SA Documents: Lionel Mtshali - The war on HIV/AIDS in KwaZulu-Natal

Author: Lionel Mtshali (Issued by: Office of the Premier, KwaZulu-Natal)

Date: Ulundi, 25 February 2002.

Title: State of the Province Address by the Premier of KwaZulu-Natal, the Honourable Lphm Mtshali

Original language: English.

Concerning: In his State of the Province Address, KwaZulu-Natal Premier Mtshali announced wide-ranging reforms in the provincial government's AIDS/HIV policy, directly counteracting the central government of South Africa and President Mbeki. In his speech (only the parts relating to HIV/AIDS are reproduced), Mtshali makes use of scientific and religious arguments for his rupture with Pretoria.

Source: Government of South Africa

State of the Province Address by the Premier of KwaZulu-Natal, the Honourable Lphm Mtshali

The bottom-line of my State of the Province Address is my government's commitment to fight against HIV/AIDS and poverty. All other policy pronouncements must be perceived in terms of the contribution they make to this bottom-line. Given the conditions of a shrinking pie, which I have already articulated, my government's programmes are to be informed by the re-prioritisation and re-allocation of our scarce and dwindling resources. The goal is to use our efforts to optimise what we can achieve out of our own available resources; out of our collective and integrated efforts, inclusive of collaborating with local government institutions, private sector, communities and civil society organisations. My government positions itself as a leader and player in the fight against HIV/AIDS, poverty and associated unemployment and crime.

The single most important step taken during 2001 by the Provincial Cabinet was the identification of six provincial priorities. They are:

These priorities form the foundation for achieving our goals of enhancing service delivery, strengthening governance and leap-frogging development. Most importantly, these six priorities provide a focus point for all government activities to contribute to our vision in a co-ordinated and integrated manner.

Honourable members, my address today will concentrate on two of our provincial priorities: The Eradication of Poverty and Inequality and the need to manage HIV/AIDS and reduce its spread.

THE WAR ON HIV/AIDS: BACKGROUND

Our economy is dramatically affected by the consequences of HIV/AIDS, as are all our governmental efforts, especially those aimed at alleviating poverty. We must accept that we are in the middle of a war and that we must deal with the HIV/AIDS pandemic as one would during a war. We have been insufficiently aware of the dramatic nature of the problem confronting us for far too long. For far too long we have stated that the situation is dramatic, but we have not drawn the necessary conclusion of matching a dramatic situation with necessary drastic measures. We have employed the ordinary ways and means of government to confront an extraordinary situation of emergency which, in its consequences, can only be likened to the impact of a vast scale war. We must now shift gear and deal with the situation at hand differently. Unless we do so, all our efforts in any other field of economic endeavour or government activity are doomed at their commencement.

The casualties which HIV/AIDS imposes on our population and the costs that it inflicts on our economy and our infrastructures of government clearly show that likening it to a situation of war is no exaggeration and is perhaps the only responsible way of placing it in the perspective it deserves.

When I was elected in 1999, I stated that the long-term goal of my administration is the eradication of poverty and arresting the spread of the HIV/AIDS pandemic. This House elected me on this basis and must now accept my intention to fulfil this mandate. Each hour that goes by is marked by an estimated 15 people contracting HIV/AIDS in our Province. KwaZulu-Natal had an estimated 80 000 HIV/AIDS related deaths in 2001. In 2001, about 40 000 of our children were infected with HIV/AIDS by their mothers. It is estimated that possibly 36% but as much as 40% of our women giving birth are HIV positive. KwaZulu-Natal has the highest prevalence of HIV/AIDS infection in our country and possibly up to 35% of our population is HIV positive.

No other priority can be higher on our agenda of concerns than the fight against HIV/AIDS. In no other province should concern about this desperate situation should be as great as in KwaZulu-Natal. For this reason, it is the primary obligation of the office to which this House elected me to pronounce that this Government must go further than any other province in addressing this problem. No greater threat to the lives of our citizens has ever come from any past war or potential enemy. Our population is being decimated and is facing the real possibility of mass destruction on a scale that only modern tools of war may deliver. In the face of this extreme challenge I and my government must act and act now. History will judge us harshly if we falter or hesitate. USibongile Khumalo uthi: Ayihlome ihlasele! Ayihlome ihlasele ingculazi! Impela ngithi isiyaviva, isiqalisile ukuhlasela!

