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Doubling TB case-finding among inmates – the success of partnership in Pollsmoor

On the 30th March, TB/HIV Care and the Department of Correctional Services (DCS) held an event to highlight and share the successes achieved in the TB/HIV programme in Pollsmoor. The honourable Western Cape Minister of Health, Nomafrench Mbombo, participated in the event; helping to cut the ribbon on a brand new digital X-Ray machine which will assist in finding new cases of TB in prison

Other screening techniques, including the GeneXpert machine which was launched two years ago and can diagnose TB within two hours, have already borne fruit. TB case-finding in Pollsmoor doubled in one year; from 190 diagnosed in 2012 to 405 diagnosed in 2013.

Since then, 68 152 inmates have been screened for TB, 9922 have been tested with the GeneXpert tests and 701 started on TB treatment of whom 28 were started on multidrug resistant TB treatment. If one TB patient infects 20 others, then the rapid diagnosis and treatment of 701 cases of TB may have prevented 14 020 other TB infections in Pollsmoor.

This is of particular importance in the prison setting, where TB prevalence and the risk of transmission is high. Inmates are therefore one of the groups of people South Africa’s National Strategic Plan for HIV, STIs and TB 2012-2016 proposes targeting with interventions. Other groups include people whose immune system is compromised and people who live or work in areas where they are exposed to TB such as inmates and officials in correctional facilities, miners and those living within mining communities. The theme for World TB Day this year in South Africa is ‘Ending South Africa’s TB epidemic: accelerating our response in key populations’. The sub theme is “Find, treat and cure TB in hard-to-reach communities”.

The main aim of Monday’s event was to show how civil society can work in partnership with government to fight the spread of TB in correctional facilities. Through funding from the Global Fund to Fight AIDS, TB and Malaria (Global Fund), the Department of Correctional Services (DCS) and the Department of Health (DOH) in partnership with the National Health Laboratory Service (NHLS) and nongovernmental organisations such as TB/HIV Care Association (TB/HIV Care), Right to Care and the Aurum Institute have implemented a TB screening service in correctional facilities throughout the country.

TB/HIV Care is responsible for supporting 91 correctional facilities throughout the Western Cape, Eastern Cape and in two management areas of KwaZulu-Natal.

World AIDS Day: the numbers and the networks

Activists often say, “Every day is World AIDS Day for me.” This may be the case for TB/HIV Care too, but World AIDS Day does provide us with an opportunity to focus on and scale up HIV counselling and testing (HCT) service delivery. This year TB/HIV Care participated in 44 events (in both a hosting and supporting capacity) in the four provinces in which we operate (Western Cape, Eastern Cape, KwaZulu-­‐Natal and Northern Cape). At these events, 8 119 people accessed HIV/TB/sexually-­‐transmitted infections (STIs) behaviour change interventions, 4217 were provided with HIV counselling and testing (HCT) (44 of whom tested positive for HIV), and 4196 with TB screening1. Over 69 065 condoms were distributed.

TB/HIV Care has always worked in partnership with other organisations and structures of government. World AIDS Day this year was no exception and saw the organisation develop and foster new relationships with municipalities, city officials and organisations. The Health Festival in Samora Machel, Cape Town saw a total of13 other organisations support TB/HIV Care in providing a holistic wellness experience for the community – enabling access to vital health services, and health and social information. Organisations present included Childline/Lifeline, The Heart and Stroke Foundation, Rape Crisis, Treatment Action Campaign, Sonke Gender Justice, SAHEP, Mosaic, The Parent Centre as well as both the Weltevreden Valley and Inzame –Zabantu clinics. The Department of Social Development and Department of Sport and Recreation also provided services. On top of this, various relationships were built with corporations through donations, including Capitec, Illovo, Parmalat, Conde Nast, Golden Harvest, and Aquelle. This allowed us to pack 1000 ‘goodie bags’ for attendees. The trend in relationship building extended to other parts of Cape Town, in the form of the Grassroots soccer tournament TB/HIV Care supported on the same weekend. TB/HIV Care has been working with Grassroots for two years, a fruitful relationship which has yielded media exposure for TB/HIV Care. Activity in Mthatha included the Mthatha team working with municipalities in various areas to provide HCT services, and with the Department of Social Development, SAPS and Home Affairs for one particular event. Pietermaritzburg partnered with with I Teach, Community Media Trust, municipalities, CCG, Department of Health and USAID. TB/HIV Care participated in the Nelson Mandela Bay district World AIDS Day in Port Elizabeth, along with the District AIDS Council, the District Department of Health, Khahlamba Project, SASSA, the Department of Social Development, the Department of Public works, and the Department of Home Affairs.

