South Africa: HIV/AIDSReduction Plan

International Patient Safety and Quality Healthcare: Developing a Newsletter or PowerPoint Assignment

Josh HyattNova Southeastern University

College of Health Care SciencesDepartment of Health Science

Doctor of Health Science ProgramDr. C. Lynn Chevalier

DHS 8750: Patient Safety and Medical ErrorPatient Safety and Quality Healthcare PowerPoint Assignment

November 17, 2013

Introduction:Prevalence of HIV/AIDS World-Wide

•The HIV/AIDS pandemic is a human, social, and economic disaster of global proportions; particularly affecting the developing countries of Africa, Southeast Asia, and Latin America.

•By the end of 2011, the World Health Organization (WHO; 2010) estimated there were between 31.8 and 35.9 million people infected by HIV globally, approximately 3.4 million of those were children. According to Kaiser Family Foundation (2012), globally there were 34.2 million people living with HIV/AIDS in 2011.

•Sub-Saharan Africa comprises the most infected adults and children (22.9 million), followed by South and South-East Asia (4 million), East Asia and Eastern Europe/Central Asia (1.5 million each) and North America (1.3 million; Avert, n.d.).

•The other geographic regions are below 1 million infected individuals. It is also estimated that in 2011, there were 2.5 million new infections globally, 330,000 of those were children, and 1.7 million deaths related to AIDS (WHO, 2011) .

Prevalence of HIV/AIDS World-Wide•Unfortunately, the trends of HIV infection are increasing globally year-to-year. As a result, heath organizations are experiencing staff and supply shortages and countries are losing vast amounts of human and financial capital.

•The availability of medications and treatment protocols has dramatically reduced the morbidity and mortality rates in some countries and, in underdeveloped countries where treatment is less available, the rates are on the rise (Petersen, 2006).

UNAIDS Response•In response to the ongoing threat of HIV/AIDS world-wide, the government agency UNAIDS established a program in 2010 entitled Getting to Zero: 2011-2015 Strategic Plan.

•The plan involves three steps to eradicating HIV/AIDS (UNAIDS, 2010):•Revolutionize HIV Prevention

• Goal: Zero New Infections•Catalyze the Next Phase of Treatment, Care, and Support• Goal: Zero AIDS Related Deaths

•Advance Human Rights and Gender Equality for the HIV Response• Goal: Zero Discrimination

Prevalence of HIV/AIDS in South Africa•AIDS and other poverty-related diseases such as tuberculosis and cholera place a tremendous strain on South Africa's health care system. •According to Statistics South Africa, in 2011 (Media Club South Africa, 2012): •The overall HIV prevalence rate was 10,6%;•About one-fifth of South African women in their reproductive ages were HIV positive;

•There were 5.38 million people living with HIV (Up from 4.21-million in 2001);

•16.6% of the adult population (aged 15–49) years was HIV positive;•There were approximately 2.01-million orphans due to HIV; •New HIV infections for 2011 among adults was estimated at 316,900; and•An estimated 1.06-million adults and 105,123 children were receiving antiretroviral treatment in 2010.

Prevalence of HIV/AIDS in South Africa•There are various governmental and non-governmental agencies that provide services to address the global impact of HIV/AIDS.

•These programs provide a combination of financial resources, research, prevention, surveillance, medications, health care workers, and infrastructure support to reduce the infection rate and improve the quality of care provided to those affected by HIV/AIDS.

HIV and TB Information in South Africa•South Africa has (Media Club South Africa, 2012):

•Generalized epidemic of HIV, driven largely by sexual transmission

•Experiences large variations in HIV prevalence across age groups, gender, geographical area and socioeconomic status

•South Africa has the third highest level of TB in the world, after India and China. New infections have increased by 400% over the past 15 years, reaching 970 new infections per 100 000 people in 2009.

•About 1% of the South African population develops TB every year. In addition, more than 70% of patients are co-infected with both HIV and TB.

•The highest prevalence of TB infection is among people aged 30–39 years and living in townships and informal settlements.

South Africa’s Response•President Jacob Zuma announces on World Aids Day, 1 December 2011, a plan to increase South Africa's commitment to fight against HIV/AIDS.

