South Africa

South Africa gave an overview of the care and support within the Perinatal HIV Unit at Baragwanath Hospital in Soweto. The Perinatal HIV Unit provides counselling 24 hours a day by training every health worker in the unit for back-up. It has made it a point to employ male counsellors for male-to-male counselling. This has encouraged most women to disclose their status to their partners. The unit is starting to see more men attending the clinic. Behaviour change and disclosure are still challenges in counselling.

Support groups are run every Wednesday in the unit, in collaboration with NGOs. A group of PLWHAs, called ACCT (which used to be called Wolanani) are involved in care and support. Some of the women in this NGO have been involved in the unit’s MTCT trials.

All pregnant women who receive antenatal care at Baragwanath Hospital are offered routine HIV testing. Uptake of the test is over 90%, and HIV seroprevalence in mid-1998 was over 20%. After the trial some women are put on anti-bacterial prophylaxis.

The unit has started a community group, sponsored by HIVNET, to prepare the community for a vaccine trial. This group will work to educate the community about research in general, and what research is ongoing and what is planned. This interaction has taught the unit that it is essential to work with the community before starting any research.

The unit provides antenatal and postnatal care for women, follow-up for gynaecological problems, family planning advice and provision, peer group counselling and access to community organisations and support groups. Counselling and testing is provided for male partners of HIV-infected women, and women are encouraged to bring partners for couple-counselling. Children born to infected mothers are followed until 18 months, and have repeat tests during this period to determine their HIV status.

Offering care and support has been the best way to help those who are HIV-infected, and others who are affected by the illness, to improve the quality of their lives, to disclose their status, and most of all start feeling that life is still worth living. The unit must ensure that it plans, budgets and provides infrastructure for those who need it most, and thereby make a difference. It is best if PLWAs should be involved when proposals are being written. The unit will soon be starting a pilot project called DART in partnership with the South African government, and will be funded by FSTI (French Government).