South Africa
Total Treatment Sites:		2
Treatment Site Location(s):		Ithembalabantu ('People's Hope') Clinic, KwaZulu-Natal  Middledrift Community Health Clinic, Eastern Cape
Patients on ART:		6,973
Patient Enrolled:		11,467
Report in PDF Format:		South Africa Country Report

Background & HIV/AIDS in South Africa

South Africa has the largest number of people living with HIV/AIDS in Sub Saharan Africa. It faces enormous challenges in scaling up its response to the now mature and generalized HIV/AIDS epidemic.  Between 1990 and 2003, HIV prevalence increased dramatically in South Africa and the overall social and economic impact was substantial; South Africa fell by 35 places in the Human Development Index (UNAIDS/WHO, 2006). During that time the country was distracted by major political changes and the transition from apartheid and it was not until 2004, years after other countries, that the South African government began its program to supply antiretroviral drugs (ARVs) (Avert, 2008).

At the end of 2008, an estimated 5.7 million adults and children were living with HIV and the total adult prevalence rate was 18.1%. HIV prevalence rates differ among provinces throughout the country, but the highest rate of 39.1% is in KwaZulu-Natal province. The HIV prevalence rate among sex workers outside urban areas was nearly 70% in 2004. Migrant laborers, truck drivers and men who have sex with men also exhibit higher than average HIV prevalence rates.

More than 1.4 million children in South Africa have lost one or both parents to AIDS and in 2007, 280,000 children under the age of 15 were living with HIV (UNAIDS, 2007). It is estimated that almost half of AIDS related deaths are caused by tuberculosis (TB). Approximately 28% of the people in need of immediate, lifesaving antiretroviral therapy (ART) treatment are currently receiving it.

The highly diverse population is divided by deep social inequalities and developing effective AIDS education and prevention campaigns is difficult.  The number of new HIV infections is high and antiretroviral treatment (ART) is still lacking.

AHF Activities in South Africa

In February 2002, AHF, in cooperation with local partners, opened the Ithembalabantu (‘People’s Hope’) clinic in Durban, situated in the KwaZulu-Natal province of South Africa. The clinic, located in a shopping center in Umlazi, is an accredited voluntary counseling and testing (VCT) site with several counselors working in conjunction with the KwaZulu-Natal Department of Health.  Services provided on site include: counseling and testing; CD4 tests and lab monitoring; care and support (social service support and counseling); treatment education classes; antiretroviral and opportunistic infection treatment; and skills and capacity building classes. 

AHF is partnering with the KwaZulu-Natal Department of Health on ART provision and laboratory monitoring. Other partners include Lifeline, which provides adherence counseling and social support, Durban Children’s Society, Natal Blind and Deaf Society, Umlazi Legal Aid Board, and many community-based organizations including education and tertiary institutions around Umlazi.

In September 2005, AHF partnered with Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to bring increased ART treatment to the Ithembalabantu clinic and the surrounding area. In addition to scaling up the Ithembalabantu clinic, AHF established a down referral network involving Primary Health Clinics in the area.  This system allows the Ithembalabantu clinic to test and identify more people who are living with HIV, refer stable clients to other local clinics, establish itself as an initiation center for more intensive scale-up of ART, and follow patients who experience complications with their regimens. 

AHF expanded its reach to Eastern Cape Province in September 2007. In partnership with the provincial Department of Health, EGPAF, and Anglican Diocese of Grahamstown, a local faith based organization, AHF began treating patients at Middledrift Community Health Clinic. Middledrift CHC has a wide catchment area with 10 Primary Health Clinics feeding into it. As of January 2009, 909 clients were in care, 226 of whom were on ART. The comprehensive care management and treatment (CCMT) program provides treatment, referrals, and adherence support. There have been no treatment failures (no need for second line treatment) and adherence rates are extremely high. In order to reach clients in difficult-to-reach, rural areas, AHF works with New Start to implement mobile VCT programs that include measures to decrease stigma.

Further, AHF’s Mass Testing Initiative (MTI) was launched to mobilize and bring together large numbers of people in order to provide HIV testing. In South Africa, AHF and its partners performed 36,000 tests at events organized around World AIDS Day 2008.

Results

Through its partnerships and innovative models, AHF continues to bring high-quality care to those most in need.  Highly successful in its partnerships, AHF is now a sub-recipient of funds from the President’s Emergency Plan for AIDS Relief (PEPFAR) through its agreement with EGPAF.  AHF has also signed Memoranda of Understanding with the KwaZulu-Natal and Eastern Cape Departments of Health, establishing Ithembalabantu and Middledrift as accredited ART rollout sites, such that most drugs and laboratory services are supported by the South African government.  Increasing capacity for the sustainable treatment of HIV/AIDS is a priority for AHF as it continues its work in one of the regions of the world hardest hit by the epidemic.