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Siyayinqoba Beat It! Episode 18 -
ARV treatment sites
In this weeks episode of Siyayinqoba Beat It! 2006 we are talking about how the slow process of accrediting ARV treatment sites is causing problems for people accessing ARVs, we speak to James Nonnies about the death of his son Msimelelo due to poor access to ARVs, we also speak to HIV positive inmate Sifiso Zulu about accessing ARVs at Westville prison in Durban. Fatima Hassan from the Joint Civil Society Monitoring Forum joins our support group to talk about the problems facing sites wanting to become accredited.
Shalom Ncala:Molweni siyani amukhela kuSiyayinqoba Beat It! support group. [Hello and welcome to the Siyayinqoba Beat It! support group.] My name is Shalom Ncala. In the Beat It! support group we are all living with HIV. Hi and welcome everyone. How is everyone today? Iviki ne viki yiyahlangane ukuzo xoxisana ngezindaba ezithintana ngeziphilo zethu, ukusuka ekugezeni kwesidoda ukufikha ukudleni ukudla ekunophilo kanye nokondla umzimba. Usiyayinqoba nguhlelo lakwo lokhu phila ngancono neHIV. Uma uphila negciwane le HIV, noma unomlingani, ilunga lomdeni noma umngani ophila negciwane leHIVi siyayinqoba nge yakho. Namhlange sibhekana ngokulashwa ngama ARVs ezindaweni zasemakhaya asemadorobheni. Masiboneni ukuthi ababukeli ukuthi bathini ngalokhu.{IsiZulu}[Each week, we get together to discuss things that affect our lives, from sperm washing to healthy eating and nutrition. Siyayinqoba is your guide to better living with HIV. If you are living with HIV, or you have a partner, a family member or friend who is living with HIV, Siyayinqoba is for you. Today we are talking about ARV treatment in rural and urban sites. Let’s hear what our viewers have to say.]
Question: Afika nini amaciza kagawulayo izikliniki zethu, ngoba ndiyazi ukuba banintsi gqithi abantu abawafunayo.{IsiXhosa} [When are ARVs gong to be available at our clinics because I know there are many people in need of treatment?]
Shalom Ncala: Namhlanje sibheka cho ngokunikana ngevume ezindaweni zekhulashwa ngama ARVs. Odokotela abazimele anadingi ukuba bangene ehlelweni ukuthola ivume bona banga kwazi ukunikhezela amaARVs njengoba kufanelekile. Umakhuchathanishwa ukunikweza ngabaARVs imithola philo eminingana isaselele umuva ngenxa yohlelo elinikheza ivume ilithatha isikhathi iside. Esinayelapha esizoxoxosana naye, nguFatima Hasaan oyi co-ordinator ye Joint Civil Society Monitoring Forum. Kodwa okokhuqala iqembu leSiyayinqobq Beat It! lahlangana nomndeni wakha Msimelelo Nonnies emgcwabeni wakhe eAberdeen. uMsimelelo washona ngoba wayengakwazi ukuthola iFluconazole kanye nama ARVs. Siyesakhulume no dokotela Xundu ovela emunyangweni wezephilo sabesesibuza ukuthi unyango unikheza kanjani umuthola philo noma isibhedlela ivume yokunikezela ngamaARVs.{IsiZulu} Today we focus on the accreditation of ARV treatment sites. Doctors in the private sector do not need to go through the accreditation process. They can dispense ARVs as they see fit. In contrast, ARV roll-out in most public clinics is lagging because of the lengthy accreditation process. To help us discuss this issue is Fatima Hassan, who is the co-ordinator of the Joint Civil Society Monitoring Forum. Welcome Fatima. But first, the Siyayinqoba team met with the family of Msimelelo Nonnies at his funeral in Aberdeen. Msimilelo died because he didn’t have access to fluconazole and ARVs. We also spoke to Dr Nomonde Xundu from the Department of Health and asked her how the Department goes about accrediting a hospital or a clinic as an ARV roll-out site.
Aberdeen, Eastern Cape
When will HIV treatment reach remote areas?
