You are here: Home Latest Developments Media Centre Speeches Keynote address by MEC Dr Magome Masike during the North West Provincial HIV and AIDS strategic planning lekgotla hosted by the Provincial Council on AIDS at Rustenburg

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Keynote address by MEC Dr Magome Masike during the North West Provincial HIV and AIDS strategic planning lekgotla hosted by the Provincial Council on AIDS at Rustenburg

Programme Director, Executive Mayor for Bojanala Platinum District Municipality, HOD for the Department of Health, Maj. Gen. (Dr.) Mokhethi Radebe, DDG for the Office of the Premier, DDG for Health Services, Dr Andrew Robinson, Executive Managers of the Department of Health and other Provincial and National Government Departments present, Acting CEO for PCA, Mme Margret Mokgothu, Chairperson for PCA, Reverend Piet  Tlhabanyane, MMCs and other local government councilors present, Members of our governance structures, Our Guest Speaker from the UNAIDS/ SANAC, Dr Damisoni, Dr Senabe from the DPSA, Ms Hlabano from SABCOHA, Members of our various NGOs, CBOs and FBOs, Distinguished delegates of this important Lekgotla, Ladies and gentlemen,

Dumelang Bagaetsho!

This important Strategic Planning Lekgotla of the Provincial Council of AIDS (PCA) takes place against the backdrop of many international and national developments taking place as effort to combat the scourge of HIV and AIDS. The recent International AIDS Society Conference is one such a development. Many other countries of the world have also had various domestic conferences to share views on how best they can tackle the HIV and AIDS challenge.

Africa and the World

Though the whole world is suffering the effects of HIV and AIDS, I believe we can all agree that the developing countries and Africa in particular is deeply hard hit and at the receiving point of the socio-economic imbalances associated with the pandemic. Here at home, South Africa, the impact of the AIDS epidemic is reflected in the dramatic change in South Africa’s mortality rates. The overall number of annual deaths increased sharply from 1997, when 316,559 people died, to 2006 when 607,184 people died. This rise is not necessarily due solely to HIV and AIDS but it is young adults, the age group most affected by AIDS, who are particularly shouldering the burden of the increasing mortality rate. In 2006, 41 percent of deaths were attributed to 25-49 year olds, up from 29 percent in 1997.

South Africa contributes 7% to the global HIV epidemic. We consume 25% of the world ARVs. Our performance and outcomes are far less yet we are highly resourced with regard to HIV and AIDS funding when compared to other African counterparts. No doubt, we are also running an expensive curative service that needs to be redirected to the Primary Health Care model.

The fact that South Africa contributes only 7% to the global epidemic, yet consumes 25% of the World’s ARV treatment is worrisome. This calls for more focus on prevention to close the flood gates of new HIV infections. An observation is made from the end term review 2007-2011, mid-year estimates has shown that 92,000 of people in the North West Province are eligible for ART. However only 42,000 had access to ART as at 2011, meaning more than 50% still need to be initiated.

Our challenges are also rooted in the global corruption chain championed by the big international conglomerates that see us (Africa) as a “milk cow”. This is despite the challenges that are before us. The little resources that we have at our disposal are taken from us to further enrich developed countries with far less social problems like ours. Africa is paying about 30 to 40% on drugs. Just on TB drugs alone, a new report by Medecins Sans Frontieres (MSF) has revealed that we are paying exorbitant high prices for drugs to treat drug-resistant tuberculosis. These prices are said to be already high but compared to the prices negotiated by the MSF International, South African government was paying up to three times more for these already pricey medicines. This is also been observed with Antiretroviral drugs. Multinationals with exorbitant profit interests are ripping us off. Without a doubt, many of the world’s drug companies are making large profits by selling drugs to the poorer nations that have massive HIV/AIDS problems. This is an immoral exploitation of those AIDS sufferers who can least afford to pay the huge sums of money for treatment, but who have the least power internationally to negotiate for cheaper prices. The countries with the biggest AIDS problems are held as a captive market and are forced essentially to pay whatever the drug companies’ demand for their products. The poor nations are thus justified in using the threat of generic drugs to force the companies to lower their prices.

The International AIDS Society conference which was recently held in Rome, Italy revealed quite astonishing facts about our challenges as Africa. One of the presenters at the conference Filippo Von Schloesser who has lived with the virus puts our situation into perspective when he said, “I have been living with HIV and AIDS for more than 25 years. I survived a heart attack. I am alive because I was born in this part of the world (Europe). I wouldn’t be speaking to you today if I were born in one of the countries, most affected and where access to care and treatment has only started to become a reality very recently”. With these words, he put it into perspective that, as an HIV positive person he would have died of heart attack if he was in our underdeveloped countries. A sad state of affairs indeed!

Speaking at the United Nations Secretary General’s Forum, Dr Margaret Chan who is the Director General of the World Health Organization (WHO) made this worrying observation about the plight of the developing nations; she said

“The crises we face are global but the consequences are not evenly felt. Developing countries have the greatest vulnerability… They are hit the hardest… People in affluent societies are losing their jobs, their homes and their savings… In developing countries, they loose their lives”. Dr Chan’s observation is an urgent call for us as a developing state to do more for vulnerable groups and to strengthen our health systems.

The North West Province is characterized by 13% of the HIV prevalence in the general population (HSRC 2010) and 30.0% amongst pregnant women (2009 Antenatal HIV Sero -prevalence survey). A downward trend is observed for our province on HIV incidence rates amongst men and women aged 15-24 but still have the second highest incidence in the country.

