Revitalising SANAC for an Enhanced Response to HIV in South Africa

This is an excerpt from a recently launched UNAIDS publication, Turn Around – The Story of South Africa’s HIV Response.

Turn Around Pic 1Revitalising the South African National AIDS Council for Enhanced Response to HIV in South Africa

The South African National AIDS Council (SANAC) has been at the heart of the sea change that South Africa has witnessed over the last decade in comprehensively turning the tide against HIV.

SANAC had humble beginnings in the year 2000 and brought together Government and civil society to work hand in hand on the AIDS response. Unfortunately this beginning coincided with the period of AIDS denialism and its full maturation was muted by the controversial national policy of the time.

SANAC made up for lost time in the heady days of 2007 when the country saw a virtual revolution that finally brought together AIDS activists, clinicians and Government to jointly overturn the national policy in the direction of aggressively providing antiretroviral treatment to a nation that had already witnessed millions of deaths from AIDS.

South Africa now has more than three million people on treatment and has reduced the transmission of HIV from mother to child to less than 2% at final transmission.

In the last five years it became clearer to all stakeholders that a genuine multisectoral response that tackles treatment, prevention and human rights was needed. Once again it was in the SANAC stable that this comprehensive policy was forged in the form of the National Strategic Plan on HIV, STIs and TB, 2012-2016 (NSP).

In 2012 SANAC migrated from a consensus building institution to one that supported the implementation of the neglected elements of the NSP.

As treatment coverage increased and as the epidemic began slowly contracting, a new role for SANAC became necessary. This new role required the extension of the response to multiple government departments such as Basic Education, Higher Education, Social Development, Correctional Services, Justice, and Science and Technology, with additional departments such as Minerals, Labour, and Transport stepping up to the plate. NGOs and civil society, as well as the private sector, needed to be drawn closer to the heart of the response.

In this environment, the Government of South Africa initiated the revitalization of SANAC as the key coordinating instrument for this new phase. In 2012 SANAC migrated from a consensus building institution to one that supported the implementation of the neglected elements of the NSP.

SANAC was established as a Trust of the Government and a Secretariat was built up to deepen coordination, improve monitoring and evaluation, and support government departments and civil society with implementation. This has led to national programmes targeting key populations such as young women, sex workers, LGBTI communities, people who inject drugs, and inmates in correctional facilities.

South Africa finances approximately 80% of the domestic response and more than 90% of the treatment costs, but has been unable to invest the required resources in prevention and supporting key populations or responding adequately to the ongoing barrier of stigma, discrimination and human rights needs of people living with HIV and key populations.

SANAC capitalized on its partnership with the Global Fund to address these previously neglected areas. This approach matched well with the policy of the Global Fund to concentrate its resources in middle-income countries on key populations.

Turn Around CoverOver the last four years SANAC has transformed the Country Coordinating Mechanism (CCM) (it had struggle for almost a decade to capitalize on Global Fund investments) to make it one of the most representative in the world; one that truly represented marginalized populations and planned thoroughly to address the gaps mentioned above.

Over two proposal cycles, Global Fund investments, under the direction of the CCM and SANAC, were reprogrammed to address young women and key populations while continuing to fund innovation in antiretroviral treatment and tuberculosis. The young women programme compliments the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative of the United States Government.

The Global Fund portfolio of grants, which now includes a record five NGO principal recipients, finances a national sex worker programme that will reach 70 000 sex workers and large scale programmes targeting men who have sex with men (MSM), transgender women, and their partners, prison inmates, and people wo inject drugs. The latter is the first programme to target heroin use in South Africa and only the third such programme on the continent.

This has all been possible with the highest level of political support from the Deputy President, who is the Chairperson of SANAC, the Minister of Health, civil society leadership, and the dedicated team at the SANAC Secretariat.

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