SPEAK OUT

Politics

RAPE AND ANTIRETROVIRALS
EXCERPTS FROM A DEBATE IN THE GAUTENG ASSEMBLY, JUNE 2001 GAUTENG LEGISLATIVE ASSEMBLY RECORD OFSPEECH BY JACK BLOOM, DEMOCRATIC ALLIANCE, JUNE 11, 2001
Jack Bloom

Mr BLOOM: Mr Speaker, I may be taking DP free time. Mr Speaker, I am the only original member of the Health Standing Committee since it was established in uncongenial surroundings at the Nasrec show grounds, in 1994.
I have seen three committee chairs, and three MECs for Health. Today I have committed my party, not only to opposing the Health Budget, but also the Committee Report. I do this, not because I disagree with anything in this report, but simply because it does not challenge in strong enough terms a Health Budget that fails to confront the health emergency that faces us...
Three months ago, I alerted this House, in the strongest terms as to the disastrous reversal in the health status of our people as a result of HIV/AIDS. Member Salojee has painted a similar picture. Unbelievably, and I do find this unbelievable, the Gauteng Health Department does not list a single key output related to combating the AIDS epidemic. There is not a single reference to HIV/AIDS in all 44 unit measures in all seven programmes. [Interjections]
Those indices set last year that do relate to AIDS - what happened to them? Well, they simply got dropped. We have no report back on them. I wish to ask here today - does this department not wish to advertise its goals as far as outputs and outcomes for HIV/AIDS are concerned? Is it afraid of being measured and reporting back to this House?
Perhaps the answer lies in the latest antenatal survey of HIV prevalence in pregnant women, which showed a leap in Gauteng from 23,9% to 29,4%. This should have been a sharp wake-up call as it was the largest percentage increase of any province in the country. Why is it that so much of what we are doing is not having anywhere near the desired impact on an epidemic that proceeds apace, as if there no interventions whatsoever?
This is a tragic illustration of the difference between output and outcome. Whereas there are many outputs one can point to, such as workshops conducted and money spent on awareness projects, advertising billboards, we see it all, the outcome of fewer HIV infections remains elusive.
We are currently distributing more than seven million condoms every month in Gauteng, one for every man, woman and child. Are they being used correctly? Are they too small? Are they being dumped somewhere? Are the tops being cut off before use? I mean, here they are, you know. I took them out of the Gauteng toilets, I don't think they did much, they just seemed to remain there. [Laughter] I think we actually need to ask some very hard, very searching questions if we are correctly focussed on outcome, which means that assessment and evaluation measures are crucial for every project. [Interjections]
I think this is very serious, we do need to know about these condoms. [Interjections] I want to say that it is inexcusable that output and outcome targets for HIV/AIDS are not incorporated in the budget book. [Interjections] Just think about it. [Interjections] Not a single outcome or output for HIV/AIDS in the official budget book and I hope that this will be rectified for future years, but unfortunately this omission is symptomatic of the whole muddle of government's national AIDS policy which this province is so timid in challenging. In his opening address this year, the honourable Premier announced that two extra-
Ms KOORTS: Mr Speaker?
Mr BLOOM: ...research sites.
Ms KOORTS: I just want to find out whether that is for sale?
Mr BLOOM: I am afraid one is not allowed to - it says here actually "not for sale," so they are free. I hope people use them for the correct purpose.
But I wish to go back to the Premier's opening address. He announced-
Mr PAPO: Speaker, will member Bloom take a question?
Mr BLOOM: I will take a question at the end. The honourable Premier announced in this room that two extra research sites, using Nevirapine to prevent the mother-to-child transmission of AIDS, so what has happened to that announcement? Two weeks ago he opened the site at Dumane/Natalspruit complex in Katorus, but what about the promised Kalafong site in Pretoria?
Both these projects, in terms of the national timetable, were supposed to open on 1 March. Now we hear that even though Nevirapine has finally been cleared for use by the Medicines Control Council, the matter has been referred back to Cabinet for the final go-ahead. Can you honestly believe this?
This foot dragging cannot be allowed to continue. We are the most advanced province in South Africa, we like to claim that we are the smart province, and yet we still hold back from rolling out a full-scale mother-to-child HIV prevention programme, even though the issue of cost has fallen away as an obstacle.
It is a disgraceful omission from this Health Budget that we do not provide a plan and a costing for Nevirapine treatment of all HIV positive pregnant mothers in this province.
I can assure the honourable MEC that on this issue the department is way behind medical staff, who are ready and able to proceed with such a programme.
Ms RAMODIKE: Honourable Speaker?
Mr BLOOM: Patients are currently advised at Johannesburg Hospital to purchase Nevirapine themselves, which-.
SPEAKER: Honourable Bloom, there appears to be another question.
Ms RAMODIKE: Can the honourable member take a question?
Mr BLOOM: I will take a question at the end. These patients who are counselled at Johannesburg Hospital, virtually all of them do. But what perverse cruelty is it that a department which is committed to free mother and child healthcare, cannot take the simple step, the simple step, of providing Nevirapine in this and other instances, right across the province?
