1 PROVINCIAL AIDS COUNCIL 10 AUG 2011 OUTCOME 2: A LONG AND HEALTHY LIFE FOR ALL SOUTH AFRICANS

Estimated number of annual new HIV infections in South Africans aged 15-49, by province (2009, EPP estimates) Source: 2009 EPP estimates provided by E. Gouws in 2010

KZN KNOW YOUR EPIDEMIC KNOW YOUR RESPONSE REPORT The following areas are important for the appropriate response in KZN. Sexual Partners Marital status, Race, Gender, Location, Education and sexual behaviour To be noted in Africa Centre Research it was found: Females, the most significant factor protecting against first sex before 17 was school attendance

SEXUAL PARTNERS: Percent of people reporting 2+ partners for the past month among those who had sex in the past year, KwaZulu-Natal (NCS 2006 and 2009) Source: HDA secondary analysis NCS 2006 and Note: All sample sizes above 260, apart from the Non-African stratum of 2009 (N= 53)

Marital Status & HIV Prevalence Source: HDA secondary analysis NCS 2006 and 2009.

HIV prevalence (95%CI) African Non-African Male Female Urban formal Urban informal Rural formal Rural informal No education Primary Secondary High school Tertiary Never married, never sex Never married, had sex Married Widowed/divorced Virgin Secondary abstinence Sexually active HIV prevalence in adults aged 15+ years in KwaZulu-Natal (2002, 2005, 2008) Source: HSRC secondary data analysis

Knowledge in KZN Knowledge on HIV transmission and prevention: The last two HSRC surveys (2005 & 2008) compared the prevalence of ‘ correct knowledge on prevention and the rejection of misconceptions ’. In KZN, just like in Eastern Cape, Limpopo and Mpumalanga, there was a significant decrease noted - the KZN prevalence levels were 49% in 2005 and 30% in 2008.

Gender and HIV in KZN Females: unprotected sex was associated with: unemployment, lower perceived power negative condom attitudes, weaker condom use norms & intentions, lower behavioural skills, lower HIV stigma, being threatened with physical violence, and experiencing physical violence.

Gender and HIV KZN Males: unprotected sex was associated with lower education, lower HIV-related knowledge, negative condom attitudes, alcohol before sex, recent clinical STI treatment, and having a partner who was trying to conceive.

Prevalence of Rape as reported by men IMAGE STUDY QOUTED IN KYE KYR REPORT

KZNNational Youth %2.7% Adults %3.4% Females:6.4%2.1% Males4.0%4.1% Economic Status and HIV The NCS 2009 reported the following percentages of people saying that they provided sex in exchange for money or gifts in the past year in KZN (national average):

Migration and HIV Barnighausen et al. (2007) found that migration was significantly associated with HIV incidence Also from KZN, Camlin (2008) reported that women ’ s involvement in migration exacerbates their disproportionate infection risk relative to men.

Orphans and Vulnerable Children in KZN ( using ASSA Model 2008 for AIDS and Demographics) Paternal Orphans Total Maternal Orphans Total New AIDS

Total New Double Orphans Orphans and Vulnerable Children in KZN ( using ASSA Model 2008 for AIDS and Demographics

THE KZN RESPONSE

PREVENTION: HCT HCT target according to NSP was (49% of targeted population) (95%) client tested, (19%) clients tested positive. Improvement of 225% testing from 2009/10 data clients screened for TB and were referred for clinical diagnosis The campaign improved the PICT implementation Campaign continues with new target of

HCT Progress DISTRICTSPre testTotal Tested Testing rate (%) Campaign TargetTarget Achieved PositivePositivity rate (%) Screened for TB Referred for clinical diagnosis Ugu 225, , % 39, ,21429,322 Ethekweni 1,054, , %204, ,380118,551 iLembe 153, , %25, ,42215,810 Amajuba 193, , %34, ,3879,645 Uthukela 195, , % 38, ,82627,104 Umzinyathi212, , % 23, ,29924,448 Sisonke173, , %21, ,58412,763 uMgungundlov u294, , %56, Uthungulu734, , % 45, ,69239,026 Zululand267, , % 43, ,19931,460 Umkhanyakude 183, , % 29, ,45619,455 Totals 3,686,2672,920, % ,

