THE COJ RESPONSE TO HIV/AIDS CITIES NETWORK MEETING 01 November 2004

1. THE COJ RESPONSE TO HIV/AIDS CITIES NETWORK MEETING 01 November 2004 Meisie Lerutla & Khosi Mashego

2. Background/Introduction HIV & AIDS Strategy – Workplace and Community AIDS Plan – Goals: 3.1 Reducing New Infections 3.2 Reducing the Impact of AIDS 3.3 Organise the AIDS response 4. Partnership Against AIDS 5. COJ – HIV & AIDS Plan 6. Factors Driving the Epidemic 7. Progress to date 8. Summary/Conclusion Table of Contents

3. AIDS Plan developed by Inter-sectoral Planning Team Regions/UAC’s/Departments Gauteng Health Department Plan addresses overall AIDS Plan for COJ and Civil Society sectors and the workers The AIDS Programme is located in 3 departments Health: community and clinics Corporate: Workplace AIDS Programme Social Services: Welfare related issues Budget mainly drawn from COJ, GHD 1) Introduction/Background

4. 2. Factors Driving the Epidemic • Mainly heterosexual transmission • Unemployment – 37% COJ residents • High levels of Commercial Sex Workers (including child prostitution) • Illiteracy – 7% COJ residents are completely illiterate, 29% of adults have matriculated • Low status of women, women comprise 43% of the working population • 42% of the population is under the age of 24 • High levels of STI’s

5. Factors Driving the Epidemic (cont..) • Women infected at younger age than men (10 years earlier than men) • Single sex hostels – 23 • 22% of Johannesburg residents stay in informal dwellings • 65% of households are headed by one person • There are only 35 cemeteries

6. 3. HIV/AIDS Strategy Mobilisation & Communication • PREVENTION • Education • Services • CARE “COMPREHENSIVE CARE • Support of people with AIDS • Health Care Services • Affected families & Orphans • System for coordination & referral ORGANISATION OF THE AIDS PROGRAMME Workplace and community All departments & sectors MUNICIPAL PROVINCIAL

7. HIV/AIDS Strategy (Cont…) MOBILISATION & COMMUNICATION: To mobilise involvement and increase understanding. Reaches workers and communities through training, cultural activities, campaigns, role-models, leadership and media. Communicates progress with the programme. The content reflects the key areas of the programme: Openness, Prevention and Care; The Partnership against AIDS.

8. HIV/AIDS Strategy (Cont….) • PREVENTION • Education – to change behavior: • Youth Strategy: life skills in schools. Peer education for out of school youth and on campuses. • Peer education for special risk settings (mining, hostels, sex-workers, prisons) • Workplace Programmes - EAP • Door to door education campaigns • Prevention of substance abuse & sexual violence • Services – in support of behavior change • STI management (syndromic management) • Condom Supply (free male and female condoms) • Voluntary testing with counseling (VCT) • Reduce MTCT • PEP for needle-stick and sexual assault

9. HIV/AIDS Strategy (Cont….) • CARE- “Comprehensive Care” • Support of people with AIDS • Community support (women, religious, civics, healers, workplace programmes) • Support groups • Counseling and VCT • Health Care Services • Comprehensive care for HIV/TB/AIDS- clinics & hospitals/OHASA • PMTCT/ARV treatment • Palliative – Home Care & Hospice Beds • Immune boosters • Affected workers/families & Orphans • EAP/Social support • Orphan support - • Welfare grants & social services • Indingency policy water/housing services/food • Poverty alleviation programmes • SYSTEMS FOR • COORDINATION AND • REFERRAL

10. HIV/AIDS Strategy Organisation of the AIDS Programme (All departments & sectors) ORGANISATION (roles & responsibilities) • PROVINCIAL • Leadership • Coordination • Capacity Building • Strategy • Provincial Plan • Policy • Guidelines • Research • Development • Monitoring & evaluation • MUNICIPAL • Mobilisation of workers and communities • Coordinated plans • Monitoring of Services - SDP • Data base of services • Tracking progress

11. 4. Partnership Against AIDS

12. JOHANNESBURG AIDS COUNCIL Aims • To create a platform to review matters related to HIV/AIDS in the City of Johannesburg. • To enjoin all the City’s inhabitants in the war against HIV/AIDS and to visibly demonstrate the City’s support for those infected and affected with HIV/AIDS. • To actively review, monitor and evaluate the intersectoral response to HIV/AIDS in the City. • To advise the City of Johannesburg on ways and means of improving impacts of the HIV/AIDS Programme.