In 1999, I set up an AIDS Council to co-ordinate our response to this scourge, and I continued to engage and familiarise myself with the subject. History will judge the tragic circumstances which have forced a concerned Premier to dwell in health policies because neither I nor any concerned fellow South African, could be satisfied with the official national government policy

There were reports that a drug called Nevirapine was available to prevent mother-to-child transmission of HIV/AIDS, but the reason why this available and inexpensive drug was not administered on a general scale to save children was not at all clear. Children who did not have to die were dying and are still dying and are convicted to die in the future.

We had to act, and may God forgive us for waiting so long. We shall not wait one day longer, nor allow any space for any further excuse, delaying tactic or preposterous theory which may get in the way of saving our children.

It should be stated for clarity and emphasis that HIV/AIDS, which stands for Human Immune-deficiency Virus, is the cause of AIDS, which stand for Acquired Immune-Deficiency Syndrome. HIV causes AIDS. In this Province, this axiom of science is not open to bizarre personal theories with any relation to reality. I want to go into the details of this matter and give the members of this House and the people of KwaZulu-Natal a full report, because people are entitled to be empowered with the knowledge of the matter.

Mother-to-child transmission of HIV/AIDS occurs in a significant percentage of HIV positive mothers, but not all mothers who are HIV positive will pass the virus on to their child before or at birth. It depends on the viral load in the mother's blood when the placenta separates during the birth process. Most infection is transmitted at this time when the blood of the mother and that of the child mix. If there is a considerable virus in the mother's blood, the baby is likely to become infected.

We are reliably informed that a number of studies and trials have conclusively proved that a single tablet of Nevirapine will halve the number of babies that become infected by their mothers. A small dose of Nevirapine suspension is also given to the baby soon after birth to supplement the dose given to the mother. For months our Province has participated in trial programmes which have been conducted in pilot facilities across the country, not to test the drug itself, which has been fully approved by the Medical and Dental Council, but to deal with the logistics of its administration. There is no relevant issue about the drug's safety, for such issues are dealt with during their approval stage, and this drug has been approved.

Months and months were consumed developing protocols dealing with the administration of this drug, including the counselling of mothers before they are tested for HIV/AIDS, the requirement of special space for privacy and confidentiality during one-to-one counselling, the training of lay counsellors, the development of standard and uniform protocols for counselling, protocols to include the mother's spouse or partner or to deal with the case of his non attendance, protocols to deal with issues of sensitiveness at home and in the community on the discovery of an HIV positive status of the mother, and other matters of this nature.

While these corollary and tedious issues were debated, analysed and dissected in the Province of KwaZulu-Natal, at least 20 000 children who are now infected with HIV/AIDS could have been saved and protected by the use of Nevirapine. But this figure could be much higher depending on different sources. I want this House to pause and think about this army of children, whom we could have saved, and their mothers, and their families. We must think of them because, in a few short years, when their HIV conditions will explode into full blown AIDS, they will ask us why we waited this long. In August of last year, I instructed the Director General to find out from our Department of Health why we cannot distribute a simple pill to every health facility every time an HIV/AIDS infected mother gives birth. It is a simple procedure which any facility should be able to perform. I was told that his investigation revealed that, in accordance with published national policies, our Department of Health was not willing to distribute the drug without first finishing their studies in the pilot sites and ensuring the availability of infrastructure such as, laboratories for testing, counsellors, formula for feeding and trained staff. Women and their babies in other parts of the province had to wait another two years before they can have access to the drug in other public facilities. I thought that somewhere in the bureaucratic meanders we had lost our marbles or not understood at all that we are fighting a war. Our Department of Health was part of an agreement to limit the administration of Nevirapine to only the pilot sites.

However, with the information outlined above, I could see no reason to continue limiting the programme to a few facilities, while our children are becoming infected in the tens of thousands elsewhere in the Province.

I looked into the issue more deeply and discovered that the basic procedure begins when a pregnant woman first goes to an ante-natal clinic where blood is taken for a series of necessary blood tests, such as haemoglobin, blood grouping and syphilis, and the HIV/AIDS test is easily added if the woman approves after being counselled. The pre-test counselling is done to empower the woman, and the whole HIV/AIDS issue is explained to her including its potential effect on her baby. The test is done on the spot and the results are given to the woman within minutes. Therefore, she can be offered Nevirapine for her to decide whether to take it when the time comes. The baby gets its 3-drop dose soon after he or she is born.