Zero Stigma and Zero Discrimination
The national theme for this year’s World AIDS Day was ‘zero stigma, zero discrimination.’ Work on stigma and discrimination is evident in much of our work. TB/HIV Care’s key populations programme deals directly with parts of the population who are most often discriminated against. Nine of this year’s World AIDS Day event were focused on key populations (inmates, sex workers and people who inject drugs (PWID)). Events in Cacadu and St Albans correctional facilities explicitly focused on zero stigma and zero discrimination. The Eastern Cape World AIDS day event in East London was supported by key populations staff, wearing t-­‐shirts with the slogan “You can’t change an HIV status but you can change your attitude.” Both Durban and Pietermaritzburg offices held events commemorating World AIDS Day for sex workers and PWID.

Girls aged 15-­‐24 are one of the groups at highest risk of HIV infection. As such youth is one of our programme focuses. Many of our World AIDS Day events targeted the 15 – 24 age bracket and youth in general. The event in Malmesbury combined MMC and HCT, focusing on youth. 14 MMCs were done at the event. At the Grassroots event, out of the total 172 that tested, 81 were in the 14 – 25 group, 64 of these female. This focus on youth is set to continue due to the partnership TB/HIV Care teams have with Grassroots Soccer. The Health Festival in Samora Machel had a large youth contingent attending. Entertainment was provided by Come and Play (Department of Sport and Recreation), LoveLife, Future Champs (boxing demonstrations), and DJs. Events at the Appelsbosch Hall in Pietermaritzburg included donations of clothes to orphans and vulnerable children and attendance was high from primary and high school learners who performed songs and poetry. In Pietermaritzburg, 1 225 people aged 15-­‐24 accessed TB/STI/HIV behaviour change interventions and 125 of this group accessed HCT.

Demanding a Plan to Tackle Gender-based Violence

TB/HIV Care has joined a working group, headed by Sonke Gender Justice, aimed at lobbying the Ministry of Women to design, fund and implement a plan to combat gender-based violence, similar to the plan that has been devised to respond to the HIV and TB epidemics; the National Strategic Plan for HIV, STIs and TB.

The group is calling for co-ordinated, concrete actions to be taken against gender-based violence rather than the ‘lip-service’ paid to the issue during the 16 days of activism campaign.

But what does gender-based violence have to do with HIV? Gender-based violence has been identified as a driver of the HIV epidemic by South Africa’s National Strategic Plan for HIV, Sexually Transmitted Infections (STIs) and TB 2012-2016. Studies published by the Medical Research Council (MRC) suggest that women with violent or controlling partners are at greater risk of HIV infection. The MRC’s Rachel Jewkes has found that 12% of HIV cases among women were associated with more than one case of violence from an intimate partner. Another Tanzanian study found that HIV-positive women (18–29 years) were ten times more likely than HIV-negative women of a similar age to report partner violence.

TB/HIV Care supported a collective action by the working group on Wednesday, the 10th December. In Johannesburg a petition was handed to Minister of Women’s Affairs, Susan Shabangu, calling on her to take action. At the same time in Cape Town, groups gathered at bridges with banners and posters asking people to hoot their support and participate in a letter-writing campaign to the Minister expressing their ideas for the proposed national strategic plan.