Maternal orphans created by dying mothers aged 21-40 are at 67% and rated the sixth highest in the country. Bojanala is found to be a leading district with maternal orphans at 37.0%, followed by Dr Ruth Segomotsi Mompati at 27% respectively. Ngaka Molema District is found to be a second leading district with maternal mortality in the country. The status of TB in the province shows increased TB caseload of new smear Positive by 10713, TB cure rate at 56.3% in 2009 from 56.6% 2004.

Vaccine Development

While there are visible international efforts to research and trial vaccines, we need to accept and agree that finding a cure for HIV is still in the far future and I will tell you why. The 6th International AIDS Society (IAS) Conference focused on HIV Pathogenesis, Treatment and Prevention and it was aimed at providing new insights into HIV disease development, biomedical prevention, clinical care that can lead to research directions and help translate theoretical advances into clinical and prevention practice while building evidence for successful programme operations and implementation. Of all the issues covered at the conference, the challenges in HIV vaccine development was a very interesting scientific deliberation.

It surfaces that, the ability of the virus to integrate its genome into human cells as well as its propensity to replicate and mutate rapidly has challenged the field enormously. The rapid mutation rate enables the virus to evade the immune system while rapid integration results in establishment of latent viral reservoirs very early during acute infection (within days) and this constitutes a major barrier to virus eradication. Early establishment of this latency narrows the window of opportunity wherein the virus could be eradicated by immune responses.

Most viral infections typically induce immune responses that involve both neutralising antibodies, preventing further infection of host cells and virus replication as well as cell mediated immunity – identifying infected cells and destroying them. This results in controlling and clearing of the viral infection and subsequent establishment of protective immunity. In HIV infection, these immune responses are inadequate and ineffective. As a result, natural clearance of infection has never been documented. This confronts researchers with a major immunological challenge because vaccine development is based on mimicking this natural clearing and establishment of long term immunity. Therefore, the immune correlates of protection for HIV are still unknown.

Viral diversity of HIV is another major challenge and has resulted in different subtypes circulating in different countries with recombinant forms in other areas. There is clinical evidence showing that certain subtypes (for example subtype D) are associated with rapid disease progression.

Another great challenge has been the lack of an ideal animal model which can mimic natural infection and pathogenesis of HIV disease in order to test candidate vaccines. The debates about what the characteristics of the vaccine(s) should be, which type of immune responses these vaccines must induce, and when and how to proceed to phase III trials to evaluate vaccine protective efficacy in humans are also unresolved.

The Positives

The picture is not all gloom though; a lot has been done and achieved. Here in our country, South Africa, we have made key policy directives on HIV which we believe will help us to reduce the burden of this disease in the short term.

In line with the policy pronouncements made by Deputy President Kgalema Motlanthe, we have already started to initiate more people early into the Antiretroviral Treatment programme. Over and above more than 120 000 people that we are currently providing with ARVs, we have planned to add more than fifty thousand (50 000) more people on antiretroviral treatment in the next six months. The Department is.

We trained close to one thousand four hundred (1400) nurses to administer ARVs in an effort to speedup process of those who need to be put on treatment. An additional number of 500 nurses will also undergo training in the current financial year. Accredited facilities to offer ARVs will also increase from 138 to 233 by March 2012.

Ladies and gentlemen, these positive developments follow a resounding success in our Mass HIV Counseling and Testing (HCT) campaign. Our province did exceeding well and it is all thanks to all of you as key stakeholders in the HIV and AIDS programme. I thank you very much for your role.

• In accordance with Medical Research Council report, an indication is given that the North West Province has performed extremely well in reducing Mother to Child Transmission of HIV by 95%; the province managed to reduce MTCT to less than 5% and geared towards complete elimination by 2016;
• The province has also been on the lime light for the outstanding performance on the HCT campaign, a leading province nationally by 105% as against the national target.
• STI incidence rates were reduced by 1%

We are bringing all these important and positive developments into this Lekgotla and surely, we should be able to do more as we build up to the World AIDS Day in December.

Going Forward

So, ladies and gentlemen, it is clear to me and I believe to all of us that HIV will be here for generation to come. The questions is what do we do and in answering this question, we must move from the premise that “Healthcare is a right not a priviledge”. I have tried to give a global perspective of this issue but we need to start with ourselves as individuals (self). Then we can contribute towards what we can do together as the department, the province and the nation.

On the basis of the above stated background the province needs to focus on strategic issues like Revolutionizing TB & HIV prevention, Catalyzing the next phase of treatment, care & support, Advancing human rights & gender equality

On Revolutionizing TB & HIV prevention, we want:

 To Strengthen strategic leadership and social cohesion;
 To intensify Political commitment to reduce burden of diseases in the province;
 Expedite a process for transformative change;
 Re- direct resources to hot spots and what works best for the province;
 Uphold economic growth path and reduce dependency.

On catalyzing the next phase of treatment, care & support, we want:

 Accelerate universal coverage on access to effective treatment for TB, HIV and AIDS ( 350CD4 Cell count, WHO stage 3 &4 )
 Establish and sustain strong provincial, district & local community systems
 Strengthen access to care, support & social protection

On advancing human rights & gender equality, the focus is on:

 Protective social & legal environment and enable access to human rights and justice
 Equitable service provision reaches people most in need
 HIV-related needs and rights of women and girls addressed


I hope this Lekgotla will thoroughly utilise this Lekgotla to foster and strengthen multi-sectoral partnership both at the provincial and local level and across all sectors. The Provincial Council on AIDS through its local and district structures should thoroughly engage with stakeholders for a sustained social mobilization.

The battle still lies ahead and we must remain united in the faced adversity!

I wish you a successful Lekgotla.

I thank you!



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