James Nonnies, Msimelelo’s father: Ndivele ndiziva ndibutlungu ukulahlekhela ngunyana wami, ekuzenikwakhe asichazele, naye wayebutlungu kuyilento leyo. Enesililo esithi nokho mama tata bendingathandi ukuba ndifekwangiku, yayilonto ifikayo apha kum. Elizweni lonke jikelele kuthiwa leciza liyafumaneka elicenda abantu abana leHIV.Apha eAberdeen ukuna ciza elifumana kalayo apha. Yintoni na nxa ukho abogqirha apha? Kunezikliniki kunde leyeza lingafikeli apha? {IsiXhosa} I’m devastated by my son’s death. When he disclosed his status, he was hurting. He said, ‘Mom, dad, I don’t want to die now’. That hurt me very much. All over the world, you’ll find the medication that helps people living with HIV, but you won’t find it in Aberdeen. We’ve got doctors, and we have clinics, so why aren’t we getting the medication?
Nomhle Nkeleni, Aberdeen Hospital: I treatment ke uyewayifumana the day bekafikile apha, because igqirha uye wamu prescribela i-treatment specific for I oral thrush,i oesophageal thrush uyachonda. Kuyekwafanela ukuba siyi order e-Graff yi-Diflucan ayikho apha because, into ebangela ukuba singabi nayo le treatment yintoba thina we are just a feeder clinic apha e-Graff. {IsiXhosa} [The day after he was admitted he received treatment. The doctor prescribed treatment specifically for oesophageal thrush. We had to order this Diflucan (Fluconazole) from Graaff Reinet. We don’t have it here because we are just a feeder clinic to Graaff Reinet.]
Dr Nomonde Xundu, National Department of Health: We said with this programme, we’ll make sure that njengoba siyi implemetor [as we implement it,] in this five year plan, we need to ensure that there is equitable access. Equitable ngokuthi [meaning] that we prioritize indawo [places] where there is the biggest need. So you get about five to six people getting to do the baseline assessment of a facility. They will look at projected patient loads and then they baza jonga kwakhona [will look again] at the physical space. Stock control mechanisms, how is this facility managing stock. You cannot, with this programme, particularly with ARVs, have a situation where people run out of the door. And then we look at within the facility, we’re talking standards. As the guidelines develop for opportunistic infections, ARVs, nutrition, STI, all of these, are they zikhona na?[ available?] ukuba khona na ziyasetyenziswa? [Availability is one thing, but are they being used?] And then we look at the skills of the human resource staff you have they been trained? And what, when? Do they need to be retrained? We do an audit, and so on. As of the end of June, 251 facilities nation-wide have been accredited, going through that whole process and we started implement in earnest in April 2004. That is about, now what, two and a half or so years down the line, we’re about half way through the implementation for the five year plan.{IsiZulu}
Vuyani Jacobs: Kudala akhalaza athgi ufuna ukuba kuma anti-retrovirals drugs, kodwa nge nxa zingekho apha eAberdeen apha ekhuhlaleni, akwaze abanenxanabo yokuzithatha, so ufe esimunxuphekweni asazi ukuthi yintoni into eyomupha ubomi. Kodwa azange ayifumane. Nakhona bekhanga zinidi ezoFluconazole because nxa iCD4 count yakhe bakaye monitharisha ayazi ukuthi ithobile isezansi incwanaba lakho lokhungena kuanti-retrovirals drugs besingeke sibe entlungwini olohlobo. {IsiXhosa} He wanted to be put on ARV drugs for a long time. But since they are not available in Aberdeen, he couldn’t access them. So he died knowing what could prolong his life, but had no access to it. Furthermore, he wouldn’t have needed fluconazole if his CD4 count was monitored and shown to be low and at a stage where he needed antiretroviral drugs, we wouldn’t be mourning him right now.
