Meet the new deputy chairperson of SANAC .................................. 2New SANAC trustees come on board ................................................ 3Reaction to fixed dose ARV treatment ............................................. 4SANAC men denounce women and child abuse ............................ 6The civil society sector gets organised ............................................. 7CCM now in place to satisfy Global Fund requirements ............... 8New appointments at SANAC ............................................................ 10The last word - SANAC CEO ................................................................. 11Contact us .............................................................................................. 11

SANAC NEWS

IN THIS ISSUE ::

THE offICIAl NEWSlETTEr of THE SoUTH AfrICAN NATIoNAl AIdS CoUNCIl

Welcome to the first edition of the South African National AIDS Council’s (SANAC’s) newsletter! Our

aim with this bi-monthly publication is to communicate to you the reader, information about the activities of SANAC in its role of supporting the rollout of the government’s anti-AIDS programme, whose plan is detailed in the National Strategic Plan (NSP) for HIV and AIDS, TB and STIs (2012 – 2016).

In supporting the Plan, the main objectives of the Council are as follows … to foster dialogue between government, civil society and all other stakeholders and to oversee the country’s response to HIV, TB and STIs; advise government on HIV and AIDS, TB and STIs policy, strategy and related matters; strengthen the governance, leadership and management of the response to HIV, TB and STIs at all levels of government; strengthen the multi-sectoral response to HIV, TB and STIs as a contribution to the overall social and economic development of South Africa, including but not limited to policy review, programme management and co-

ordination, technical assistance and capacity building and sectoral support; mobilise resources domestically and internationally to finance the response to HIV, TB and STIs, including but not limited to estimating expenditure and resource needs, fund-raising from domestic and international institutions, including Treasury, donor co-ordination and investigating new sources of funding for the multi-sectoral response and the NSP; ensure the monitoring of progress against the targets set in the NSP and ensure mid and end of term evaluations for the prevailing NSP; create and strengthen partnerships for an expanded national response in South Africa to HIV, TB and STIs among government agencies, non-governmental organisations (NGOs), donors of funds, agencies of the United Nations, the South African private sector and people living with HIV, TB and STIs.

A lot has been happening to pursue these objectives and it is the intent of SANAC News to keep you updated on developments relating to these activities. Read more in the following pages.

ISSUE 1: AprIl 2013

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SANAC NEWS

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Mmapaseka Steve Letsike is new deputy chairperson of the South African National AIDS Council (SANAC), taking over from previous deputy chairperson,

Mark Heywood. Heywood, Director of social rights group, Section 27, stepped down voluntarily to “make way for a change of management”.

Although new to this role, Letsike is no stranger to the country’s response to HIV and AIDS.

She was the chair-person of SANAC’s women’s sector and was also the interim chair-person of the Lesbian, Gay, Bi-sexual, Trans-gender and Inter-sex (LGBTI) sector. Respectively, the two sectors represent organisations and other bodies that work with and/or run programmes focusing on women and the LGBTI community in the area of HIV and AIDS, health and social upliftment.

These are roles that have suited Letsike quite well over the years. This is evident in how she describes herself. “I am a feminist, an activist for LGBTI rights and a defender of human and women’s rights”, she says.

In 2009, the weekly newspaper, Mail & Guardian, recognised her as a force to reckon with in these roles and voted her as one of 300 young South Africans you should take out for lunch.

Currently, she is the chair-person of the Civil Society Forum (CSF) of SANAC. The CSF constitutes all the 17 civil society sectors of SANAC and Provincial Council on AIDS representatives.

Letsike’s resumé includes work with the Department of Social Development, OUT LGBT Well-being and the Open Society Initiative for Southern Africa. Currently, she is the Training and Advocacy Manager for Anova Health Institute, with a focus on the health needs of men, especially gay men and men who have sex with men (MSM), through the Health4Men project. She has been in this position since 2011.

Her other activities include, amongst others, being a member of the Gender-Based Violence Council, member of the One in Nine Campaign and member of the Department of Justice and Constitutional Development’s Task Team on Hate Crime/Corrective rape.

Letsike is also serious about her own personal development. She is currently studying towards a degree in Development Studies.