In my efforts, I was not alone. In August 2001, my office was approached by Prince Mangosuthu Buthelezi, the Honourable Minister of Home Affairs and Chairperson of our House of Traditional Leaders in KwaZulu-Natal, who personally had begun looking into this issue and meeting with experts and pharmaceutical companies. Because of his positive advice and through his good offices, I organised a meeting and requested that my Director-General, the Superintendent-General of Health and the Head of Department of Social Welfare and Population Development meet a delegation from the German Pharmaceutical Company Boehringer Ingelheim. Because of this meeting, this company has offered the Province, through Prince Mangosuthu Buthelezi, a donation, free of charge, of Nevirapine for the management of mother-to-child transmission of HIV/AIDS for a period of five years. The meeting took place on the 6th of August 2001.

After the discussions, the meeting agreed that this matter should be forwarded to me so that I can discuss it with the Minister of Health. In the meeting, the Department of Health had raised concerns about accepting the offer arguing that obtaining the drug is not really a problem as it is very inexpensive, but the real expense lies in the provision of infrastructure such as, laboratories for testing, counsellors, formula for feeding and the training of staff.

I immediately embarked on an extensive process of consultation in preparation for the bilateral meeting with the Department of Health and tried to drive home a few facts which to me, as a laymen, were both simple and cogent. First, while the Department of Health established Nevirapine pilot sites around Durban and Pietermaritzburg to test the efficacy of Nevirapine, a large number of HIV positive pregnant women around the Province are not receiving the much needed assistance. The issue of efficacy was no concern of mine, because, for as long as there is certainty that the drug is safe, the fact that it is effective in only 60% of the cases or in 100% of the cases should not prevent its general distribution, for as long as we do not have anything better to use. Now it turns out that the drug is highly effective. Sadly, in future we will be faced with the severe problem of HIV/AIDS infected orphans requiring treatment and care in spite of the fact that the opportunity was presented to administer free drugs to manage the issue.

Second, there was the formula feeding issue. I did not understand how this could affect the Nevirapine distribution. The concern was that formula feeding had to be part of the programme before Nevirapine could be widely distributed for fear that a small percentage of the children saved from HIV/AIDS infection could then be infected at a later stage through their mother's milk. It was thought that there was a small chance that HIV/AIDS could be transmitted through breast-feeding. I could not understand why, in order to avoid this small possibility of a secondary subsequent infection, all the children of HIV/AIDS infected mothers would need to be left open to the much greater chance of getting the primary infection. It now appears that both AZT and Nevirapine trials in breast-feeding populations have shown a continued efficacy for 18 to 24 months and experts are now recommending that the formula should not be substituted and that mothers should continue breast-feeding exclusively for 6 months.

There have been more fundamental policy and moral issues which remained incomprehensible to me. I fail to understand why the Province should refuse a free donation of medicine merely because the drug costs are not the main expense. The money saved on the drug could be used to provide the necessary infrastructure. Equally, people talk about infrastructure costs, but what about the suffering of our mothers and children? What about the physical, emotional and moral costs?

This is not a matter of politics. I am a father and a grandfather. I am a God-fearing man. For me, this is a matter of principle and common decency. I have turned upside-down the scientific facts to find a reason which can justify the failure to act and ameliorate the suffering and reduce the death of so many of our children, I have found none. The undisputed facts before me are that there are sound scientific bases on which Nevirapine is recommended, which include that it is effective in reducing the number of HIV/AIDS infected babies born to HIV positive mothers. It is cost-effective in that it is more expensive not to treat and it is safe. There to me is where the issue stops.

Yet, I went into corollary issues to avoid any red herrings and found that in the short-term, the drug is safe and, while long-term results may take some years to be understood, it is possible that the drug does lead to the virus becoming resistant to it. I was advised this should not deter us from using Nevirapine. This resistance is transient and fades away. I also found that there are countries in the developing world which show the best practices in eliminating mother-to-child transmission of HIV/AIDS such as, Thailand, Botswana, Uganda and Brazil. Here at home, the Western Cape and Gauteng have already embarked on a wider dissemination of Nevirapine. In developed countries, they have all but eliminated mother-to-child transmission of HIV/AIDS.