Nomhle Nkeleni: Ukusukhela kulonyaka ophelileyo after kuye kwaziswa from e-departmethini ukuba eGraff is one of the hospitals izi zizwa creditor, kwaqalisa ngetraining so usemuninsi umuntu otrainiweyo professionals nurses, counsellors, i like aba abayenza iVCT ne PMTCT and all that seyiqalile itraining kuya trainwa all the time. Nabo abogqirha sebatrainwa regarding understanding yeARVs. {IsiXhosa} [As of last year after we learnt that Graff Reinet is one of the hospitals that will be accredited, we started with training. So a lot of people have been trained; professional nurses, counsellors that do VCT and PMTCT and so on. Even the doctors are being educated about ARVs.]
Vuyani Jacobs: Abantu bayafa because le process ye accreditation inzima kakhulu. Iyona into ebutlungu ke abantu abango nesi, no sister,no gqirha bayayifuna lento but urhulumente usukha kunde ukusukhela izansi ukuza abatwini, lento ufuneka ukuba ibene bridgiong point ukuba kufuneka kufundiswe in masses then ke ngoku la process ikhawuleziswe {IsiXhosa}[People are dying because this accreditation process is difficult. The sad part is that doctors and nurses want things to happen fast, but governance takes time to reach people. So there should be a bridging point whereby people are educated in masses to speed up the process.]
Support group
Shalom Ncala: I can’t seem to understand what is going on with the government. Why is the accreditation process taking so long? Who is in charge of these things? Why are those people there when they cannot speed up these processes?
Fatima Hassan: It’s so hard to explain the delays by government in speeding up accreditation, especially since this process started from Nov 2003. There’s two things you have to bear in mind: the first is that the operational plan talks about accreditation, and it lists about 20 different things that have to be in place before a site can be accredited, but that was never the intention of the accreditation process. The accreditation was initially meant to make sure that you had a doctor, you had a nurse, you had access to voluntary counselling and testing, you had access to the drugs, and you had access to laboratory facilities. The rest would over time fall into place, so the requirement of a dietician, the requirement of a nutritionist, the requirement of a social worker, was something which was meant to come in place at some later point, but would never act as a barrier to initially providing ARVs, and what needs to happen, really, is that the National Department of Health needs to give up control of the accreditation process. As long as the Minister and the National Department of Health is in charge of accreditation, there will only be one team in the whole country that is responsible for accreditation, and that situation is untenable. We’ve got an emergency, we’ve got five and a half million people living with HIV/AIDS, we’ve got 800 000 people who need treatment. What needs to happen is that every province should be allowed to accredit facilities themselves, and if we said today, you’re allowed to do that, by tomorrow - I guarantee you - hundreds of facilities across the country will start providing ARVs because they won’t be hampered by the bureaucratic delays of the National Department of Health.
Thami Mthembu: Is the situation the same in the private sector? Are you finding this much red tape as well?
Fatima Hassan: In the private sector, you don’t have to be an accredited facility to dispense ARVs. If you are a doctor in private practice, as long as you have a dispensing license, they you can prescribe any medication. But certainly there isn’t this list of 20 different items that you have in place before you can start providing ARVs. And in the private sector, as you have money, you can go into any facility and be able to get ARVs.
Thami Mthembu: As a person who’s coming from a particular community, I mean I live in Chesterville, or as a person sitting at home, who’s living in Aberdeen, what can I do towards making sure that the process is not being prolonged?
Fatima Hassan: You can lobby your local counsellor to find out why are there not facilities in your area, or nearest to your home that are accredited as yet. You can use your local municipal elections to bring up those issues, and bring it onto the political agenda because it’s an issue that is affecting people’s lives and their health. You can go to the actual facility, to the local clinic, and speak to the superintendents or the person in charge and say, ‘Why is your facility not accredited? Where is your accreditation plan? When do you expect to be accredited? Why are you not accredited as yet, if you’ve already been visited? And why is the National Department not helping you if they feel you are not fulfilling some of the criteria?
Vuyani Jacobs: Can’t we take the Minister to court and charge her with homicide, or culpable homicide? I’m serious.