Welcoming her on board, SANAC CEO, Dr Fareed Abdullah said: “Steve is a dynamic young leader who will be making a huge contribution to the HIV and TB response in South Africa. Although she’s young, she’s been involved in SANAC for a number of years and understands the SANAC civil society sector so well that it makes her a natural leader for this component of SANAC”.

Abdullah urged “all the sectors in SANAC to work with her and to support her as we will do in the Secretariat”.

Although SANAC (the Council) is the high level public face of the AIDS, TB and STI response in the country, the legal entity through which it operates is the ‘SANAC Trust.’ The Trustees are responsible for the governance of the Secretariat and are appointed by the Deputy President. On 26 February 2013, Deputy President Kgalema Motlanthe, in

his capacity as the Chairperson of SANAC (the Council) appointed new Trustees to the SANAC Trust.The new members of the Trust are Justice Zak Yacoob (chairperson), Mr Yusuf Abramjee, Dr Brian

Brink, Rev Desmond Lambrechts, Ms Steve Letsike, Ms Prudence Mabele, Ms Vuyiseka Dubula, Dr Thobile Mbengashe, Adv Thoko Majokweni, Dr Ayanda Ntsaluba, Mr Happy Ntshingila, Dr Nothemba Simelela.

The first meeting of the new Trustees took place on 16 and 17 March 2013 and the new Trustees have taken on their new responsibilities with enthusiasm. The Secretariat welcomes the new Trustees to the SANAC family.

Steve Letsike (with scarf), attending the civil society meeting where she was elected as chair of the forum.

Inaugural Meeting of the new SANAC Trustees. From left: Dr Fareed Abdullah (SANAC CEO), Mrs Anu Yacoob, Justice Zak Yacoob (Chairperson of Trustees), Deputy President Kgalema Motlanthe, Ms Steve Letsike (Deputy Chairperson of SANAC) and Dr Aaron Motsoaledi (national Health Minister).

SANAC gETS NEW dEpUTy CHAIr

" I am a feminist, an activist for lgBTI rights and a defender of human and women's rights."

MorE rECrUITS joIN SANAC BoArd of TrUSTEES

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This month (April), some public sector AIDS patients started taking simplified ARV treatment of just one pill a day to manage their infection. The South African National

AIDS Council (SANAC) welcomes this change in treatment protocols by the Department of Health.

“On behalf of men in South Africa and organisations working with men and boys, we welcome the good news by the Minister of Health that the national Health Department is introducing fixed dose combination (FDC) anti-retroviral (ARV) treatment. In the process of rolling out the once a day ARV tablet, which contains a combination of three vital ARVs - Tenofovir, Efavirenz and Emtricitabine - the ARV programme should improve through increased compliance and maintenance of patients on ARVs, including the introduction of new patients to ARVs”.

“Instead of taking several pills at different times of the day, the FDC allows for patients to take one pill once a day, which will improve adherence. We have to make sure that those who are still taking several

pills remain in the system and stay motivated, said Rev Bafana Khumalo, the national chairperson of the men’s sector of the South African National AIDS Council (SANAC).

The People Living with HIV sector believes that FDC therapy will improve and strengthen adherence to treatment.

“There are many reasons why people do not adhere to their medication. Amongst them are issues of high dosages or too many pills to take (which is also known as pill burden) and  side-effects. Too many people, about 70% in South Africa, have HIV and TB at the same time and in most cases they have to take treatment for both illnesses simultaneously. This means many of us take far too many pills and that discourages some not to take them. We need more simplified treatment to influence adherence. The introduction of fixed dose combination therapy is a very progressive step towards

improving and reducing factors that contribute to poor adherence”, says Vuyiseka Dubula, an executive member of SANAC’s sector of people living with HIV.

Fixed dose combination therapy will also apply to pregnant women, thus replacing the dual combination therapy consisting of Nevirapine and AZT. All HIV-positive pregnant women in South Africa, during pregnancy and throughout the breast-feeding period, will be on fixed dose combination therapy regardless of their CD 4 count. This will continue even after breast-feeding if their CD 4 count falls below 350. In fact, pregnant women are a priority group and are the first in line to receive FDC therapy as the Health Department begins phasing in this treatment model.