In October 2001, I then met with our Minister of Health, Dr Zweli Mkhize, to discuss the alarming spread of HIV/AIDS in the Province, the offer of free Nevirapine by Boehringer Ingelheim South Africa and the unfortunate impression of people in other parts of the Province that since Nevirapine sites are only around Durban and Pietermaritzburg, the provincial government does not care for them. We reached two separate agreements in that meeting:

* Firstly, that I as the Premier can accept the offer of free Nevirapine for five years from Boehringer Ingelheim.

* Secondly, the Minister requested me to put in writing the concern of the people of the Province about the limited pilot sites. This I did. Up to this day, I have not yet been favoured with any progress report in this regard.

In the meantime, communities, non-governmental organisations and health workers have been knocking on my door asking what the government is doing about the spread of HIV/AIDS in the Province and how can they join in the war against AIDS.

THE WAR ON HIV/AIDS: MOVING INTO FULL ACTION

Therefore, I, as Premier of KwaZulu-Natal, decided that enough is enough. As the wise adage goes for evil to prevail, it is enough that people with good intentions should do nothing. Archbishop Njongonkulu Ndungane was indeed quoted as saying that government stands accused of sinning against God and the people of South Africa. He went further to say that if the life of a child rests on getting a drug, but she is denied it, this is a sin and is immoral. National government policies are standing in the way of the right to life and health of a born individual, and thus have overstepped the mark.

On Monday, 21 January 2002, I issued a media statement wherein I took a principled position that the government of this Province is under an obligation to supply anti-retroviral drugs to pregnant mothers who are HIV positive. In this regard, I have formally accepted the free donation of Nevirapine from Boehringer Ingelheim for five years. I took it upon myself to commend doctors at Empangeni and Bethesda and other public hospitals and clinics who were supplying anti-retroviral drugs to patients in those parts of KwaZulu-Natal ravaged by the scourge of HIV/AIDS. I encourage them to remain faithful to the Hippocratic Oath which in part states:

"I will apply, for the benefit of the sick, all measures which are required... If it is given me to save a life, all thanks... I will prevent disease whenever I can, for prevention is preferable to cure."

In addition, I publicly reiterated our commitment to implement in this regard section 11 of our Constitution, which guarantees the right to life, and section 27, which provides for the right to access health care services including reproductive health care. In fact, constitutionally no one can be refused emergency medical treatment. The administration of Nevirapine is an emergency measure in a life-threatening situation to the baby.

Judge C Botha of the Pretoria High Court (The Treatment Action Campaign case) has looked very closely at the issue of the National Government's refusal to roll out Nevirapine throughout the country in order to prevent mother to child transmission of HIV. His observations are instructive:

After reviewing the submissions of the government and eight provinces including our Department of Health on why the administration of Nevirapine should only be limited to the pilot sites, the judge observed, A There is in my view incontrovertible evidence that there is a residual or latent capacity in the public sector outside the pilot sites to prescribe Nevirapine. The experience in the Western Cape is evidence of it. Dr Grant (The acting Medical Superintendent, Bethesda Hospital at uBombo) lends support to this in respect of a rural hospital in KwaZulu-Natal.

The judge, therefore agreeing with our assessment that this is a national catastrophe, felt that doctors in the public sector must be allowed with some qualifications to prescribe Nevirapine. The judge felt this would allow an element of flexibility and would add further capacity that hitherto has been inhibited to manifest and develop itself. This provides another means of access, less structured, less perfect, but infinitely to be preferred to the choice between all or nothing.

In addition, the judge decried the fact that A there is no comprehensive and co-ordinated plan for a rollout of the MTCT programme. There is no unqualified commitment to reach the rest of the population in any given time or at any given rate. This of course is what Section 27 (2) of the constitution expects when it obliges the state to take reasonable measures to achieve the progressive realisation of the right to health care. Needless to say that the lack of a clear plan, and commitment to roll out this programme has been our people's greatest concern. As the judge remarked, "A programme that is open-ended and that leaves everything for the future cannot be said to be coherent, progressive and purposeful... What I find unacceptable in the respondent's (government) approach is the formulation that once the lessons have been learnt from the test and research sites, the rollout will follow as the means allow. That does no justice to the exigency of the case."