Fatima Hassan: Certainly from the work that we’ve been doing from the Joint Civil Society Monitoring Forum, and we’re made up of seventeen leading civil society organisations, and we’ve been joined by the private sector and the South African Human Rights Commission, our work has shown consistently, over the last two and a half years, that the Minister’s actions, or her lack of actions in certain key areas, has directly lead to the premature sufferings and deaths of thousands of people in this country. The government boasts that it has the largest treatment programme in the world. It’s simply untrue, and it’s not something that they should even be proud of, because if you look at the gap, we’ve got about 175 000 people on treatment, but 800 000 people need treatment. We’re not even getting 20% coverage. In countries like Brazil they have 83% coverage. There are only three countries in Africa that are treating at least 50 % of people who need treatment: Rwanda, which is even poorer than us, which is weaker in public health infrastructure and who just came out of a genocide, is doing better than South Africa, because they have a political will and leadership. Namibia and Botswana are treating at least 50% of people, and they have much smaller infrastructures and they have much less resources. So, we’re faring quite badly, and for that reason, I would agree with you that certain action has to be taken against the Minister to say, ‘In my view, you are not doing your job, you are failing in your job, you are delaying this programme, you are delaying accreditation, you are delaying the procurement of drugs, you are creating confusion around the safety and efficacy of ARVs’. And for that reason, legal action should be taken against her, I think’.
Shalom Ncala: [We talk more about ARV treatment sites after the break. Don’t go away. ] {Sesotho} We will be right back so stay tuned.
Shalom Ncala: [Welcome back to the Siyayinqoba Beat It! support group.] {Sesotho}. The programme for everyone affected and infected by HIV. Namhlanje sikhuluma ngokulashwa ngama ARVs ezindaweni zasemakhaya asemadorobheni, sizobona ukhozekha ecaleni enkantolo lokthuti kutholwe amaARVs ijele lase Westville kwaZulu Natal. {IsiXhosa}[Today we are talking about ARV treatment in urban and rural sites. Our next insert looks at the recent court case for access to ARVs at Westville prison in kwazulu Natal.]
Westville, KZN, Can prisoners access ARVT?
Narrator: In 2005, Siyayinqoba did a story on Sifiso Zulu and the lack of access to ARVs at Durban’s Westville Prison. Shortly after our broadcast Sifiso and a few other inmates went on a hunger strike as a form of protest for access to ARVs.
Sifiso Zulu: Njengomuntu uphila ngaleli gciwane inhliziyo yama ibuhlungu kakhulu. Njengoba ngiyezwa, ngiyabukela neTV izindabeni, ngiyezwa oTAC bapromotor bathi ngephela ngephela bathi amaARVs anengalelo elikhulu ukuphiliseni iziphilo zabantu abaphetwe yileli gciwane. So inhliziyo yama ingajabula kakhulu uma nalangaphakathi ekhaya noma kulomizi okhona eWestville ungathi uhlelo lama ARVs lungaqalisa khona.{IsiZulu} [As a person living with HIV, I am very disappointed, because when I watch television, I hear organisations such as TAC saying that ARVs are very effective in keeping people with HIV alive. So I would be very happy if the roll-out of ARVs was also happening here in Westville Prison.]
Vuyo Mbuli, News Reader: A hunger strike by 119 HIV positive inmates at Durban’s Westville Prison has been called off after the intervention by the Correctional Services Dept. The prisoners, who stopped eating on Monday, claimed not to have access to Anti-retrovirals treatment. A team has been established to help resolve issues that may have led to the hunger strike. About 200 women prisoners alone at the Westville Prison are HIV positive, more than 50 others have died of AIDS-related illnesses in the past year.
Lorreta Jacobus, Deputy Minister of Correctional Services: According to our information, there was no hunger strike at Durban Westville. Unfortunately there was a group of inmates that had taken the Department of the Correctional Services as well as the Department of Health to court claiming that we denied them access to Anti-retrovirals. And, I must also say that that is incorrect because at the moment we refer inmates who are HIV positive, who we know are HIV positive, to the relevant health facility, because as Correctional Services, we are not a healthcare facility.