“This is exciting news indeed that we are starting to see a breakthrough and shift for the significant improvement of health and well-being for all people living with HIV, especially mothers and children”, said an executive committee member of SANAC’s children’s sector, Anthony Ambrose.

“This is simplifying the way patients have become used to taking ARV treatment. Patients will now take one pill a day. This pill is an all-in-one package of all three anti-retrovirals (Tenofovir, Efavirenz and Emtricitabine) that a patient needs for optimal treatment. And they will take it once a day as opposed to taking a combination of pills three times a day”, says Dr Fareed Abdullah, chief executive officer (CEO) of the South African National AIDS Council (SANAC).

“We have come a very long way since the advent of anti-retrovirals. At one point, patients used to take up to 16 pills a day”, Dr Abdullah adds.

“This simplification of treatment makes taking AIDS treatment convenient. We hope that it will result in patients complying with and adhering to their treatment. We hope that this will enable many more patients to take their medication everywhere and anywhere they may be”, he says.

Professor Ashraf Coovadia, chairperson of SANAC’s children’s sector, advises that “it is important to inform the public that whilst government will be rolling out the new PMTCT programme with FDCs, the current PMTCT programme which utilises AZT & Nevirapine to mothers and Nevirapine to infants is still an effective strategy”.

According to SANAC CEO, Dr Abdullah, “not everybody will switch to one pill a day immediately, as the Department will roll this out over the coming months. Patients who are on second line treatment will not be switched to the one pill a day treatment. Patients should talk to their doctors and nurses to find out if and when they will switch treatment. There will always be some exceptions, but by this time next year

the Health Minister expects that 80% of all patients will be on the new formulation”.

The rollout of the FDC therapy will be in two phases, with HIV-positive pregnant women, patients newly-initiated on ART and those who are co-infected with TB and HIV being prescribed FDCs in April. Patients who are already taking treatment will be switched to FDC therapy starting in July/August.

Abdullah noted that within SANAC there were some people who wanted everyone to start at the same time, but there was an understanding that there will be phases to the rollout.

“We appreciate the move by our government to introduce the FDC. But the government should

equally put more efforts and ensure that we all get the same treatment”, said Mluleki Zazini, chairperson of the PLHIV sector.

But Zazini moved to make a call to all people living with HIV that are affected by the phasing in approach to “be patient and continue taking their current treatment, considering that their health will be compromised if they default”.

“The introduction of fixed dose combinations needs all of us to do social mobilisation to educate people about this change. We also have to make sure that our supply chain management is not interrupted so that we do not have stock-outs of medicines”, added Vuyiseka Dubula, of the PLHIV sector.

SANAC oN fIxEd doSE CoMBINATIoNS (fdCS):

" The introduction of fixed dose combination therapy is a very progressive step towards improving and reducing factors that contribute to poor adherence."

ga-Rankuwa-based AIDS activist, Andrew Mosane, is one of the first patients to receive fixed dose combination (FDC) anti-retroviral therapy. He says this

treatment will make taking ARVs simple for him.“At the moment I’m taking five pills every day –

two in the morning and three at night”, Mosane says.“Seriously, it was a challenge taking five pills on a

day to day basis. I was taking AZT, 3TC and Efavirenz. FDC is good because it is easy dosage. It is a single pill. You don’t get drug burdened or get tired when you have to take your drugs. It is also good because it has fewer side-effects”, the 36-year old adds.

According to the national Health Department’s guidelines on FDC treatment, pregnant and breast-feeding women, people who are taking anti-retroviral treatment for the first time and those co-infected with HIV and TB should be prioritised for treatment with FDCs. People like Mosane, who do not fall under these categories and are already taking ARVs, will start switching to FDC therapy in later months. So, having him on FDCs already is an exception to the rule.

Asked how he got to be on FDC therapy, Mosane explained: “I am an activist and I wanted to take the lead in this. I’ve been taking ARVs since 2006 after I was diagnosed with HIV in 2003 and my bloods were checked for eligibility to switch treatment to another set of drugs. It was a right choice for me to take that step”.

