Your daily Selection of IRIN Africa PlusNews reports, 10/8/2004

[Guest guest]

U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - SOUTH AFRICA: HIV/AIDS care centre not being fully utilised

2 - UGANDA: Policy on HIV-testing for children reviewed

1 - SOUTH AFRICA: HIV/AIDS care centre not being fully utilised

DURBAN, 8 October (PLUSNEWS) - An HIV/AIDS care facility in South Africa's

KwaZulu-Natal (KZN) province is not being fully utilised because people do

not know it exists.

Two-thirds of the 240 beds at the Dream Centre, a " step-down-care "

facility, are standing empty - despite the fact that the institution is

located in the province with the highest HIV prevalence rate in South

Africa.

According to the centre's management, the low usage is because the concept

of step-down-care, which functions as an intermediary between hospital and

home-based care, is relatively new and has not been integrated into

provincial hospitals' response to the HIV/AIDS pandemic.

Although the centre is funded by the South African Department of Health,

there has been " a lack of proper cooperation " between provincial hospitals

and the Dream Centre, said Dr. Henry Sunpath, the medical director. " Most

patients are still not aware of the existence of the Dream Centre - they

are denied access because of ignorance. "

The Dream Centre, located in Pinetown, a suburb north of the port city of

Durban, is the only such facility in KZN, where the HIV/AIDS prevalence

rate is 33 percent - much higher than the national rate of 25 percent.

There are less than a handful of step-down-care institutions in the entire

country, added Chitray, one of the Dream Centre's social workers.

Most provinces operate drop-in-centres that provide immediate aid, rather

than practical long-term assistance.

The Centre integrates palliative care and rehabilitation, which it

provides to HIV/AIDS patients until they are ready to return to their

homes, and offers terminal care to patients in the last stages of the

disease. " We provide care for those who need care the most and for whom no

[customised] care system exists, " Sunpath explained.

After the Dream Centre opened in July 2002, Sunpath visited all provincial

hospitals to introduce the concept of step-down-care to doctors, nurses

and other healthcare workers.

It is difficult for patients to reach the Dream Centre. According to

Sunpath, public hospitals do not make ambulances available to transport

patients to the centre, as " HIV does not count as an emergency " , and most

patients cannot afford private transport.

He said institutions like the Dream Centre were critically important in

South Africa, where about 70 percent of public hospital beds were occupied

by HIV patients, who are mostly long-term. This drained hospitals'

resources, as it cost about R800 (US $121) per day to care for a patient.

" Because wards [in public hospitals] are crowded with HIV-positive

persons, other patients have difficulty getting admitted and are often

turned away or discharged too early, " explained Sunpath. Patients did not

receive adequate support, as nursing staff were either overworked or the

HIV/AIDS clinics lacked resources.

Daily expenditure per patient at the Dream Centre is just R170 (US $25)

because it only offers basic services, such as nursing care, medication,

psychosocial support and nutrition, provided by 65 doctors, nurses,

paramedics and administrators.

Expensive laboratory tests are outsourced to cooperative public hospitals,

such as McCord Hospital in Durban, which also sends out social workers,

psychologists, physiotherapists and counsellors to provide services at the

Centre.

With beds remaining empty and public hospitals showing little initiative

to collaborate, Sunpath and Dream Centre general manager Les have

asked the KZN department of health to intervene and organise a meeting

with the province's hospital managers. A date for such a gathering is yet

to be set.

" We need a public awareness campaign to endorse step-down-care and remove

the stigma associated with a facility specifically dedicated to HIV/AIDS, "

Sunpath said. " The government should support this campaign. "

Theoretically, such a facility should be filled to capacity, as it offers

treatment free of charge, although it does accept patient donations. " We

are government-funded, but the provided budget covers only about 70

percent of our operational costs, " said Chitray, adding that the centre

urgently required further funding.

Patients generally stay for a short period, until they are nursed to a

level that allows them to return to their homes. During this time their

families are trained in home-based care, including nutrition, social

support, nursing and physical care.

Patients requiring antiretroviral (ARV) treatment are referred to public

hospitals participating in the government's free ARV rollout plan, helped

to access social welfare support and disability grants, and linked with a

home-based care network in their community to lessen the burden on the

family.

The centre also cooperates with the Sisizabonke Network, which

incorporates 25 home-based care organisations operating throughout the

province.

[ENDS]

2 - UGANDA: Policy on HIV-testing for children reviewed

KAMPALA, 8 October (PLUSNEWS) - The Ugandan government is reviewing its

policy on HIV-voluntary counselling and testing for children following

recommendations by experts that disclosure of a child's sero-status should

only be done by a person with whom the child feels most comfortable.

Currently, a Ugandan below the age of 18 years is legally a child.

According to policy, a child cannot be tested for HIV without the consent

of a parent or guardian. But officials say the reality is that many

children who lack parental support begin sexual activity early or have

been caught up in war-situations and got infected.

" Children in special circumstances, have to be dealt with according to the

prevailing situation - like children in conflict situations, children

heading families and child mothers or wives, " the experts recommended.

They also say that the policy should take disabled children into

consideration.

" The policy has to consider that counselling of children with disabilities

should be conducted in a setting that takes into consideration their

specific disability, for example, deaf children. We need to get

counsellors who know the sign language, " Madra, one of the

experts, told PlusNews.

The UN Children's Fund (UNICEF) country representative in Uganda,

Mogwanja, said that there was need to analyse the situation so that young

people could access care and treatment.

" Children between the ages of 12 and 17 may sometimes be socially and

psychologically mature enough to seek healthcare for themselves, " Mogwanja

said. " They may not be comfortable, or even wish to have their parent,

guardian or teacher know their HIV status. "

" There will also be a situation where exemptions may have to be made

regarding the age of consent for HIV testing, " Mogwanja added. " This

includes formally abducted children, child mothers and children who have

been raped or defiled. "

Uganda has won acclaim in the world for its anti-AIDS campaign that has

paid off by reducing infection rates from 30 percent in the 1990s to about

6 percent presently. An estimated one million people are HIV-positive, of

whom 10 percent are children. A million people have died of the disease

since it was first diagnosed 22 years ago.

[ENDS]

[This Item is Delivered to the English Service of the UN's IRIN

humanitarian information unit, but may not necessarily reflect the views

of the United Nations. For further information, free subscriptions, or

to change your keywords, contact e-mail: Irin@... or Web:

http://www.irinnews.org . If you re-print, copy, archive or re-post

this item, please retain this credit and disclaimer. Reposting by

commercial sites requires written IRIN permission.]

Copyright © UN Office for the Coordination of Humanitarian Affairs 2004

IRIN Contacts:

IRIN-Asia

Tel: +92-51-2211451

Fax: +92-51-2292918

Email: IrinAsia@...

To make changes to or cancel your subscription visit:

http://www.irinnews.org/subscriptions

Subscriber: AIDS treatments