The good and not so good in the KwaZulu-Natal Provincial AIDS council
The first KwaZulu-Natal (KZN) Provincial AIDS Council (PAC) was formed in 2007, when South Africa’s first National Strategic Plan (NSP) came into effect. However, the then KZN Premier Sibusiso Ndebele showed little interest in the province’s HIV crisis, and the MEC for Health, Peggy Nkonyeni, appeared more interested in defending quacks like Zeblon Gwala than in accelerating the ARV rollout.
However, as the tide changed nationally, with both Thabo Mbeki and Manto Tshabalala-Msimang swept from their jobs as President and Minister of Health, things changed in KwaZulu-Natal too. Dr Zweli Mkhize replaced Ndebele as Premier and Dr Sibongiseni Dhlomo replaced Nkonyeni as MEC for Health. Both Mkhize and Dhlomo are medical doctors.
Even though the Tara KLamp episode (see box on right) has cast a shadow over the work of Mkhize and Dhlomo, both have been instrumental in transforming the KZN PAC from a dysfunctional bureaucracy into a vibrant and responsive council that other provinces can learn from. The premier deserves credit for his work in this regard.
[box]The KwaZulu-Natal Provincial AIDS Council has been transformed and invigorated under the leadership of Premier Zweli Mkhize. We take a look at what has changed since the dark days when Peggy Nkonyeni was in charge of the province’s health.[/box]
The role of civil society
In the dark days of Nkonyeni and Tshablala-Msimang, civil society organisations working in the health sector in KZN were relatively disconnected. TAC recognised this problem, and began a concerted effort to build alliances with like-minded organisations. Among others, TAC worked with the AIDS Foundation, LoveLife, The Children’s Rights Centre, the South African Medical Association (SAMA) and the Community Media Trust.
At the same time, TAC wrote numerous letters to Nkonyeni highlighting issues like medicine stockouts and poor treatment adherence. She was however not receptive, treating TAC as a threat rather than an ally in the fight against HIV and TB. TAC was left with no choice but to join forces with partner organisations to picket outside the then dysfunctional PAC.
TAC and its allies soon realised that without a working PAC it would be impossible to implement the Provincial Strategic Plan (PSP). So together these groups campaigned to get the KZN PAC up and running, helping to build a platform on which civil society could raise its concerns and to provide a new means of holding provincial government accountable.
[box]The effective AIDS council in KwaZulu-Natal is partly the result of strong political leadership from Premier Mkhize and partly thanks to civil society groups having organised themselves to demand action.[/box]
What makes the new KZN PAC different?
One of the most impressive features of the KZN PAC is just how many people are involved in the three-monthly meetings, which are chaired by Premier Mkhize himself. Unlike Nkonyeni, Mkhize has an open-door policy.
Some of those who attend the meetings include:
- Doctors, researchers, and representatives of civil society organisations and faith-based groups. The presence of these individuals means that groups like TAC and the National Association for People Living With HIV&AIDS (NAPWA) have the opportunity to raise issues with the PAC once other channels have been exhausted.
- Staff of the Provincial Department of Health, but also all provincial MECs. Their participation means that even the MECs for Sport and Housing must attend these meetings. In this regard, the KZN PAC sets an excellent example for other AIDS councils – including the South African National AIDS Council (SANAC). SANAC has recognised the KZN PAC as a model against which other provincial AIDS councils can be benchmarked.
- Representatives from district and local AIDS councils (DACs and LACs) Usually the mayors who chair these councils and the civil society representatives who are deputy chairs also attend these provincial meetings. Their attendance allows DACs and LACs regular opportunities to raise issues at the provincial level. In this way, the KZN PAC already achieves much of the bottom-up communication that is so important in the new structure of SANAC.
How issues are raised
Of course, all these people cannot simply bring every complaint to the PAC. For example, in the case of a medicine stockout it would be better to first raise the issue with the relevant health facility. If unresolved, the matter could then be taken up with district or local AIDS councils or district health managers. If the matter were not settled at that level, it could be raised with the PAC.
Of course, these rules are not set in stone, and exceptions might be made for urgent matters.
TAC, HIVEX and the PAC
HIVEX is an unproven, implausible treatment that its proponents claim can treat HIV using electromagnetism. As yet no studies have been published to support the claim that this treatment is of any use in humans. Even so, until recently HIVEX was offered as a treatment for HIV at a cost of R1,000 for a series of sessions at a facility in Durban. The treatment was provided by a company called HIVEX Ltd.
TAC members investigating HIVEX discovered that some HIV-positive patients had stopped taking ARVs after starting HIVEX treatment. Doctors reported similar findings. HIVEX denied telling people not to take ARVs, but refused to stop offering electromagnetism as a treatment for HIV.
TAC won a complaint against HIVEX at the Advertising Standards Authority of South Africa. Then on World AIDS Day 2011 TAC picketed at the HIVEX offices and handed the staff a letter demanding that the company stop offering HIVEX as a treatment for HIV. We also met with and raised our concerns with Clive Harvey Fox, the man in charge at HIVEX.
Finally, TAC also discussed the matter at a meeting of the PAC. The council decided to form a special adherence task team of which TAC would be a member. The team’s mandate was to address the problem of quackery in KZN, with HIVEX identified as a priority. The council instructed Ethekwini Mayor James Nxumalo to investigate HIVEX and asked him to report back at the next meeting of the PAC. Harvey Fox was invited to put his case before the PAC but he failed to appear at the meeting. Soon after, the HIVEX Ltd facility in Durban closed down.
Although TAC did a lot of the groundwork in this case, swift action from the KZN PAC proved to be the final push that helped to get rid of this quack treatment.
The Tara KLamp debacle
The good work carried out by the KZN PAC is to some extent undermined by its failure to deal efficiently with the issue of the Tara KLamp. The Tara KLamp is an unsafe circumcision device being used as part of the circumcision programme in KZN.
TAC strongly supports the rollout of voluntary medical male circumcision — but circumcisions must be done using standard medical procedures and not the unsafe Tara KLamp. Done in the right way, circumcisions can help save many thousands of lives. Done with the Tara KLamp, they can lead to avoidable pain and mutilation.
TAC has addressed the issue of the Tara KLamp directly with Premier Mkhize and Dr Dhlomo through meetings and letters, to little effect. We also raised the issue with the PAC, which assigned the matter to a medical male circumcision committee led by Dr Sandile Shabalala. This committee has failed to act on the problem. One member of the committee has even misrepresented TAC’s position as being against medical circumcision, which we are not.
TAC has thus been forced to take action outside the PAC, recently lodging a complaint with the public protector about the use of the Tara KLamp and the way in which it was purchased. Just as Premier Mkhize and Dr Dhlomo deserve credit for helping to revitalise the KZN PAC, they will also be held responsible for failure to act on the Tara KLamp
By Patrick Mdletshe and Marcus Low
Patrick Mdletshe is the elected Chairperson of the Treatment Action Campaign KwaZulu-Natal. Marcus Low is editor of NSP Review