“About two months before FDCs became available I insisted on taking blood tests because I wanted to start taking Truvada and Efavirenz and the results came back showing that I can switch my medications. But I did not want to start taking these drugs because I knew that the fixed dose combination would soon be available, even though I did not know when”.

“By luck, it happened that the facility manager at Phedisong Clinic in Ga-Rankuwa, north of Pretoria,

where the national Health Minister Dr Aaron Motsoaledi, would launch the FDC therapy wanted someone to be on television to speak about their life with HIV and how FDC therapy will help them. Most people were afraid to be on national TV, so I came in and took the opportunity and grabbed it with both hands. That’s how I managed to switch onto FDC treatment”.

He lamented the fact that “there are restrictions to people who are already on treatment as the restrictions mean that they will have to wait longer before they can switch to fixed dose combination therapy”.

However, he believes the country is moving in the right direction by introducing FDC therapy. “It is going to save South Africa some money. But we have to guard against stock shortages”, Mosane opines.

Taking the pain out of taking ArVs

Andrew Mosane with his pack of FDC ARV supplies

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The SANAC men’s sector, in partnership with the PEPFAR-funded Brothers for Life campaign and the national Department of Women, Children and Persons with

Disabilities, recently hosted a televised national dialogue with South African men. The dialogue was facilitated by the chairperson of SANAC, deputy president Kgalema Motlanthe and it aimed to develop a plan of action on the role of men in curbing and promoting healthier and safer communities, especially for women and children.

The dialogue brought together prominent and ordinary South African men from all walks of life, including business, labour, political leadership, sports, and other sectors to unite as one and call for all violence against women, children and other men to end.

“These men have millions of ordinary as well as young men who look up to them and can bring about a united call to action for men to actively protect women and children in their communities”, said SANAC men’s sector chair-person, Reverend Bafana Khumalo.

The dialogue resulted in a National Declaration by men to say no to all forms of gender-based violence. SANAC News will bring you details of the Declaration in the next issue.

The dialogue was called against this background: South Africa has the highest rates of rape reported to the police anywhere in the world. In 2012, the number of rapes documented by the police rose to over 64 000 – or 175 per day. These figures are believed to considerably under-estimate the true number of rapes as many cases go unreported.

According to a 2010 study by the Medical Research Council (MRC) more than 25% of a sample of 1 738 South African men from KwaZulu-Natal and the Eastern Cape admitted to raping someone when anonymously questioned. Of these, nearly half said they had raped more than one person.

In 1997, violence against women was added as one of the priority crimes under the National Crime Prevention Strategy. Nevertheless, the rates of reported rape, sexual abuse of children and domestic violence continue to rise. In many cases, lesbians have also been targeted with so-called “corrective rape”. KwaZulu-Natal has seen an increase in the abuse of elderly women.

Regrettably, it is men who commit the majority of all acts of domestic and sexual violence. In addition, men perpetrate violence against other men. South Africa’s National Injury Mortality Surveillance System tells us that the rate at which South African men kill each other is amongst the highest in the world.

The new SANAC governance structure, which was approved at Plenary, intensifies the role of Civil Society in the Council. It is imperative that the SANAC Plenary,

its various committees, the Provincial and District Councils on AIDS and the Secretariats at national, provincial, district and local levels are reformed in a way that facilitates the work of implementing the new National Strategic Plan (NSP) on HIV and AIDS, TB and STIs in an unfettered way.

An audit of all 17 civil society sectors represented in the South African National AIDS Council (SANAC) found a number of weaknesses and disorganisation. To strengthen the civil society sector’s participation within SANAC, it was proposed that a Civil Society Forum (CSF) that will act as an advisory body to the sectors be established. The CSF duly came into existence in 2012 and it aims to facilitate and maximise the participation of NGOs and other civil society networks, including those representing people living with HIV. The Forum will meet four times a year to review progress of civil society participation and to share resources and information.

Elections were held to choose the leadership of the CSF. Two women were elected to lead the Forum. The chair is Mmapaseka Steve Letsike and Prudence

Mabele is the deputy. Representatives from various SANAC committees were elected for key roles to strengthen the advisory body. Seventeen (17) SANAC civil society sectors are represented at the Civil Society Forum.