TargetActual 2010/ / Total June / AGES adult years adult 50 years and older516 child 4 months to 14 years3 872 neonate 0-3 months73 MEDICAL MALE CIRCUMCISION

RECOMMENDATIONS Facilities and districts to mobilize and market the programme Urgent filling of roving teams’ post. NGOs to play a supportive and assistants’ role. Municipalities and other departments – COGTA, DOE, DAC to make an input in the implementation. Other stakeholders, traditional leadership, traditional healers, counsillors, Religious Sector being mobilised to input Discussions with SANC and HPCSA

# STI treated % Condom Distribution 18% male & 26% female ( 11 condoms per man per month) DOH REPORTS

TREATMENT

ART Facilities and NIMART DISTRICTART Facilities March 2010 # of New ART Facilities (PHC’s) Total # Of ART Facilities June 2011 # Of Nurses Initiating SUB- DISTRICT ART Service Point Ethekwini % Sisonke % Ilembe % Uthungulu % Umkhanyakud % Zululand % Amajuba % Umzinyathi % Uthukela % UMgungundlo % Ugu % TOTAL %

ART2007/8 2009/ /11 TargetActualTargetActualTargetActual # ART patie nts regist ered ,922459,670 % ART Achie veme nt 180% 125% 96% ART EXPANSION

ART Expansion – June 2011 DISTRICTADULT MALESADULT FEMALES CHILDRENTOTAL#OF PATIENTS NIMART Ethekwini Sisonke Ilembe Uthungulu Umkhanyaku Zululand Amajuba Umzinyathi Uthukela UMgungundl Ugu TOTAL

KZN PROVINCIAL: TB SUSPECTS Qrt 3 / 2010 – Qrt 1 / 2011 Qrt 1 /2011Qrt 4 / 2010Qrt 3 / 2010 #%#%#% Total Number of Outpatients (headcount > 5yrs) Number (%) Suspects % % % Number (%) Suspects Tested % % % Number (%) Positive % % % Number (%) on Treatment %732590% %

KZN PROVINCIAL TB CASE FINDING: Qrt 3 / 2010 – Qrt 1 / 2011 Q1/2011Q4/2010Q3/2010 ALL TB PTB % Of All TB SM+VE % Of All PTB NO SMEAR % Of All PTB SMEAR-VE % Of All PTB EXTRA PULMONARY % Of All PTB BACTERIOLOGICAL COVERAGE80.4%78.1%71.3%

KZN Smear Conversion Rate Qrt 3 / 2010 – Qrt 1 / 2011 New Patients Q1/2011Q4/2010 Qrt 3/ 2010 #% Converted % % % Still Positive %2864.2%3786.0% No Smear % % % Defaulted %1091.6%1192.0% Died %1672.5%1873.0% Transferred %2453.6%2524.0% Total

KZN Smear Conversion Rate Qrt 3 / 2010 – Qrt 1 / 2011 Re- Treatment Patients Qrt 2 / 2011Qrt 1 / 2011Qrt 4 / 2010 #%#%#% Converted % % % Still Positive %402.8%372.4% No Smear % % % Defaulted 412.4%241.7%271.8% Died 663.9%664.5%563.7% Transferred 563.3%533.7%342.3% Total

KZN PROVINCIAL TREATMENT OUTCOME: NEW SM+VE: Q4/2009 – Q2/2010 Q2/2010 Q1/2010 Q4/2009 #%#%#% SMEAR +VE REPORTED CURE RATE % % % Rx COMPLETED3975.7%4516.5%5816.5% DEFAULTER RATE4776.9%5538.0%6357.1% FAILURE RATE991.4%1382.0%1351.5% DEATH RATE4446.4%4406.4%6086.8% TRANSFER RATE2774.0%3495.0%4435.0% NOT EVALUATED5447.8%1612.3%6977.8%

