/private partnerships in the business sector; mobile services; service at venues
frequented after hours; non-profit franchising; community “drop in” centres offering a variety of services.
f) Distribution of free Condoms:
International evidence suggests that making condoms freely available increase the uptake and use in
protected sexual contacts. This has to be accompanied by a more general communication and education
strategy and targeted behaviour change programmes. The province plans to have a 5-fold increase from 33
million to 150 million male condoms per annum by 2010. The female condom programme also needs to be
expanded, as a key strategy to place prevention control in the hands of women, especially in preparation for
the introduction of microbicides in 3-4 yrs time.
g) Prevention of Mother to Child Transmission:
The province has been successful in achieving complete coverage of its pMTCT programme and evaluations
suggest that it is being very effective in reducing HIV transmission to children across the Province. Despite
these successes it is recognised that the programme can be further strengthened. In particular the Province
will undertake to achieve greater integration of pMTCT services into Maternal and Women‟s Health and Child
Health services; review the present ART regimen; explore feeding options and continuing support
(transmission through mixed feeding remains a problem) and improve the follow up of mother infant pairs.
h) Treatment and Prevention of STIs:
The identification and treatment of STIs is one of the most cost effective HIV prevention interventions
available. The Province will concentrate upon increasing the access to high quality STI services for all
groups but especially young men and women and particular high-risk groups such as commercial sex
workers. A regular quality control system is being implemented that will assess the quality of STI services
across the Province. Access will also be improved through the public-private partnership initiative where
private practitioners are provided with technical and commodity support to improve the management of STIs
in the private sector. Contact tracing of STI clients will also be strengthened.
i) Surveillance, monitoring and evaluation:
Surveillance is the cornerstone to any public health programme aimed at responding to the HIV epidemic. It
provides critical information for the understanding of the dynamics, magnitude and spread of the epidemic.
The province will continue with its innovative concentrated ANC prevalence surveillance system. In addition
it will work with key technical partners to establish specific second generation behaviour surveillance
systems across the province. The objective of a HIV/AIDS surveillance system is to develop a system that
combines information on HIV prevalence, new HIV infections, and linking it to the broader social, and
behavioural characteristics that render individuals at high risk of infection. This would include tracking and
monitoring the magnitude and spread of the epidemic, and understanding the associated risk factors.