The HIV, STI and TB National Strategic Plan (NSP) 2012-2016 is the culmination of extensive review of documentation, consultation and deliberation with a wide range of stakeholders over several months. These processes were key in determining the strategic priorities in dealing particularly with the dual epidemics of HIV and TB in South Africa.
The South African National AIDS Council (SANAC) was requested to participate in developing the 2012-2016 NSP. It is no secret that the new NSP will need to be significantly improved from the country’s 2007-2011 NSP, during which South Africa failed to reach its target to halve the HIV infection rate by 50%. The new NSP also focuses more attention on TB, but has neglected STIs compared with the previous NSP. The previous NSP also promised many interventions without duty allocation in terms of responsibilities.
The NSP 2012-2016 is driven by a long-term vision for the country with respect to the twin epidemics and has adopted UNAIDS’ three zeros – zero new infections, zero deaths associated with HIV and TB, and zero discrimination – as part of a national twenty year vision.
The Men’s Sector made written submissions after consulting its membership, including the provincial leadership, with the help of the dedicated team and newly formed Men’s Sector secretariat.
SANAC Men’s Sector Submissions on the Zero draft:
In terms of cross cutting issues “Game Changers”
- Conduct sustained and integrated mass media campaigns with targeted messages to increase knowledge and understanding of the importance of testing and wellness, and to foster behaviour change, especially in terms of gender norms transformation.
- Government to provide financial and logistical support to NGOs, FBOs and CBOs.
- Eliminate obstacles to access to services and information through actively supporting advocacy campaigns to this end, including supporting calls for the abolishing of charges on toll free public services such as the AIDS Helpline counselling services; actively supporting the roll out of the National Health Insurance scheme; and engender a rights based paradigm in the provision of services to groups such as men who have sex with men (MSM).
- Provide adequate training for staff and volunteers in public and private health services and civil society, including traditional healers, on the basics of HIV, TB and STIs (testing, screening, treatments, and rights); on the gender dynamics and transformation challenges of the pandemic including the specific needs of LGBTI communities, inmates, migrants and MSM.
Pillar 1: Prevention – Universal Testing for HIV and Screening for TB
Expand HIV and TB testing services to men, and their families in their communities, workplaces and other convenient locations, in addition to clinics and hospitals, with an enhanced focus on mobile populations and agricultural industries targeting vulnerable yet neglected male populations. Routine HIV and TB testing should be integrated in all public and private health facilities, with strengthened provider-initiated approaches. Couple counselling and testing could also be further promoted.
Educate and empower men about how they can best support their partners to test; support their male peers to test; and support their partners when they test positive. Many women report that fear of violence discourages them from testing. Also develop strategies that are designed to encourage men to support their male peers to test and support one another if they test positive.
The importance of STI screening should be emphasised and should also be made available at public and private health facilities. Awareness should be drawn to the links between STIs and HIV.
Combat stigma attached to HIV and TB to increase testing. Public figures and celebrities should be encouraged to publicly test, and disclose their positive or negative status, in order to normalise testing and reduce the stigma associated with HIV.
Pillar 2: Sustain Health and Wellness
Increase access and adherence to treatment though expanded treatment literacy programmes to address misunderstandings regarding various forms of treatment such as the purpose of PEP; encourage men to support their partner’s access and adherence to treatment; accelerating task shifting to increase the role of nurses in administering ART; increasing capacity within the nursing profession to address human resource shortages; and increasing the number of males within the nursing, lay counselling, home-based caring and related health care professions; and expanding the distribution of ART medication, including through the utilisation of non-traditional outlets and mechanisms.
Provide ongoing care and support for services providers and caregivers in the public and civil society sectors to prevent fatigue and sustain passion and appropriate skills levels.
Promote the consistent use of condoms as a health sustaining behaviour including and emphasising its use as a contraception tool. This requires, for example, that there is widespread access to condoms and lubrication, especially for MSM and for inmates and appropriate size condoms are made available for teenagers. Non-traditional condom distribution mechanisms, such as the WHAT IS IN YOUR POCKET Campaign of SAMAG should be explored. Distribution should be accompanied by basic gender equity education, using already existing materials.
Increase the emphasis on provision of female condoms: The condom shortfall is most marked in relation to the female condom, whose level of distribution remains significantly below that of the male condom. It is clear that female condoms, as a female-controlled method, should be given greater attention in condom promotion strategies.
Ensure rapid roll-out of MMC as part of comprehensive prevention package, including mass media campaigns on the benefits of MMC. Ensure that gender equality education is integrated into all MMC processes. Standardised Medical Male Circumcision protocols/guidelines must be implemented.
Implement strategies to promote responsible alcohol consumption given the clear links between alcohol abuse, violence, sexual risk and heightened vulnerability to HIV infection and poor treatment outcomes.
Involve men in PMTCT programming with increased efforts at getting men involved in ante-natal processes generally and PMTCT processes in particular; supporting women to talk to their partners about PMTCT and HIV testing; and increase awareness about the processes and benefits of PMTCT amongst men and women.
Promote healthy seeking behaviour by men’s which will result in increased utilization of public health facilities more generally through increased programming for men’s sexual and reproductive health, mental and physical wellbeing, penile and testicular health including cancer screenings, family planning, prevention of unwanted pregnancies, safe and legal abortions.
Pillar 3: Changing Social Norms and Values
Conduct research to understand the epidemiology of most at risk groups, particularly young men, and introduce specific strategies to reduce their vulnerability. Increase research into attitudes of men to ascertain the reasons for their low uptake of treatment and testing.
Steps need to be taken to address stigma and discrimination. More educational and awareness raising campaigns and initiatives need to be rolled out on HIV and AIDS and the constitutional rights that protect HIV positive persons with a specific focus on the rights to equality, human dignity and privacy. This can assist in reducing societal stigma attached to HIV positive persons as such training will seek to create mindsets and attitudes that understand the importance of respecting the human rights of all.
- Women’s vulnerability to HIV needs to be addressed through strategic interventions to reduce sexual and domestic violence
- Conduct broad based anti-homophobia campaigns to challenge the stigma and discrimination faced by the LGBTI community. Similarly, anti-xenophobia campaigns and training should also take place.
- Address challenges facing vulnerable men through ensuring that the Department of Health adopts medico-legal protocols to address the needs of male victims of sexual violence and ensure that the Department of Correctional Services (DCS) adopts and implements policies and practices to prevent sexual abuse in detention settings, and incorporates gender training as a component of prisoner reintegration.
- Integrate a strong focus on HIV education in schools and through initiatives such as the Girls
Empowerment Movement and the Girls and Boys Education Movement.
SANAC hosted an open NSP consultation at Centurion in Pretoria on the 05-7 September 2011 and new gaps were identified and NSP shift in terms of Pillars.
Sectors advocated for change especially the NSP draft 1 outlook and retaining of pillar 3 Human Rights and Access to Justice.
- Pillar 1 as, Strategic Objective 1: Prevention of HIV and TB Infections
- Pillar 2 as, Strategic Objective 2: Sustain Health and Wellness
- Pillar 3 as, Strategic Objective 3: Protection of Human Rights and Promotion of Access to Justice
- Pillar 4 as, Strategic Objective 4: Social and Structural Approaches to HIV and TB Prevention, Care and Impact
- See the Men’s Sector Policy Summit recommendations on the summarized policy summit report.