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SA makes progress in fight against HIV/Aids

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Picture: Doctor Ngcobo / African News Agency / Taken November 30, 2023 South Africans join the world in commemorating World AIDS Day, which is marked on December 1 every year, to show support for people living with and affected by HIV and Aids, and to remember those who have lost their lives to the pandemic.

By Bheki Mngomezulu

Every year on December 1, the global community observes World Aids Day. The event is used to reflect on progress made in curbing the pandemic, identify lessons learnt and table proposals on what should be done.

Globally, the first Aids Day was observed on December 1, 1988, under the theme “Join the Worldwide Effort”. At the time, South Africa was a pariah state and thus not part of the global community in many respects.

Following the advent of democracy in 1994, two years later, in 1996, the South African Department of Health organised a special event called “The National World Aids Day”. The event was held in two cities, Bloemfontein in the Free State and Pretoria in Gauteng. Since then, this has become an annual event.

In Africa, HIV/Aids treatment began in 2002. The first African country to take the pandemic seriously was Botswana, which established a national HIV/Aids programme called Masa, a Setswana word meaning “a new dawn”. This was the Botswana government’s response to the highest HIV/Aids prevalence cases in the country at the time.

Other countries on the Continent followed suit.

The brief background means that 2023 marks the 35th anniversary of the World Aids Day event if we count from 1988.

It was being organised under the theme “Let Communities Lead: A clarion call to invest in and strengthen community-centred approaches in the management of HIV”.

The theme is relevant and timely, especially at a time when the call for Africanisation and decolonisation is gaining momentum.

In the past, many decisions have been taken in boardrooms. Communities were excluded from the talks. The inclusion of communities in trying to address the HIV/Aids pandemic is thus a welcome development.

If HIV/Aids has divided nations, South Africa has had its fair share of challenges. When president Thabo Mbeki was in office, there was an uproar following his statement that rather than addressing the pandemic medically, it was important to address some of the causal factors, such as poverty and inequality. At times, he was misconstrued, at other times, he was deliberately contradicted for political expediency.

When Jacob Zuma became president, he took a different approach. His administration put resources into the treatment campaign. Public hospitals upped their game in testing patients and then providing them with antiretroviral therapy (ART). However, for one to qualify, the CD4 count had to be less than 500 cells per mm³.

The year 2016 marked a new epoch in the fight against HIV/Aids in South Africa when new changes in the treatment guidelines were introduced. Key among them was that anyone who needed treatment had to get it immediately and not wait for the CD4 count to drop below 500 cells per mm³.

Since then, South Africa’s response to HIV/Aids has improved.

The results of a study conducted by the Human Sciences Research Council (HSRC) and other partners between 2017 and 2022 attest to the claim made above. The results show that in 2017, South Africa recorded that HIV cases stood at 14.0 percent. By last year, the figure had gone down to 12.7 percent. The figures translated to 7.9 million people living with HIV in 2017 compared to the reduced figure of 7.8 million people in 2022.

A close analysis of the HSRC data presents interesting discussion points. For example, the report states that in South Africa, the availability of HIV treatment medication has resulted in people who are 15 years and older being virally suppressed compared to 61 percent in 2017. According to the study, viral suppression was higher among women, at 83 percent, compared to men, at 79 percent, with men aged 25 to 34 years recording 66 percent of those who were virally suppressed.

HSRC researchers and their colleagues tried to understand the causal factors for the promising picture. Their observation was that there were few new infections within the population. There were more children who were born HIV-negative than had been the case before. Half of the men aged 15 to 24 were found to be medically circumcised last year compared to only 43 percent in 2017. This was a huge improvement.

The study also revealed that 90 percent of South African people, 15 years and above, living with HIV knew their status. Ninety-one percent were on ART and of that number, 94 percent were virally suppressed.

The study concluded that South Africa was on the right track to meet the UN Aids target of 95 percent of all people living with the pandemic being on ART and 95 percent of those infected knowing their status.

While the results are encouraging, they should not lead to complacency. More work needs to be done by everyone.

Prof Bheki Mngomezulu is Director of the Centre for the Advancement of Non-Racialism and Democracy (CANRAD) at the Nelson Mandela University.