KZN PROVINCIAL TREATMENT OUTCOME: Re-Treatment : Q4 / 2009 – Q2/2010 Q2/2011 Q1/2011 Q4/2009 #%#%#% Cases REPORTED CURE RATE % % % Rx COMPLETED % % % DEFAULTER RATE % % % FAILURE RATE302.4%362.7%241.7% DEATH RATE1219.8% %1319.4% TRANSFER RATE655.3%654.9%876.3% NOT EVALUATED %675.1%1228.8%

TB/HIV Integration Progress with TB/HIV integration – all facilities implementing both HIV and TB services Improved screening of TB amongst HIV positive patients Increased uptake of IPT 124,963 pts – 71.5% towards target of pts by June 2011

Newly Diagnosed TB Cases (New + Re-treatment cases) Quart/Year Q1/ 2011 Quart/Year Q4 /2010_ Quart/Year Q3/2010_ #%#%#% Number of Newly Diagnosed TB Cases Number of Newly Diagnosed TB counselled for HIV % % % Number of Newly Diagnosed TB cases who tested for HIV % % % Number of Newly Diagnosed TB cases who tested positive % % % Number of Newly Diagnosed TB HIV+ cases started CPT % % % Number of Newly Diagnosed TB HIV+ cases already on CPT % % % Total of Newly Diagnosed TB HIV+ cases started on ART % % % Total Number of TB/HIV Co-infected patients on ART % % % Total Number of HIV+ve patients started TB Treatment KZN PROVINCIAL: TB/HIV Qrt 1 / 2011

Newly Diagnosed TB Cases (New + Re-treatment cases) Quart/Year Q2/ 2011 Quart/Year Q4 /2010 Quart/Year Q3/2010_ #%#%#% Number of Newly Diagnosed TB Cases Number of Newly Diagnosed TB counselled for HIV % % % Number of Newly Diagnosed TB cases who tested for HIV % % % Number of Newly Diagnosed TB cases who tested positive % % % Number of Newly Diagnosed TB HIV+ cases started CPT % % % Number of Newly Diagnosed TB HIV+ cases already on CPT % % % Total of Newly Diagnosed TB HIV+ cases started on ART % % % Total Number of TB/HIV Co-infected patients on ART % % % Total Number of HIV+ve patients started TB Treatment KZN PROVINCIAL: TB/HIV Qrt 2 / 2011

CARE AND SUPPORT

Year Foster Care CSG TOTAL NO OF CHILDRE N 4/ / / / GRANTS IN THE PROVINCE

Care and Support Support Groups for People Living with HIV – 546 support groups for PLHIV established in the 11 districts with the total of 12,220 people participating – Support group facilitators workshoped on HIV toolkit, which covers disclosure, living positively with HIV and facilitation skills HCBC Programme

PMTCT

Mother to child transmission of HIV Transmission measured Aug 2010 within the general population of Children who attended PNC Data Source: MRC 2011

AMAJUBA

eTHEKWINI

ILEMBE

SISONKE

UGU

UMKHANYAKUDE

UMZINYATHI

uThukela

Uthungulu

Zululand

The Local AIDS Councils and Ward Committees The Local AIDS Council structures are to ensure that Ward AIDS Committees are supported with regards to the following issues: Reduction of Defaulter rate – TB & HIV and AIDS Treatment Compliance Support, Care and Compassion Fighting Stigma Awareness and Advocacy Teaching Ward Committees Comprehensive Response to HIV and AIDS Teenage Pregnancy and Family Planning Distribution of Condoms Human Rights and Gender - Mainstreaming Domestic Violence and Rape Intergenerational Sex Orphan and Vulnerable Care (Disability/Senior Citizens/Youth in distress) Youth Awareness – Adolescent and Reproductive Health Substance Abuse – Alcohol and Drugs