•South Africa identified that prevention is key and became the basis for their National Strategic Plan (NSP) for HIV, sexually transmitted diseases (STIs) and TB 2012-2016

•In addition to adopting the UNAIDS three Getting to Zero goals, they added a fourth:•Eliminate HIV transmission from mother to child

National Strategic Plans (NSP)•The South African NSP has some aims to reduce new infections in South Africa by 50% by taking a holistic approach and addressing the issue of violence towards women.

•The plan is based on establishing five goals and four strategic objectives to effectively prevent or treat HIV and TB infections.

NSP GoalsThe five goals of the NSP are [South African National AIDS Council (SANAC), 2012]: •To reduce new infections by at least 50% by using a combination of prevention approaches;

•To ensure that at least 80% of people who are eligible for treatment for HIV are receiving it, with at least 70% being alive and still on treatment after five years;

•To reduce new TB infections and deaths from TB by 50%;•To ensure an enabling and accessible legal framework that protects and promotes human rights to support implementation of the plan; and

•To reduce the self-reported stigma related to HIV and TB by at least 50%.

NSP Strategic ObjectivesThe NSP’s four strategic objectives (SANAC, 2012): •Address the social and structural factors across all sectors that drive these epidemics, influence their impact, and affect the way we care for affected people;

•Prevent new HIV, STIs and TB infections through a combination of biomedical, behavioral, social and structural interventions;

•Sustain health and wellness, primarily by access to quality treatment, care and support services, and to develop programs that focus on wellness; and

•Protect the human rights of people living with HIV, primarily through ending stigma, discrimination, human rights violations and gender inequality.

Commitment to Women and Children•The South African government, as part of the HIV reduction program, has placed great emphasis on preventing violence against women and children

•Some of the research cited in the NSP demonstrated that young women were subjected to violence and intimidation by their partners. This has been demonstrated to have a correlative effect on HIV infection.

•The focus of these programs include:•Law enforcement programs protect and prosecute•Community and professional education programs•Public awareness

NSP: HIV Counseling and Testing•The South African government launched its HIV Counseling and Testing Campaign in April 2010, which offers free testing to all patients at public hospitals and clinics across the country.

•The goals of the campaign are to (SANAC, 2012):•Provide public education, encouraging everyone knowing their HIV status and to be screened for TB through the information and interventions they need to manage their health and to prevent further HIV transmission;

•Fast-track newly infected people into a treatment program;•Raise awareness of the issues around HIV/AIDS, foster a culture of collective responsibility among South Africans; and

•h voluntary HIV counseling and testing;•Providing people with Remove the social stigma attached to HIV/AIDS.

NSP Treatment•As part of the recommended treatment protocols under the NSP, the government has focuses community-based services. These community-based services focus on:•Expanding the quality and reach of health and wellness services;•Early diagnosis;•Follow- up;•Support to adherence to treatment plans; and •Retention in care.

•The HIV/AIDS prevention and treatment plan aims to reduce the rate of infection in the country by 50%, while providing free antiretroviral (ARV) treatment to 80% of those who need it by 2016. •Compare that In 2004, 47,000 people were on antiretroviral (ARV) treatment; however, by mid-2011 this had increased to 1.79-million people.

•An increase in ARV treatment has seen a reduction in the number of people dying as a result of HIV infection. By 2010, deaths in Gauteng, where life expectancy is 57 years, had dropped by 20% in 2010 (SANAC, 2012).

NSP: Maternal & Child Health Programs

•The South African government added material transmission as an addition Getting to Zero goal. As a result, there is an emphasis on reducing the rate of mother-to-child transmission of HIV/AIDS.

•The government now integrates all aspects of its HIV programs with its maternal and child health programs, and campaigns vigorously for women to report for antenatal visits as soon as they suspect that they are pregnant in order to do the necessary tests on time.