We can light a candle in this Legislature, which we did some time ago, yet we cannot give Nevirapine to desperate expectant mothers at our leading hospital, even though this is supplied free of charge by Boehringer-Ingelheim.
The West Rand has the highest incidence of AIDS in Gauteng, yet not a single mother-to-child programme is operating there, nor in the Vaal area. I recently visited the Yusuf Dadoo hospital in Krugersdorp where the staff informed me that they could start virtually straight away, if they were supplied with Nevirapine.
I am sure the honourable Premier does not wish to be known as a child-killer, but this is the practical outcome of every day's unnecessary delay. On this issue he even defies his former ally, COSATU. Has he forgotten so soon his activist background?
The other area where there is no excuse and I repeat no excuse, not to use anti-retroviral drugs as a preventative treatment is that of rape victims. The honourable MEC for Health is exceedingly cautious in this area, but there are considerable grounds for off-label use such as is currently being done successfully in the Western Cape, as do states in America, such as California and New York strongly advocate such use, with detailed guidelines, which I can provide on request.
Deputy Justice Minister, Cheryl Gillwald has said that the Western Cape rape protocol should serve as a model for other provinces, so why is this mysterious blind spot in our province?
I wish to say that the horrific truth is that sexual violence is a major transmitter of the HI Virus, particularly amongst young women and children. There are about 10 000 reported rapes a year in Gauteng and we must remember this is a vast underestimate and about 40% of these involve children.
Available studies indicate that up to 30% of these rapes could involve HIV infections, particularly for children and let us bear in mind that 75% of rapes are gang rapes, involving considerable tissue damage.
Just as in the case of anti-retrovirals for needle stick injuries, the best evidence indicates that anti-retrovirals taken within 72 hours of the rape provide close to total protection against HIV infection. Lowered immune resistance due to the trauma of rape victims means that they often succumb quickly from HIV to AIDS, dying a miserable death, while the rapist gets off scot-free.
We have heard from the honourable member Salojee, I think a very brave speech. He talked about that it is a moral issue and that we should all look to our individual consciences on this matter and I too, wish to know how anyone in this House can deny anti-retrovirals to rape survivors as their only means of avoiding a death sentence? I think it is extreme hypocrisy to declaim on the rights of woman and child and yet turn a cold, stony heart on this scourge.
We have just been told, we had an announcement that it is Child Protection Week and we have a nice pamphlet, "Gauteng, a province fit for children" and it says "combat HIV/AIDS, children and their families must be protected from the devastating impact of HIV/AIDS." Well, I think this is the grossest hypocrisy when we don't plan ahead to save victims of rape and a large number of them happen to be children.
Let me say that what we are missing is a proper AIDS strategy which must begin to include anti-retroviral drugs and we heard it in the speech of honourable member Salojee and not in the report, note, but we did hear it in the speech. Especially in the preventative areas and the issue of price has really gone away in that area, because it has come down dramatically. We need a continuum of treatment options, starting with a generally available basic care and treatment of opportunistic infections. Experience gained with anti-retrovirals expands the possibilities for upgrading, which can capitalise on treatment advances which are being made. Let me just say on the issue of voluntary testing. I don't believe it will ever take place on a mass scale, unless we can offer a real benefit, which at present is not perceived at all and let us realise that 90% of people with HIV don't even know that they have it.
We actually have to build hope into this system, not just for patients, but for medical staff whose morale is being badly affected as the first wave of HIV deaths begins to hit us. It is particularly amongst paediatricians, they are used to treating children who go on to outlive them in fact, but now they are seeing patients die on them and it is having a devastating impact on morale.
This impact of AIDS, to my mind, means that we cannot delay further with other reform measures that will ensure the best value with limited resources and I wish to quote here my fellow African, a great son of Africa, our President, the Honourable Mr Mbeki. In his speech in October 1999, at the third Southern Africa International Dialogue at Victoria Falls, he expresses his frustration with endless conferences which failed to achieve anything. His immortal words are: "Nothing is done, until it is done."
I commend these words to the honourable MEC, who regularly gives assurances of progress in key areas, but somehow these never materialise. After much delay, Chief Executive Officers have been appointed in hospitals, but still they find their hands tied in trying to manage effectively. Despite all promises by the MEC, they have barely more powers than the superintendents they replace. In the critical area of labour relations, they are totally undermined by the fact that dismissal decisions remain with head office and there are endless delays in disciplinary proceedings.
The CEOs of major hospitals, such as Johannesburg and Chris Hani Baragwanath are still treated like untrustworthy children and they have yet to be made Chief Accounting Officers, which is an essential step in delegating powers. I will remind the honourable MEC in this area that "nothing is done until it is done."