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Two THCA community mobilisers show that age is not a barrier to education

Deon Martin started as a community mobiliser with TB/HIV Care Association (THCA) in 2015 and is currently a driver for the False Bay and Dunoon medical male circumcision (MMC) teams.

Deon left school in grade 11, but says he was partly inspired to study for his matric when he started working for THCA and saw the potential for his future growth. At the age of 47, after attending night school, he completed six subjects in six months and graduated with his matric in August this year.

Deon said that when he received his results he was overwhelmed. This achievement has spurred him on to further his education and next year Deon plans to study for a degree in social science. He feels that a degree in social science, coupled with the experience that he has gained working at THCA will equip him with skills that he can apply to both his life and out in the field.

Deon describes himself as a community person who is driven and motivated. He loves his job and people in general and is passionate about helping those that are disadvantaged.

Anthea Scullard started working for THCA in 2015 and is currently a community mobiliser for the False Bay MMC team. When her husband passed away she was forced to return to the workplace.

Anthea soon realised that in order to progress she needed to empower herself and decided at the age of 53 to study for her matric. Once the decision was made she wasted no time in enrolling for six subjects at Westridge High School and attending night classes. She also hosted a study support group in her home.

Anthea says that going back to school was not always easy, but with the help of God and the prayers of her family and friends she obtained her matric in June this year. Anthea also recently obtained 100% for her learner’s licence test and her next goal is to obtain her driver’s licence.

Anthea describes herself as a strong person who loves helping other people. She would love to move into the field of education by training and inspiring other adults to empower themselves and achieve success.

Both these colleagues epitomise one of the core values of THCA; empowerment. They serve as examples that it is never too late to set and achieve personal goals in life.

We need to urgently expand access to PrEP

JOHN MUTSAMBI writes:

Despite having the biggest HIV epidemic in the world, South Africa continues to make remarkable progress in the fight against HIV and AIDS. The country has become a hub of HIV prevention research and it has the largest anti-retroviral therapy (ART) programme in the world. On 1 June, 2016, a national programme to provide oral pre-exposure prophylaxis – or PrEP – to sex workers was launched and TB/HIV Care’s eThekwini and Pietermaritzburg sites became two of the first 10 sites in the country to roll out this novel HIV prevention tool. But PrEP advocates are urging for a wider roll-out on the grounds of ethics, cost-effectiveness and to avoid unintentionally encouraging stigma.

At the recently-concluded 21st International AIDS Conference (AIDS 2016) a senior official from the South African National Department of Health (NDoH), complimented TB/HIV Care’s eThekwini site for its sterling work in rolling out PrEP, the pill which, if taken regularly by someone who is HIV negative, helps to prevent that person becoming infected with HIV. To date, this site has initiated a total of 47 clients on PrEP while its sister site in uMgungundlovu, Pietermaritzburg, which started the rollout two weeks later, has also initiated 18 on PrEP.

This pioneering work, makes South Africa a torch bearer in rolling out a programme that could become a model for other countries, particularly those in the sub-Saharan region that have been hard hit by the HIV epidemic.

As PrEP advocates working in collaboration with civil society we welcome this programme and convey special thanks to Dr Aaron Motsoaledi, South Africa’s Minister of Health, for helping to spearhead the push for PrEP implementation.

However, the staged implementation of this HIV prevention method has sparked questions about ethics. One community member said: “Why is the government prioritising sex workers as a key population in the implementation of PrEP when there are other key population groups such as men who have sex with men, people who inject drugs, people in sero-discordant relationships, truckers and prison inmates who are also at high risk of getting HIV?”

And a sex worker remarked: “Some community members call us ‘the drivers of the epidemic’. I think that providing PrEP to sex workers only will further strengthen this stigma.”

These are all voices with concerns that should be listened to. As PrEP advocates, we urge decision-makers in the NDoH to urgently consider expanding access to PrEP to other key population groups, including adolescent girls and young women. We know that this process will not be easy and we are prepared to work very closely with civil society to support the NDoH’s efforts.

As we wait for information from PrEP demonstration projects to inform our decisions about how best to roll out PrEP, we also feel that at this point, we should also learn as we go. Further delays in expanding access to PrEP will result in continued high rates of new infections that could be averted and the associated costs of illness and providing lifetime ARVs. South Africa cannot afford to wait any longer to provide PrEP to those who are vulnerable, no matter who they are.

National viral hepatitis study on key populations set to begin recruiting

A consortium of partners is undertaking a viral hepatitis service provision and research project for key populations (people who inject drugs, sex workers and men who have sex with men) in South Africa. The study will assess information gaps on populations disproportionately affected by viral hepatitis and provide an evidence base to guide future interventions.

Hepatitis B and hepatitis C are infectious diseases that affect the liver. They are usually without symptoms for many years. This means that those infected are infectious without even knowing it and can silently develop progressive liver damage. This year the World Health Organisation (WHO) released the first ever Global Strategy for Viral Hepatitis. The strategy aims to eliminate viral hepatitis as a public health threat by 2030.

People who inject drugs, sex workers and men who have sex with men are at higher risk of contracting viral hepatitis B and C. Viral hepatitis is a particular concern in a context of high HIV prevalence because co-infection can result in more rapid progression of both diseases.

At present viral hepatitis services for “key populations” are limited in South Africa and there is very little information on prevalence levels, though studies that have been done indicate that rates are high in key population groups. The forthcoming study is funded by the Bristol-Myers Squibb Foundation Secure the Future, and implemented by TB/HIV Care Association, in partnership with the University of Cape Town, Anova Health Institute, the National Institute for Communicable Diseases and OUT Wellbeing.

Spanning seven cities – Cape Town, Johannesburg, Pretoria, Mthatha, Pietermaritzburg, Port Elizabeth and Durban – the study builds on already occurring service delivery processes.

Hepatitis B and C diagnosis usually require expensive and time-consuming laboratory activities. In this study, participants will be tested for HIV, hepatitis B and C at service delivery sites. The point-of-care (‘rapid’) hepatitis C testing will be done in a variety of ways, and the results will be compared to standard laboratory tests. This will indicate whether inexpensive rapid test mechanisms can be reliably used in the South African context. If this proves to be the case, it opens up new possibilities for making hepatitis testing a common part of health screening processes.

The study’s results will provide an evidence base to support national efforts to reach the WHO 2030 target of reducing the public health threat of viral hepatitis to zero.