13. JOHANNESBURG AIDS COUNCIL (Cont..) FUNCTIONS • To assume an advocacy role that will highlight (continuously) issues related to prevention and care of those infected and affected by HIV/AIDS. • To support communication efforts around all issues related to HIV/AIDS that are disseminated by the HIV/AIDS and STI Programme around prevention and awareness. • To contribute materially towards the training of “AIDS Activists”, Home based care initiatives and other outreach campaigns. • To jointly plan and conduct major campaigns in a calendar year such as – valentine’s; candlelight; World AIDS Day, etc. • To coordinate and strengthen the partnership with the Gauteng AIDS Council and the National AIDS Council.

14. 5. COJ – PlanObjectives for 04 / 05 • To increase availability & accessibility of condoms community/workers • To increase condom usage targeting vulnerable groups & areas • To capacitate health professionals in the COJ so as to provide an effective HIV/AIDS & STI service • To capacitate workers to deal with the epidemic/peer education & support • To capacitate CBO’s, NGO’s in the COJ to support the implementation of the HIV/AIDS programme • To promote & increase access to VCT on site testing • To promote effective coordination of HIV/AIDS activities • To create awareness & increase level of understanding in the community • To mobilise the community involvement & strengthen partnerships against HIV/AIDS & STI • To provide Regions with uniform policies, SOP’s & guidelines • To develop an effective, efficient monitoring & evaluation strategy of the HIV/AIDS & STI programme

15. 6. Progress to date • Preventative Services • + 3 million free male condoms supplied • STI services in 95% of clinics (syndromic management) • PMTCT services all hospital and health centers (large clinics) • PEP for victims of sexual assault in specialised services (CHB;JHB; Hillbrow) • VCT services at 23 COJ clinics • Workplace programme • Health care • 90% of clinics have infrastructure to provide care for HIV infected persons • Need to improve clinical training of PHC nurses and doctors in treatment of AIDS • TB cure rates in COJ improving slowly but still high average (+56% cure rate)

16. Progress to date (cont…) • Social impact of AIDS • Growing more problems • COJ has approximately ?20-25000/50,000 orphans • Access to grants still a problem • Burials have increased • Hunger, poverty, abandonment, difficulties with burials, social distress, school attendance • Note: food parcels, free uniforms, school nutrition programme (Provincial Govt)

17. 7. ARV’s therapy in the management of HIV • Capacity needed • Intensive training of health professionals (58) • Doctor support inadequate– prescription of drugs • Laboratory to monitor CD4 and viral loads • Pharmacy - reliable drug supplies, safe storage • Community education – public awareness, understanding, compliance • NB. COE – An opportunity for training of staff

18. 8. Review of the AIDS Strategy • Well developed but needs proper, effective implementation with monitoring, evaluation and relevant research • Institutional capacity in department, NGO’s and communities need to be developed rapidly • COJ have large scale implementation programmes with GHD – but needs stronger, better coordination and communication of the AIDS effort across and within department

19. 9. AIDS Plan 2004-2006 • Reduce new HIV infections & the overall HIV infection rate • Reduce the impact of AIDS on people living with HIV, their families & society as a whole • Organise an effective AIDS response involving all government departments & civil society sectors

20. AIDS Plan 2004-2006 (cont…) • Reduce the impact of AIDS on people living with HIV, their families (and society) • Increase openness on AIDS • Provide access to comprehensive TB/HIV/AIDS care in 100% of local areas • Strengthen health systems management • Assess the feasibility of adding ARV treatment to the package of AIDS care • Extend access to comprehensive orphan support services to 100% of local areas • Increase access to poverty relief • Develop methodology for monitoring & evaluation of comprehensive care

21. AIDS Plan 2004-2006 (cont…) • Organise an effective AIDS response involving all government departments & civil society sectors • Organise all departments & sectors in a Partnership against AIDS • Monitor & evaluate implementation of the AIDS strategy • Strengthen capacity of departments & society sectors. Strengthen Workplace AIDS programme • Establish local Inter-Sectoral AIDS programmes • Coordinate & communicate the AIDS programme

22. AIDS Plan 2004-2006 (Cont...) • GOALS • Reduce new HIV infections & the overall HIV rate • OBJECTIVE • Improve understanding of HIV risk, transmission & prevention amongst youth & general public & workers • Reduce risk behaviour through implementing effective educational programmes for specific groups: • Youth • People in special risk settings • Workplace AIDS Programmes • Provide accessible, effective services • Free male condoms/some female condoms • An STI service

23. 10) Conclusion • Workplace Programme • All departments (and UAC’s) have HIV/AIDS “champion” • Intensive programme in all Council Departments (and UAC’s) familiar with workplace policy • Anonymous (voluntary) testing programme to all Council employees (politicians and workers) • Availability of ARV’s to staff memebrs who disclose (note confidentiality issue!) • Develop/strengthen EAP (employment Assistance Programme) in COJ • Social Development • Strategic Plan for COJ to address issue of orphans,(orphanages) child headed household • Improve community programme