South Africa: Lessons From HCT Campaign – Living With Aids # 481

Published: July 21, 2011

About 15 million South Africans were targeted for HIV testing in the government’s HIV Counselling and Testing (HCT) campaign, but the effort got slightly over 10 million people to test. The campaign has challenged South Africans and the health system in significant ways.
The campaign has been described as ambitious. Never has any country in the world targeted such a huge population – 15 million citizens to test for HIV – and had 10.2 million people accepting the HIV test. But the campaign was not without any flaws. There are reports that some of the tests were obtained in a manner that violated the human rights of people.
"We are hearing stories of people being tested without their consent. We are hearing stories of people being told: ‘If you don’t have an HIV test, we’re not going to give you the treatment that you need’. We are hearing stories of people saying: ‘Look, I already know that I’ve got HIV. Why do I need to test again’?", says Mark Heywood is the deputy chairperson of the South African National AIDS Council (SANAC), which is responsible for co-ordinating the HIV Counselling and Testing (HCT) campaign.
Heywood says that in carrying the campaign forward there needs to be systems to identify human rights violations as they occur and there also needs to be better education of health workers and the public around issues relating to human rights.

"If we are having a big campaign amongst rural people, what do we do to make sure that those people who test positive have support, that they are not isolated and victimised within their community? If we’re targeting men who have sex with men we can’t just test men who have sex with men for HIV. We also have to be educating health care workers to make sure that clinics and hospitals are friendly – not discriminating against, not stigmatizing men who have sex with men. I don’t want to discover my HIV status and, then, find that if I go into a clinic that I’m going to be humiliated and made fun of because I’m gay", he says.
From April last year, the Health Department aimed to test 15 million South Africans for HIV by this June. So far, the campaign has tested 10.2 million people. This is out of 12 million citizens who were counseled for HIV testing since the start of the campaign. The enormity of the effort, which came into an already over-burdened health sector, has "tested the totality of the health system", says Dr Thobile Mbengashe, the Chief Director of the HIV and AIDS and STIs unit in the national Health Department.
"It has always been unknown to what extent can you stretch the system to actually achieve high output, high qualities and reach many people within a short time. That’s the first thing. I think the second one is that you can learn more by doing and fix the things that need to be fixed as you do. And you actually become very effective. Let me give you an example. When we started the campaign, there were only about 490 facilities that were providing ART services out of the 4 300. Between the time when the HCT campaign was launched and now, over 2 000 facilities are able to provide ART.
We learned that it is possible to provide ART services and provide quality using nurse practitioners who are actually trained to provide this. We had about 290 nurses who were actually qualified to provide ART. We trained and we have now 1 700. Those are actually providing services in those health facilities which were not there. And all that was done during this time", Mbengashe says.
"This is learning as we go, it’s about doing things differently", says SANAC’s Mark Heywood.
"Some people might argue that you should not undertake a campaign like this at all until you are absolutely sure that the system can support that sort of campaign. But I think in a country like ours to do that would be irresponsible because part of this campaign is about: How can we get ahead of the HIV epidemic? One way to get ahead of the epidemic is to normalise HIV testing, is to use HIV testing as a way to try to begin to break down the stigma around HIV, and it’s to use HIV testing to try to get much larger numbers of people onto treatment. There are certain risks in that. But I think it is more irresponsible to sit back and wait until we have the perfect system before we embark on something like this", he adds.

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