Biology

This research project examined inter-governmental relations in the health sector in South Africa. It focused on HIV/AIDS services but the intention was to use HIV/AIDS as a tracer or probe of broader health system functioning. The main objectives of the research were to describe what HIV/AIDS services are provided, how the different functions are allocated between government actors, and how they are then coordinated. The study was conducted in two parts. Phase 1 was completed in the second half of 2002 and provided a broad National Overview of HIV/AIDS activities in the national, provincial and local spheres of government. Phase 2 was done in early 2003 and consisted of detailed Case Studies from three different tracer municipalities. The research methodology was mainly qualitative and exploratory and included literature review, document analysis and key informant interviews. An output of the Local Government and Health Consortium, funded by Health Systems Trust and comprising Health Systems Trust, Centre for Health Policy and Health Economics Unit

Capacity building for PMTCT and Infant Feeding in South Africa began in April 2001, soon after the start of the Pilot PMTCT Programme. A consultant was seconded from UNICEF to facilitate training of front-line health providers in the provinces, thereby developing a critical mass of Trainers using the selected training manual to address the key competencies of health providers with regard to PMTCT and IF. As the demand for training increased, and with limited capacity in most provinces to manage the process, a tender was issued by the National DOH and the CDC to support training efforts. A Consortium was awarded the tender in July 2002. The Consortium consists of the Health Systems Trust, Womens Health Project and the School of Public Health at the University of Western Cape. These organisations were appointed to co-ordinate and sustain the demand for training in seven provinces, which included conducting a rapid assessment of the training and a training needs assessment in each of the provinces, assisting provinces in developing a provincial training plan and evaluating the short term impact of the training.

South Africa provides HIV+ mothers with free commercial infant milk for six months of the infants life in 18 pilot sites for the prevention of mother-to-child-transmission (PMTCT). Many mothers in the PMTCT-programme choose to accept this formula, but few studies of actual feeding patterns have been conducted. Studies in some PMTCT pilot sites have shown that mothers have difficulties in formula feeding their children. The risks of replacement feeding are well known in general, but very few detailed studies of the issues involved have been in any African setting.

Sexually transmitted infections (STI) are a major public health concern in South Africa, especially given the cofactor effect on HIV transmission. It is estimated that 11 million new cases of curable STI occur annually and thus STI control has been placed high on the public health agenda. This report assesses the adequacy of training of medical doctors on the management of sexually transmitted infections at eight medical schools in South Africa within the context of the national STI control programme. It analyses the STI curriculum in medical schools, the knowledge and practice of community service doctors (CSD) on STI management and the extent of medical school involvement in the national STI control programme.

Compiled by Celicia M Serenata Project Manager: HIV/AIDS Tel: (012) 312-0128 or (082) 413-2381 Fax: (012) 328-5743 or (012) 326-2891 e-mail: serenc@health.gov.za Any queries, comments or additions can be forwarded to the above address.

Control of Sexually Transmitted Infections (STI) is a key intervention in the fight against HIV/AIDS and is one of the key areas of focus for the national strategic plan. This booklet provides an overview of broad issues related to the management of STI in South Africa. It reviews both the public and private sector issues describing the key health system problems and strategies being taken to address them by different stakeholders.

This report summarizes the results of a survey of 771 AIDS-affected households in different parts of South Africa. The households were randomly selected from the client lists of non-governmental organizations providing support to AIDS-affected households in the regions where the survey was conducted. The survey and this report are an attempt to document the impact of HIV/AIDS on South African households. Although it is not representative of all AIDS-households in South Africa, the report provides a snapshot of the devastating impact of HIV/AIDS on already poor families. As bleak as the findings of this survey are, the households in this survey are likely better off than most since all households in the survey had contact with non-government organizations providing support to HIV-affected households.

Voluntary counselling and testing (VCT) has an important role to play in this country's response to the HIV epidemic. This role can be evidenced at both the level of primary prevention by preventing the spread of HIV and at the level of secondary prevention of HIV, by the alleviation of distress among people infected and affected by HIV.For effective VCT, there is a need to understand that counselling and testing must be confidential and voluntary. This process must be accompanied by ensuring preparedness for clients to come into terms with their HIV status. This preparedness includes dealing with fear, guilt, stigma, discrimination, care for a chronic and fatal condition, early death, what one can do when infected and what to do to remain uninfected. This assessment of the public sector VCT sites was aimed at informing the National Department about progress made thus far with the implementation of their VCT programme.