The Civil Society Forum hosted its first meeting for 2013 this April and discussed issues such as the Civil Society Forum’s terms of reference, the sector’s governance and co-ordination structure, the primary mandate of each Civil Society sector and its role in the implementation of NSP 2012-2016, sector representation (constituencies, geographical coverage, key areas of work and implementation capacity), sector NSP Implementation plans, monitoring and evaluation framework and reporting structure, amongst others.

“This is an exciting time for the forum. We have an opportunity to engage and to maximise the Civil Society Sector participation in SANAC to contribute to the broader national HIV response. New leadership is in place and it’s waiting to work hard. The new NSP provides the country with the best possible framework with which to proceed and it contains the most up-to-date policies for addressing HIV, STIs and TB”, says CSF chair-person, Steve Letsike.

Women and child abuse -men must stop it

STrENgTHENINg CIVIl SoCIETy pArTICIpATIoN IN SANAC

“ These men have millions of ordinary as well as young men who look up to them and can bring about a united call to action for men to actively protect women and children in their communities.”

SANAC men's sector chairperson, reverend Bafana Khumalo

“ The new NSp provides the country with the best possible framework with which to proceed and it contains the most up-to-date policies for addressing HIV, STIs and TB”

CSf chairperson, Steve letsike.

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In order to receive funds from the Global Fund, each country needs to have a Country Coordinating Mechanism (CCM). In the past, the CCM function was performed by SANAC’s Resource Mobilisation Committee (RMC). During an audit of the Global Fund portfolio conducted in 2011, the Inspector-General of the Global Fund identified many weaknesses in the way in which the RMC conducted its

Global Fund affairs. That is why when the new governance arrangements for SANAC were agreed at the SANAC Plenary last year it was decided to create a dedicated CCM for South Africa.

The CCM is made up of representatives from government, the private sector and civil society. For the first time all 9 provinces are represented on the CCM. The CCM is chaired by the SANAC CEO, Dr Fareed Abdullah, and the Deputy Chair is Tshiamo Moela, from civil society.

The CCM has met four times since its creation in November 2012. It is supported by a small team of staff from the SANAC Secretariat.

Within a short space of time the CCM and the Secretariat have been able to increase the amount of money disbursed to South Africa from US$20 million to US$ 101 million. See graph below.

In addition, the CCM has approved an alignment of all 5 grants to South Africa to the government’s fiscal and financial cycles. This has resulted in an additional US$ 26.9 million to South Africa.

The CCM is now finalising a submission to the Global Fund to renew all our grants. If approved, this will bring in a further US$ 244 million for the period 1 October 2013 to 31 March 2016.

SA NoW HAS A gloBAl fUNd CCM

This group picture was taken at the Global Fund CCM meeting on March 8th. Executive Director of the Global Fund to fight AIDS, TB and Malaria, Dr Mark Dybul, is seated second from left.

SANAC CEO Dr Fareed Abdullah (chair) Mr Tshiamo Moela (deputy chair from civil society) Mr Brian Kanyemba (civil society) Mr Brian Mkandawire (civil society) Mr Beau Nkaelang (PLHIV) Mr Leon Swartz Mr Chief Mabizela Ms Thandeka Mxenge General Edna Joseph Dr Faith Khumalo (from various government departments) Ms Marlene Poolman Prof. Kallie Snyman Ms Khunjulwa Makatesi Ms Aldina Ntsewa Mr Charles Magagula

Ms Ntsiki Hayward Dr Fikile Ndlovu Dr Liz Floyd Me Tefo Tabi Ms Shirley Hugo Mr Vuyisa Dayile (from various provincial AIDS councils) Mr Louis Hollander Mr Kasthuri Soni Dr T Balfour-Kaipa (from the private sector) Ms Teresa Guthrie Mr Steven Cohen (SANAC Costing Technical Task Team) Dr Catherine Sozi Dr Sarah Barber Mr James Maloney Mr William Abrams Dr Bernd Appelt (Development partners)

Dr Yogan Pillay Ms Sesupo Makakole-Nene Professor Keith Househam Ms Juanita Arendse Prof Ian Sanne Mr Pappie Majuba Dr Maureen van Wyk Ms Marieta de Vos Dr Renier Koegelenberg Mr Charl Fredericks (Global Fund money principal recipients) Ms Rosantha Govender Ms Wanda Beukman Ms Kashmira Bhana (LFA) Dr Nevilene Slingers Dr Miriam Chipimo Ms Celicia Serenata (SANAC Secretariat).