•NSP recommendations:•All HIV-positive TB patients should, irrespective of their CD4 count, and that all infants under 24 months who test positive for HIV should be placed on ARVs;

•Infant children of HIV-positive mothers are treated regardless of their CD4 count;

•HIV-positive pregnant women, and people co-infected with TB and HIV, receive free antiretroviral (ARV) treatment at CD4 counts of 350 or less; and

•Antiretroviral treatment for prevention of mother-to-child transmission of HIV starts at 14 weeks into pregnancy, instead of only during the last term of pregnancy.

NSP: Male Circumcision•Based on studies from the World Health Organization (UNAIDS, 2007), there is evidence which links male circumcision to a reduction in the risk of heterosexually acquired HIV infection in men by up to 60 percent.

•South Africa first launched its ongoing campaign to promote and conduct medical circumcision in April 2010. •As of 2012 (SANAC, 2012) about 250,000 men have been circumcised.

•The target for 2016 is to have more than 4.3-million men circumcised.

NSP: Condom Distribution and Education•The South African Health Department encourages and promotes the use of condoms, especially among older age groups, where HIV infections are increasing.

•The NSP call for free condoms to be provided at public health facilities and other public centers.

•The NSP makes a clear point that education should be provided regarding:•The proper application and disposal of a condom and•That condoms should be used regardless of circumcision

NSP: Military Involvement•The South African government is also using this opportunity to promote HIV/AIDS awareness, prevention, treatment, and care for all the soldiers and their families, as well as their veterans (Helfrich, 2013).

•The military is aligning itself with the NSP goals to educate the soldiers on HIV/AIDS issues and affect a positive reduction of rates in a more controlled environment.

NSP Successes•By mid-2012, Health Minister Aaron Motsoaledi announced that almost 20-million South Africans had been tested knew their status. Millions were also screened for TB

•An increase in ARV treatment has seen a significant reduction in the number of people dying as a result of HIV infection

•Decrease in the overall rate of material-fetal HIV transmission

•Increase in the number of male medical circumcisions•Improved access to condoms through all health facilities and public areas

•Buy in to the NSP from public health agencies and the military

Conclusion•The government of South Africa has dedicated the time and resources to address the pandemic of HIV/AIDS in their country through a series of educational, testing, prevention, and treatment programs.

•The country has already began seeing positive effects in their society as a result of their commitment to eradicating this disease.

•The country also focused on social issues, especially women and maternal-fetal services, that have made a significant impact on the culture and environment of HIV/AIDS infection and discrimination.

ReferencesAvert. ( n.d.). Global HIV and AIDS estimates, 2009-2010. Retrieved from

http://www.avert.org/worldstats.htm#Helfrich, K. (2013, November, 07). The South African military and HIV/AIDS. Retrieved from

http://www.defenceweb.co.za/index.php?option=com_content&view=article&id=32577:the- south-african-military-and-hivaids&catid=111:sa-defence&Itemid=242Kaiser Family Foundation. (2012). Global health facts. Retrieved from

http://www.globalhealthfacts.org/data/country/profile.aspx?loc=1Media Club South Africa. (2012, July 2). Healthcare in South Africa. Retrieved from

http://www.southafrica.info/about/health/health.htm#Petersen, P.E. (2006, April). Policy for prevention of oral manifestations in HIV/AIDS: The approach of the WHO Global Oral Health Program. Advances in Dental Research,19(1), 17-20. doi: 10.1177/154407370601900105South African National AIDS Council. (2012, June 17). South Africa’s HIV/AIDS battle plan. Retrieved from http://www.southafrica.info/about/health/aids-prevention.htm

ReferencesUNAIDS. (2007, February). Male circumcision and HIV: The here and now.

Retrieved from http://www.unaids.org/en/resources/presscentre/featurestories/2007/feb

ruary/20070228mcpt2/UNAIDS. (2010). Getting to zero: 2011-2015 Strategies. Retrieved from

http://search.unaids.org/search.asp?lg=en&search=three%20zerosWorld Health Organization. (2010). Global summary of the AIDS epidemic: 2011. Retrieved from

http://www.who.int/hiv/data/2012_epi_core_en.pngWorld Health Organization. (2011). Global health sector strategy on HIV/AIDS in 2011-2015. Retrieved from http://whqlibdoc.who.int/publications/2011/9789241501651_eng.pdf