The learned judge then summed up his incisive observations, "About one thing there must be no misunderstanding: A countrywide MTCT prevention programme is an ineluctable obligation of the state... It is clear that with Nevirapine it is affordable. To the extent that the impression was created... that the further rollout of the programme will depend on the availability of resources, it must be dispelled. The resources will have to be found progressively. The availability of resources can only have an influence on the pace of the extension of the programme. But there must be a plan for a further rollout. Only if there is a coherent plan will it be possible to obtain the further resources that are required for a nation-wide programme, whether in the form of a re-organisation of priorities or by means of further budgetary allocations... I repeat: A MTCT prevention programme with the full coverage is affordable with proper planning."

As a Premier who heads a legitimate government, I must ask myself, as our posterity will undoubtedly do, what went wrong in South Africa for a judge to have to order us to have a plan and re-prioritise in order to save out children. Certainly, History will judge us harshly for the appealing of this ruling and the many unfounded attacks made on it on the grounds that it threatens to interfere in government policy-making.

On 30 January, we held a Cabinet meeting where the supply of Nevirapine throughout the Province was discussed. Cabinet stood resolutely by the announcement I made on the 21st of January 2002 that KwaZulu-Natal will supply Nevirapine to HIV positive pregnant mothers. I now call on this House and on the people of KwaZulu-Natal to support me and my Government in taking the matter further, and to be with me as we cut through the false issues and red herrings. The issue is saving the children and we must treat this matter as what it is: a medical emergency. I need the support of the entire Province to treat this as the emergency it is.

I am pleased to announce that our Department of Health has submitted to Cabinet a plan for the rollout province wide, of the MTCT programme. Cabinet of course adopted this with the proviso that the time frames be brought forward. We agreed that the public institutions and doctors that are ready to prescribe Nevirapine must go ahead. We also agreed to re-prioritise and allocate more resources to this programme. This is what is required if we are to do justice to the exigency of the case. I will not have another 20 000 HIV positive children, who could have been saved on my conscience in 2002.

I report to this House with a clear conscience. I have done what my conscience demanded of me, and what the people of our province expected of me as a responsible leader and as a person who cares. I only hope that when one day I stand before Him on judgement day, God Almighty may forgive me for not having acted sooner to save His children from the HIV/AIDS scourge.

In my desperation after being informed about the infrastructural needs that are required for a province wide roll out of Nevirapine, I even considered calling, as an interim measure, for the distribution of the drug to all pregnant women without testing or counselling and therefore irrespective of their HIV status. This would be like an immunisation programme. This approach would be very helpful in rural areas. Of course, I am aware of the importance of counselling and the moral and ethical considerations involved. I am aware that Judge C Botha advised against prescribing the drug without proper counselling and testing. However, I feel that as an interim measure until infrastructure is available, this should be considered. Certainly, the drug must be made available to all known HIV positive pregnant mothers.

I must repeat: our Province has had an estimated 80 000 AIDS-related deaths in 2001. About 40,000 babies were infected by their mothers last year. Nevirapine will result in a great saving to paediatric departments in the near future and the removal of much suffering on the part of thousands of families. It will also spread the message regarding prevention in terms of contracting HIV/AIDS infection. We cannot hesitate nor falter. This is a principled stand which I have taken out of a deep concern for the plight of unborn generations who are condemned to premature death even before they see the light of day, for sins not their own. No leader worth his or her salt would turn a blind eye to the suffering our children go through. This is a moral position. It is not a political issue. Let us stand together, without divisions or doubts, as one family who share a common determination to save our children.

THE WAR ON HIV/AIDS: THE NEXT STEP

Saving the children is essential but not sufficient. We need to save the mothers and we need to save all those whose lives are threatened by HIV/AIDS such as rape survivors. Research into developing an HIV vaccine must continue but it should be kept in mind that it might take many years before such vaccine is available. This means that the preventive anti-retroviral drug will remain the major weapon in the efforts to contain the pandemic. A few weeks ago Business Day reported that Minister of Finance Trevor Manuel declined the offer of very large institutional donors in the United States for funding of HIV programmes. He indicated that the problem we have in our struggle against HIV/AIDS does not hinge on the lack of available financial resources, but rather on the lack of capacity of our Government to deliver programmes. Simply put, we do not have enough people on the ground to spend the money we can raise internationally to finance our war against AIDS.