Jonathan Berger, AIDS Law Project: We heard that there were prisoners who qualify for Anti-retrovirals and were not accessing the treatment that they need to keep them alive. So it really was about compelling the prison authorities to take all reasonable steps to ensure that these prisoners are put onto treatment.
Loretta Jacobus: We provide basic primary healthcare, but in terms of the administration of Anti-retrovirals, and pre-programmes that needs to go with that, we refer our inmates to the Department of Health or to health facilities outside. We are, however, in the process of having some of our facilities accredited as sites that we can administer from and with that goes a whole training programme of our staff that we’ll embark on, and just coincidentally, Durban Westville is one of the sites that we’re working on to get accreditation for.
Dr Nomonde Xundu: If we were to accredit a prison, it would depend. They would need to qualify on what we have outlined according to the requirements for accreditation.
Judge J. Pillay Judgment in the case of Prisoners vs. Government: That the response be, and I hereby order it with immediate effect, to provide antiretroviral treatment in accordance with the Operational Plan, to the first, second, third, fifth, sixth, seventh, ninth, tenth, eleventh, twelfth and fifteenth applicants, and all other similarly situated prisoners, at Westville Correctional Centre at an accredited public health facility.
Jonathan Berger: There are three things that have to happen. The first is that correctional services have to remove all the barriers that are in the way of prisoners getting access to treatment at Westville. One of the barriers has been the issue of the requirement of an ID document. The second is to place prisoners who qualify for Anti-retrovirals treatment on Anti-retrovirals treatment immediately. The third part of the judgment then is for the state, on or before the 7th of July, on oath in an affidavit to set out what steps it is taking to comply with the second part of the order, putting people on treatment.
Loretta Jacobus: As the Department of correctional services, we respect the judgment of any court of law. The basis of our appeal, summarised, is that we don’t believe that a court of law has the right to prescribe medical healthcare that belongs solely with a medical official. And that’s the basis of our appeal, or one of the points of our appeal.
Narrator: In July 2006, the Department of Correctional Services released Sifiso Zulu from Westville Prison on what they termed ‘early parole’.
Sifiso Zulu: Ngalendaba yalama ARVs into eyezekhile idepartment engifuna ukhukhuveza bakhomisile ukuthi abanasirhe, ungathi abazele labafuthi ama authorities of Department of correctional services ngoba iziboshwa zifa phambikwabo, yifaphambikwabo sigula kodwa still bayazi ukuthi ioperational plan leyeHIV icomprihensive, operational plan yeHIV policy isisho ukuthi basi asseswe masi refere khuma accredited site kodwa bona abakuyenzanga lokho until icala lifakwa enkantolo. {IsiZulu} [In the issue of ARVs, what I want to say is that the Department of Correctional Services is heartless. Prisoners die right in front of them even thought they know that the operational HIV/AIDS policy says that we should be assessed or referred to ARV sites. That never happened up until the case went to court.]
Support group
Shalom Ncala: What I need to understand from you, Fatima, that how big is this problem, how many people in our prisoners actually suffering from AIDS and are dying from HIV related AIDS illnesses, if you can just unpack this for us? Make me understand.
Fatima Hassan : You know, the data that was released by government a few years ago, indicated that at least about 40% of prisoners, so 40% quite a big number of prisoners in the South African in a correctional service system, are actually living with HIV. The percentage of prisoners who are accessing treatment around the country in a meaningful and sustainable way is quite negligible. It’s estimated that at Durban Westville prison that at least nine prisoners die of AIDS-related illnesses every month. So it’s quite a high number and our prison authorities are sitting back and doing nothing. So if you saw from this particular insert, were it not for the court case that the AIDS Law Project and the Treatment Action Campaign brought on behalf of those 15 applicants as well as other prisoners at Westville, those prisoners would not be accessing ARVs.
Shalom Ncala: [We talk about more about ARV treatment sites after the break.] {Sesotho} We will be right back.