List of CCM members selected from various sectors:

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NdiTsheNi MuNgoNiSANAC is pleased to welcome Nditsheni Mungoni into the family. Mr Mungoni has been appointed as Senior Manager, responsible for leading the National Strategic Plan (NSP) Implementation Unit at the South African National AIDS Council. He will be leading a team of experienced programme and technical people. The unit will be responsible for amongst other things, the PEPFAR grant, implementing the prevention progamme, leading the Programme Review Committee and the Technical Task Teams.

Before joining SANAC, Mr. Mungoni held several positions with public health consultancy firm, Health and Development Africa (HDA) and Mott MacDonald Health International. He was the deputy manager for Mott MacDonald Health International and the Director of Social Programmes and Capacity Building Unit at Health and Development Africa.

KhopoTso BodiBeWe also welcome the award-winning former radio journalist, Khopotso Bodibe. Until recently, Bodibe was the radio unit editor of the only specialist health news agency in southern Africa, Health-e News Service. He also started and headed the agency’s office in Johannesburg. Bodibe is respected for his tireless work in producing and presenting the “Living with AIDS” feature on the public broadcaster’s SAfm, the only slot on South African radio that was dedicated to HIV and AIDS issues.

He has joined the South African National AIDS Council as Communications Manager, a crucial role in ensuring that the organisation communicates timeously on relevant issues regarding HIV and AIDS, TB and STIs.

His responsibilities include SANAC publications such as the one you are reading right now, developing and maintaining the website and liaising with various audiences, including the media, regarding SANAC and NSP activities.

We have now entered the second year of the NSP and we are in a much better place than we were 12 months ago. In the first instance, SANAC civil society is much better organised

and definitely more united. Under the leadership of Steve Letsike, the new Deputy Chairperson of SANAC and the newly elected sector leaders, all sectors are working and busy developing their sector plans. The decision of the SANAC Plenary to create a Civil Society Forum has proven to be the correct decision and civil society has regained its special place within SANAC and its various committees. The sectors that need special mention for their efforts are the sex worker, sports and entertainment, men’s, children and PLHIV sectors.

On the resource mobilisation front, the Country Co-ordinating Mechanism (CCM) has already facilitated the flow of about US$100m into the country from the Global Fund. It has now submitted a proposal to the tune of US$251million to finance programmes for sex workers, MSM, prisoners, rape survivors and uncircumcised men in addition to already approved funding for ART, PMTCT and OVC programmes.

The third area of progress has been the implementation of the new structures of SANAC. We are glad to report the new structures – the Plenary, Inter Ministerial Committee (IMC), NSP Financing Committee, Programme Review Committee (PRC), CCM, Civil Society Forum (CSF) and Technical Task Teams – are functional and have met at least once since the launch of the new SANAC governance structures in August 2012. The logistics for these meetings has been improving steadily and the content of the deliberations is significantly improved. We are back to talking about AIDS, TB and STIs and how to tackle these scourges rather than the politics and conflicts of the sector.

Though there has been progress, we are a long way off from the full implementation of the NSP and much work still needs to be done in the provinces, civil society sectors and in many government departments.

One of the main weaknesses has been communications. So, I am particularly pleased that we have been able to publish the first SANAC NEWS that you hold in your hands right now! This, together with the re-launched website and the appointment of a Communications Manager at the Secretariat will address this weakness. It is important that all SANAC partners see SANAC NEWS as their own organ of communication and regularly contribute to it.

A luta continua!

NEW SANAC SECrETArIAT AppoINTMENTS THE lAST Word - SANAC CEo

You may want to contact us about the various activities of SANAC or the NSP. You may send your comments and/or questions to: communications@sanac.org.za or contact us via our website www.sanac.org.za

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