Our immediate priority will be that of building capacity on the ground. The programme of distribution of Nevirapine is the first stage in building that capacity which we are undertaking with the awareness that the same capacity, the same health workers and the same volunteers will need to be used and employed for much greater and broader efforts. We need to begin developing programmes to provide anti-retroviral drugs to those who are infected with HIV. These drugs can prolong the time before HIV becomes full blown AIDS and, therefore, the quality of their lives. However, in addition to being extremely expensive, the distribution of this type of anti-retroviral drug presents enormous logistical problems. In addition to having to deal with the issues of testing and counselling which I referred to earlier, in this case we must confront challenges arising out of the wide distribution and reticulation of very expensive drugs with often complex administrative procedures and protocols. We must also run large programmes to educate the recipients on how to take them and ensure that the administering of the drug is accompanied by other measures aimed at improving the overall health of people who are HIV positive, such as better diet, intake of vitamins and improved primary health care.

We must make a commitment today to move in the direction of giving anti-retroviral drugs to all those who can benefit from them. We must build capacity to make this possible and create programmes which can offer the basis for our raising money directly from international donors to fund them. For this reason, I call on the community of NGOs, churches and people of goodwill in our Province to join hands to begin building capacity on the ground and assist my Government to prepare proposals which together we can submit to international funding organisations to receive their financial assistance to save the lives of our people.

We must also deal with the victims of HIV/AIDS above and beyond those who are immediately infected with this disease. Among such victims are children who are orphaned. We need to reach out to them in all practical ways and, in so doing, our efforts must rely on a plurality of approaches. We need to provide assistance to the extended family to be able to provide for those who have been orphaned, but we must realise that by itself this measure may not be sufficient. We need to look at other measures which may go beyond the paradigm to which we are accustomed. Also, in this respect, we must realise that the dramatic nature of the situation confronting us calls for drastic and innovative solutions. In searching for such solutions, we must look at the experience of other countries as well as at what South Africa has to offer.

The office of the Premier will undertake an urgent assessment of current policies and programmes pertaining to the care of HIV/AIDS orphans and other children in distress including street children with a view to the development of an intersectoral response co-ordinated from the Premier's Office. With the assistance of international donors and specialised NGOs, my Government will consider developing children's villages. These children's villages are mainly populated by children, under the supervision of few adults performing the roles of teachers, paediatricians and social workers. These are indeed communities consisting of children in which children themselves are required to perform the bulk of functions relating to the organisation of their daily lives and the operation of their community. This will allow a new generation of children to support one another in their plight while having the opportunity of having a fresh and possibly joyous start in life, removing them from the plight of their HIV ravaged communities. It will also enable children to grow up with a greater sense of responsibility in respect of the fight against AIDS and other matters. Obviously a project like this can only begin through pilot projects.

The war against HIV/AIDS will be long and cannot be won by government alone. We can only win it if we change our attitudes and, from this moment on, begin dealing with this problem differently than we did before. We need to move ourselves into emergency mode. We must conduct this war with the assistance of each and every segment of our society. We need to summon and enlist their support and launch from this House a firm appeal for all citizens of KwaZulu-Natal to mobilise in this effort. My government has taken the challenge of managing HIV/AIDS and reducing its spread by also embarking on the following initiative:

* The Provincial HIV/AIDS Action Unit was established in 1999 and the year 2000 saw the launch of the AIDS CHALLENGE 2000. To date significant progress has been made in that:

1. Partnerships with NGOs/CBOs, private sector have been strengthened. Currently 34 organisations across KZN are working with the AIDS Action unit. No less than 19 private sector companies are working in collaboration with the unit to develop HIV/AIDS programmes and workplace policies.

2. 484 HIV/AIDS Communicators (HACs) have been integrated into the Community Health Worker (CHW) programme. Currently 2 780 CHWs are recruited to run door-to-door campaigns.

3. Life skills Programmes in schools have been implemented in secondary and primary schools with 1 558 educators having been trained to date.

4. Voluntary counselling and testing (VCT) has been implemented in 9 identified sites across the province.

5. 30 home-based trainers have been trained on the nationally recommended training manual for home-based-care. Each health district has identified an NGO to render home-based care in their region.

6. 23 drop-in centres have been established across the province and are fully operational.

To build towards an integrated response where all three spheres of government and the various sectors of society contribute, the goals for 2002/3 will be to:

The collaboration between departments to jointly address HIV/AIDS is now becoming a reality. The departments of Works, Social Welfare and Population Development, Health, have for example, in partnership with Non Profit Organisations and the Independent Development Trust launched projects to create assets for HIV/AIDS support centres, community gardens and irrigation schemes and other income generating projects to improve the quality of life of the communities and ensure proper nutritional source for them.

