Planning and government support
The overall guidance and framework for the National Service Plan (NSP) was provided by the South African National AIDS Council (SANAC). The NSP provides a national framework that covers issues relating to basic education, safety and security, employment, skills development, economic infrastructure, rural development, human settlements, responsive local government, environmental protection, public service and citizenship, as well as health. It will guide the development of detailed implementation plans at provincial and sectorial levels for dealing with both HIV/AIDS as well as TB, shared Mr France K Morule.
The NSP is based on a 20-year vision for reversing the burden of disease from HIV, STIs and TB in South Africa. The NSP and related provincial-implementation plans are based on evidence and experience, and at the same time are flexible enough to accommodate new research findings.
Interventions must also have high impact and must be able to be rolled out to scale. Finally, the plans must include all sectors involved in HIV, TB and STIs: they must promote partnerships across sectors and at all levels of society.
HIV and TB co-infection in South Africa
South Africa has experienced both TB and HIV epidemics in alarming proportions. It has the third-highest incidence of TB in the world, after India and China. Approximately 1% of the South African population develops TB every year. New TB infections have shot up by 400% over the last 15 years, reaching 970 new infections per 100,000 people in 2015. The HIV epidemic is driving the TB epidemic as 73% of the 450,000 TB patients in South Africa, are also co-infected with HIV, said Mr France K Morule.
The highest prevalence of TB infection is in people who are in the age group 30-39 years, and living in townships and informal settlements. This confirms the fact that TB is a disease that affects poor communities disproportionately. Groups that are more likely to be exposed to HIV and TB, or to transmit them are called key populations and special efforts have to be made to reach out to these groups with services for prevention, treatment and care, said Mr France K Morule.
Key populations for HIV services include young women in the age group of 15-24 years; people living close to national roads and in informal settlements; young people not attending school; people with low socio-economic status; uncircumcised men; people with disabilities; sex workers and their clients; substance abusers; men who have sex with men; and transgenders.
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