AIDS Councils in need of care

In October 2012, the SA National AIDS Council (SANAC) committed itself to a wide range of initiatives designed to improve its effectiveness and that of the country’s HIV prevention efforts. Measures included increasing national funding for prevention activities, the reinvigoration of provincial AIDS Councils, and the broadening of representation within the body’s leadership.

Among others, the National Strategic Plan states clearly: “Governance and reporting arrangements will start at ward level through districts and municipalities to provincial AIDS councils and finally to SANAC. There will be a clear guiding framework to support implementation and set out expected roles and responsibilities.”

One year after the reforms were announced, SECTION27’s snapshot survey of provincial structures reveals that SANAC has achieved only limited success. While provincial councils are now established in each of the provinces surveyed by SECTION27, their functionality and responsiveness varies significantly and is mostly poor.

With the exception of Limpopo, survey respondents indicated that provincial AIDS Council meetings are held regularly, with most being held quarterly. Meetings are chaired by the respective provincial premiers, except in the Western Cape where it is headed by the MEC for Health, Theuns Botha.

In the Eastern Cape, KwaZulu-Natal and Mpumalanga, provincial AIDS Council meetings appear to be co-governed by both members of civil society and the provincial government. Task teams of provincial government officials have been appointed in KwaZulu-Natal to implement council resolutions.

The SECTION27 survey shows that while province-specific issues have dominated council proceedings, common themes are evident. These include discussions about the National Health Insurance (NHI) scheme, ongoing drug shortages and stock-outs, and the need for better leadership in the HIV fight. Discussions have also focused on councils becoming officially constituted, active and fully functional.

In the Limpopo and Eastern Cape, activities have slowed considerably amid recent political disruption. Although the National Association of People with AIDS (NAPWA) and TAC have made significant contributions to council discussions, the quality of the state participation in the Limpopo Province has been poor.

Solly Milambo, the TAC Provincial Chairperson in the Limpopo says that a sense of despondency seems to be setting in: “The Premier firsts meets with Cabinet to discuss and decide everything and then meets with us. We had less than two hours to discuss everything. We have not resolved a single issue … they have done nothing.”

Change is needed in the way the provincial AIDS Council meetings are run, he says: “Some of the organisations represented have no constituency … We need organisations that have a real constituency to be represented.” Milambo hopes that once the [mid-term] review of the National Strategic Plan (NSP) is conducted, improvements will be possible.

The scope of the activities performed by each provincial AIDS Councils has varied. In the Eastern Cape, a provincial spokesperson indicated that the National Association of People Living with HIV/AIDS (NAPWA) had piloted a ‘Stigma Index’ [to measure levels of stigma and discrimination]. Results were being disseminated to the province via the council with a view to better informing policies and interventions.

In KwaZulu-Natal, provincial AIDS Council support has been given to major initiatives, including the HIV Counselling and Testing Campaign (HCT), the PEPFAR-supported Zazi campaign aimed at young HIVpositive women, and the Hlomanje campaign. The Council has also supported a ‘Sugar Daddy’ project which warns against the risks of cross-generational sex, as well as a World AIDS Day event. Provincial infant mortality levels are being monitored with the additional support and guidance of research institutions when needed.

Progress in the Limpopo Province has been less encouraging. Meeting cancellations have meant that the Council had not yet developed adequate monitoring instruments, and still appears to have no advisory role to the provincial government. Similarly, even after four meetings this year, the provincial AIDS Council in Mpumalanga had not developed specific monitoring and evaluation components, and the Council does not appear to be engaged yet in any specific activities.

In the Western Cape, council discussions have focused largely on issues related to new developments in AIDS and TB research, including male circumcision and genetic methods of detecting TB. While initial work related to circumcision campaigns has been undertaken, wider debate about whether such campaigns potentially infringe upon traditional circumcision culture may limit further activity.

SECTION27’s survey may not provide an in-depth picture of the provincial AIDS Councils, but it indicates that their progress has been inconsistent and, at times, far from adequate. Many lack a clear vision of what they wish to achieve and have been weakened by political wrangling and interference. A year on, SANAC’s vision of improving the effectiveness of its provincial structures has not been fulfilled.

NSP Review did approach SANAC for comment on the importance and role of AIDS Councils, but received no response.