The Department of Housing has established a housing policy for HIV/AIDS victims. There are 2 projects running at the moment, namely God's Golden Acre and Lily of the Valley and a further one has been approved, The Dream Centre.

As the single largest employer in the Province it is pleasing to note that most provincial government departments have now also put in place departmental policies on HIV/AIDS in the workplace, embarked on or support the HIV/AIDS Awareness Programme and are in the process of establishing counselling programmes.

The Department of Traditional and Local Government Affairs and the Town and Regional Planning Commission facilitated research on how planning needs to respond to this pandemic. The results of this research are now used to advise municipalities on how to make provision for the impact of HIV/AIDS in the preparation of their Integrated Development Plans (IDPs).

The Department of Education and Culture has approved in principle a dedicated Planning Unit responsible for actions to mitigate the impact of educator-incapacitation and deaths as well as the plight of AIDS orphans. Its annual budget allocated to fight the HIV/AIDS pandemic has been increased substantially from R4 million to R14 million.

This department has also focussed its attention on the values and life-skills relevant to reducing the spread of HIV/AIDS and its efforts are appreciated and supported by the children's parents, teachers and the community at large. During 2001, the HIV/AIDS Education Programme of the Psychological Guidance Special Education Systems (PGSES) aimed at training educators in 60% of schools, focussing on teachers of Grades 5-7 and Grades 8-10. Educator training workshops were organised and conducted in all regions. Learner Support Materials for the programmes was reproduced and distributed. In order to keep parents, the schools themselves and education managers informed, advocacy workshops were also held.

As the youth is the one group that is most at risk, strenuous effort was made by the Department of Education and Culture to hold workshops to sensitise learners (mainly the leadership corps, the Representative Councils of Learners (RCLs)) to the dangers of behaviour which is conducive to contracting HIV/AIDS and related sicknesses. The RCL members in turn devolve what they have learnt to the children they represent. This peer leadership is apparently more effective than using adults to propagate the message. However, this strategy needs considerable development and expansion, particularly with regard to synchronisation with other role-players doing similar work.

The Department of Social Welfare and Population Development indicates that there is evidence that the current 55% growth rate of Government Support Grants applications over the last 20 months is as a result of the ever increasing impact of the HIV/AIDS epidemic. This is due to more children requiring alternative care. There has also been a sharp increase in the number of foster placements of orphans. Financial support granted to a number of Welfare Organisations and Community Based Organisations, fighting the spread of HIV/AIDS is a direct intervention towards the reduction of the spread of this scourge.

In support of the paradigm shift from viewing HIV/AIDS as a health challenge to viewing HIV/AIDS as a development challenge, new activities will be launched during the course of the year. Through a programme funded by the government of Denmark, KwaZulu-Natal is one of the provinces to be assisted to develop an integrated Response Framework For Poverty and HIV/AIDS. As is the case in all three provinces, the programme will be coordinated from the Office of the Premier.

In view of the fragmented response to the plight of HIV/AIDS orphans, I have instructed the directorates of Poverty and HIV/AIDS and Human Rights within my Office to visibly undertake an assessment of current policy and programmes initiatives within the province which provide care for AIDS orphans and other children in distress including street children.

CONCLUSION

In conclusion, I would like to emphasise that I have acknowledged challenges that face us as a South African Nation as well as citizens of KwaZulu-Natal. I zeroed on poverty, and HIV/AIDS, unemployment, crime, infrastructural investment and good governance. These factors act as either casual variables or correlates to HIV/AIDS and Poverty. I have challenged the citizens of this province to weather the storm of the above manifested challenges through decisiveness, discarding all prevarications and duplicity. Through this House, I would like to promise the people of KwaZulu-Natal that my government is committed to do whatever is possible within our stretched efforts and resources. Excuses have been banished out of this province. Action, reflections and learning and action again shall from now onwards become our distinguishing mode and ethos of operation.

With unity, political will and dedication to serve the people of KwaZulu-Natal, we shall overcome any challenge. A people resolve to succeed, come what may, will never be found wanting. We as government shall re-prioritise and re-allocate our resources with a view to defeat the twin scourges of HIV/AIDS and poverty. We are going to rob the graveyard of our babies and children. We shall endeavour to develop and implement pro-poor, pro-women and pro-jobless public policies and programmes. Indeed our mind in this regard is made up and we dare not fail!

I thank you.

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