MONITOR HIV & TB RESPONSE

AIDS — or advanced HIV — means that a person’s CD4 count has fallen below 200 and they are more at risk of getting other illnesses. In South Africa almost a third of people living with HIV start treatment with a low CD4 count. The lower the CD4 count, the more at risk people are to get other illnesses and possibly die.

Advanced HIV is a major challenge for people starting treatment late, or restarting treatment after an interruption. Easier and quicker diagnosis and treatment needs to be made available. For those scared to return to the facility because of being shouted at, or those denied ARVs because they don’t have an ID or transfer letter, or because they are a member of a key population, the results can be dire. TAC is committed to advocacy to ensure clinics are welcoming and to improve diagnostics and treatment for people with AIDS and cryptococcal meningitis.

Waiting all day at the clinic is a frustrating reality for people living with HIV. Yet a simple solution exists — for people who are collecting ARVs to simply get a longer supply of medication. Not only would “multi-month dispensing” mean fewer trips back to the clinic — making medicine collection easier for people living with HIV — but it would also reduce the burden on congested and overstretched facilities. Yet South Africa is far behind in extending ART refills compared to other countries. TAC supports 12 monthly prescriptions and the rapid rollout of 3- and then 6-month supply of ARVs to reduce unnecessary burdens on people living with HIV and the health system.

In addition to longer ARV refills, another strategy to reduce waiting times is to allow people living with HIV to collect their treatment at pick-up points either at the facility or externally in the community. Yet many people using facility pick-up points tell us that they must still collect files, take vitals, and see a clinician before getting their parcel — adding unnecessary delays, many people have never even been offered the option to collect from a pick-up point, and others still wish they could collect their ARVs closer to home.

TB remains the leading cause of illness and death among people living with HIV, especially people with advanced HIV and those who are not yet taking ART. Although treatable, deaths remain high partly due to delayed diagnosis and treatment — often because symptoms of TB are regularly overlooked by healthcare workers, and the opportunity for early TB diagnosis and treatment is missed.

In response to this, TAC demanded that TB be declared a “Public Health Emergency” in the country leading to the rollout of the TB recovery plan. TAC will continue to monitor the implementation of the TB recovery plan to ensure that TB services are actually improved for communities. TAC will use community-led monitoring data in order to assess these improvements at facilities and to hold duty bearers accountable for improvements.

Womxn in South Africa continue to face disturbing levels of oppression, violence and injustice. While the Constitution guarantees equality and freedom for all regardless of sex, gender or sexual orientation, the prevalence of abuse, rape and murder in our society shows us these guarantees remain only on paper. TAC, the Social Justice Coalition, Sonke Gender Justice, and others have worked for over a decade to improve the criminal justice system and change gender norms in society. We recognise that the problem of patriarchy and violence against womxn in our society is complex, deeply entrenched and has no quick solutions. But that is no excuse for inaction.

While most people agree that rape, abuse and murder are wrong — everyday actions that oppress womxn and the widely-held belief that womxn should defer to men, get little criticism. These acts of patriarchy also need to be dealt with to ensure equality in everyday life. We call on men who truly believe in an equal and a just society to do things very differently. To constantly interrogate their actions and privileges to understand how they contribute to the disempowerment and control of womxn. To refuse to hide behind our various cultures and traditions — equality and respect for womxn is more important than any culture.

At our public clinics and hospitals the experience for people who use drugs, sex workers, & LGBTQIA+ communities can be hurtful and dehumanising. Both clinical and non-clinical staff like security guards continue to be unfriendly and discriminatory, be it at the clinic gate, in waiting areas, or even during medical consultations. Disgraceful privacy violations continue to occur that destroy people’s right to privacy and make clinics feel unsafe and uncomfortable to be in. Where this has become unbearable, some people have stopped going to the facility altogether. Shockingly, many people are even denied services altogether because they use drugs, are a sex worker, or are part of the LGBTQIA+ community. Where key populations do continue to suffer the daily indignities of using the public health system, specific services such as lubricants, PrEP, methadone, new needles, and hormone therapy, remain unavailable for the most part.

TAC considers it morally unacceptable and a violation of constitutional rights that people who use drugs, sex workers, and LGBTQIA+ communities are disrespected, humiliated, and dehumanised at public health facilities. We are committed to activism that will ensure the provision of safe, friendly, welcoming, and confidential services at all health facilities — as well as increasing the availability and accessibility of quality key population specific services, closer to where people actually live and work.

Once on treatment, it is important to recognise that people living with HIV live dynamic lives, may be late for and/or miss appointments, and may even miss taking some pills. When they do, the public health system should meet them with support when they return to the clinic. But often, when people living with HIV return to the clinic they are treated badly. Others who move to a new place or relocate for work, can be denied ARVs because they do not have a transfer letter — something that is not required by ART guidelines to start/restart ARVs.

TAC believes that all people living with HIV starting or restarting treatment should be treated with dignity and respect. People returning to care should be treated with compassion to ensure that they can restart treatment easily, without being shouted at or sent to the back of the queue. TAC is pushing for the proper implementation of the National Department of Health’s adherence guidelines. TAC is monitoring and exposing cases where people are sent away empty handed for not having a transfer letter.

In South Africa around 300,000 people daevelop tuberculosis every year and about 56,000 people die. Yet TB infection control in our public health facilities remains inadequate. For years we have been calling for certain measures to be adopted for TB infection control, only to see key measures made quickly possible during the COVID-19 pandemic. If we are able to educate people about COVID-19 infection control, to ensure the use of masks in clinics, to screen people for COVID-19 symptoms on arrival, to ensure the provision of COVID-19 posters in all South African languages, then these things must be possible for TB as well.

TAC believes that all public health facilities should follow a checklist of basic steps to ensure adequate TB infection control measures are in place. We will continue to monitor to ensure this is happening through Ritshidze, and expose and take action where not.

PEPFAR funding still constitutes nearly a quarter of AIDS funding in South Africa. It is critical for people living with HIV and key populations that this funding is used optimally and with the best possible impact. The HIV response in South Africa stands on a precipice. South Africa has achieved a great deal. But the health system on which the response is built is crumbling and future scale-up and progress are very much under threat. We cannot see the end of AIDS without a significant shift in how money for health in the country is invested. PEPFAR is a key part of that.

TAC continues to lobby PEPFAR to re-think, re-prioritise, and re- imagine the role their funding can play in this country through leading the development of the “People’s COP”. Using Ritshidze data, the “People’s COP” outlines the challenges and the key community recommendations to PEPFAR. This data, together with community members’ stories, show the reality of using the public healthcare system and trying to access HIV and TB services.

You can find all “People’s COP” documents here.