Shalom Ncala: [Welcome back to the Siyayinqoba Beat It! support group.] {Sesotho} The programme for everyone affected and infected by HIV. [Today we are talking about ARV treatment sites.] {Sesotho} Say maybe some of these people are killers and whatever, what does the constitution say about the right to life for every South African citizen?
Fatima Hassan: The constitution provides that everyone has the right to dignity, has the right to access healthcare services, and has the right to equality and also has the right to access the courts when they feel that their rights are being violated. On prisoners in particular, there’s a section in our constitution in the Bill of Rights which says that every prisoner has the right to conditions of detention which are consistent with human rights and with dignity and with the right to access healthcare services. They don’t have the right to optimum medical treatment, but they certainly have the right to basic medical treatment. They also have a right to consult with a medical practitioner of their choice, and to be seen by a medical practitioner of their choice. So the constitution guarantees a detained, accused, convicted prisoner, irrespective of the crime that they’ve committed, the right to access healthcare services. And you know, it’s understandable that some people will feel, ‘Oh, but this person killed my brother’, or ‘This person committed this crime’, or ‘This person raped my sister, so why should I provide them with anti-retrovirals?’ The problem is, unlike you or me or somebody who has a lot of money, they’re not free. They can’t walk into any public health facility or private healthcare facility and say, ‘I need TB treatment’, or, ‘I need ARVs’, or, ‘I need medication for my heart’. Because they’re in prison, the only place they can access any healthcare services is from the prison it selves.
Shalom Ncala: It takes you from prison, when a person comes out of prison say maybe they haven’t been put on ARV but they are still feeling as well as maybe I feel that person can actually go and infect other people which create another problem reinfection as well as new infections which actually blows up the prevalence rate of HIV/AIDS in our country..
Fatima Hassan: The idea behind our constitution, and in fact it was Nelson Mandela, and I see you have a nice photo of him at the back there, he was the one who said that you measure a country’s democracy by the way in which you treat it’s prisoner, the lowest. The person who is usually regarded as the lowest in the chain of who you should be concerned about is the prisoner. If you treat the prisoner with standards of dignity and humanity, then that’s how you know if a country is a true democracy or not. So we can’t simply say, because we no longer have the death penalty, and we no longer put people in prison for life, not to be rehabilitated, not to be sent back into our communities. We put people in prison, 1) To punish them, 2) To deter other people from committing the same crimes, but also to rehabilitate them so that one day, like Sifiso, they will come back into the community and help with community work. So you can’t basically say ‘We won’t give you ARVs’, because that, in a prison setting with the realities of the South African correctional services situation, is in fact a death penalty and you can’t be punished twice.
Shalom Ncala: Namhlanje sifunde ukuthi kusemuqokha uuthi umuntu ophila ne HIV athole amaARVs. Abantu abakutholi ukholwashwa oluthatha isikhathi eside ukunikenza uvume. Ukuthola amaARVs idaba lamalungelo wesintu. Funisisa ngokuthola amaARVs emthola mphilo eduze nawe nalapha kunomthola philo enevume oseduze nakuwe. Qubekani ukusithumela izincwadi nisitshele ukuthi iqabangani ngohlelo lwethu. Ningathinthana nathi kumuninigwana esescreening manje. Siyathemba ukuthi niwujabulele uboniso futhi uzwa uboya weSiyayinqoba, sisonke singayihlula. Hlangana nathi ngeviki elizayo iqenjini likaSiyayinqoba Beat It! kuze kube kuloso sikhathi, hlala unemphilo, hlala unethemba. Salani Kahle. {IsiZulu} [Today we’ve learnt that it is vital for a person living with HIV to have access to ARV treatment. People are not getting this treatment due to a long accreditation process. Access to ARVs is a human rights issue. Enquire about access to ARVs at your local clinic and where your closest accredited clinic is. Please keep your letters rolling in and let us know what you think of our programme. You can contact us on the details on your screen now. We hope that you enjoyed the show and are feeling the Siyayinqoba spirit, together we can Beat It! Join us again next week in the Siyayinqoba Beat It! support group. Until then, stay healthy, stay positive. Goodbye.]
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