Despite major strides to curb HIV infection, and boasting the world's largest ARV treatment programme, people are still dying from AIDS in South Africa which continues to be the epicentre of the pandemic and has suffered setbacks in recent years as Covid-19 took centre stage, notes MedicalBrief.
Reflecting on the several sobering moments at the 11th SA AIDS Conference which opened in Durban Tuesday, Spotlight notes that there were several sobering moments.
Chief among these was when co-chair of the South African National AIDS Council and chair of the Civil Society Forum, Steve Letsike – flanked by several representatives of civil society – told a fully packed plenary hall at the Durban International Convention Centre about a visit earlier on Tuesday to the Hillcrest AIDS Trust Centre – a hospice where 80% of the admitted people (living with HIV) are in their end stage of life.
Letsike told delegates that the youngest was a 14-year-old and 25-year-old. “We should be concerned. We should be angry,” Letsike told delegates.
“If our ARV (antiretroviral) programme has no efficient psychosocial support system extended to care and support, we are a ticking time bomb,” Letsike said. “Our people are dying. We should not allow them to die when we have a successful ARV programme. We can’t. Let’s not lose this investment where we can live longer.”
South Africa has the world’s largest ARV treatment programme. According to estimates from Thembisa, the leading mathematical model of HIV in South Africa, around 5.7m of the estimated 7.8m people living with HIV in the country in 2022 were on ARV treatment.
Health Minister Dr Joe Phaahla in his keynote address reminded delegates that the clock is ticking for 2025 – the date set to reach the UNAIDS target of having 95% of all people living with HIV diagnosed, 95% of all people diagnosed with HIV on sustained ARV treatment, and 95% of all people receiving treatment to have viral suppression.
“In the remaining two years,” Phaahla said, “we have to accelerate our efforts to meet the targets. Though we have made great strides towards achieving the first 95 percent, we still have a long way with the second and the third 95 percent.”
According to him, we are currently at “94% of people living with HIV who know their status, 77% of those who know their status and are on antiretroviral treatment; and 92% of those on treatment who have a suppressed viral load”. “More effort is needed to place and retain more people with HIV on treatment,” he said. “To achieve the 95-95-95 targets, we must initiate an additional 1.4m people on treatment.”
Director-General of Health Dr Sandile Buthelezi said he would determine the exact circumstances around the people at the hospice Letsike referred to. “But in this day and age – whether you are 15 or 50 years – no one should be dying of AIDS or getting to that end stage,” he said. “With ARVs, everyone should be alive. We will need to see what are the circumstances around that. Why are they at that stage? Were they put on treatment? Did they default? So we just need to get information, but it is worrying and not acceptable.”
Although not directly speaking to the cases Letsike referred to, Phaahla in his address said that certain interventions will have to be scaled up, including “social behaviour change communication, treatment literacy, and adequate resourcing” to get the country to 95 on the second and third targets.
“We also need to improve access to treatment and prevention commodities such as Pre-Exposure Prophylaxis (PrEP), especially for key and vulnerable populations inclusive of sex workers, the LGBTQI+ populations, and young people – particularly adolescent girls and young women,” he said.
KwaZulu-Natal’s Health MEC, Nomagugu Simelane-Zulu also lamented the quality of social behaviour communication, especially for young people. Simelane-Zulu during her address said that it looks like HIV messaging is not reaching young people. “It looks like our messaging on HIV is stale. It is the same message as when I was a teenager. We need to change that,” she said.
How to target youth and adolescents is among the key themes in several sessions throughout the three-day conference. For example, some sessions will explore PrEP uptake and barriers for adolescent girls and young women in Tshwane.
In other sessions, the benefits and acceptability of technology such as using WhatsApp groups as a platform for health education among adolescent girls and young women in South Africa, will be explored, along with a session on how to address child and teenage pregnancies in KZN, that can be a key contributory factor in bringing down new HIV infections.
Simelane-Zulu, in her speech, stressed the worrying number of teenage pregnancies in the province. From April to December last year, KZN recorded 26 515 pregnancies among girls between the ages of 10 and 19 and 1 254 of them were in the 10 to 14 age bracket.
According to SA AIDS Conference chair, Dr Gloria Maimela, a Youth HIV track is being launched at this year’s conference that “is run by youth, for youth who will set the tone and agenda on how we end the epidemic, for their sake”. There will also be updates on what is new in paediatric and adolescent HIV with respect to long-acting injectables, among others.
According to the UNAIDS Global Aids report of 2022, of the 38m people living with HIV globally, South Africa remains the epicentre of the pandemic with 8m people living with the virus, despite roads having been made to curb infections and the country having the world’s largest ARV treatment programme.
Conference chair Maimela said Covid-19 not only killed frontline HIV workers but widened the inequality gap.
She emphasised that the Covid-19 pandemic forced the healthcare sector to shift focus away from HIV in a dramatic fashion.
“As the pandemic gripped the world and South Africa, we lost focus on an epidemic that counts on destruction to continue unabated young people continued to be infected by HIV. Although the HIV incidence rate in the youth is lower in 2022 than in 2019, the rate of decline will undermine South Africa’s ability to reach the 2025 global coalition prevention targets.”
Phaahla said while Covid-19 had setbacks for the country’s HIV and TB programme, there have been some lessons learnt.
“The HIV/TB prevention programme was severely compromised during the pandemic but we are recovering, it challenged plans and compelled us to enhance new methods some of which have also given us some new advantages, especially in the area of tech we have now started to look more into tech in providing our services,” Phaahla said.
Nelson Muffuh, from the Joint United Nations Programme on HIV/Aids (UNAIDS), has called for sustained and adequate financing for investments in health infrastructure and systems.
Among others in attendance were South African National Aids Council (Sanac) civil society chairperson Steve Letsike; KZN Premier Nomusa Dube-Ncube, as well as a number of scientists, researchers, programme implementers, policy-makers and people living with HIV.
The event aimed to provide a platform for taking stock of the post-pandemic South African HIV/Aids, TB and STI response, and “to deliberate on emerging priorities as the country forges ahead with efforts and strategies to eliminate HIV as a public health threat”, the Presidency said in a statement
Referring to the UN targets, Phaahla said that four districts in Durban had already made strides in realising that goal: uMzinyathi, uMkhanyakude, Harry Gwala and uGu.
However, the rest of the country was way behind, particularly in meeting the targets for men and children under 15.
eThekwini Mayor Mxolisi Kaunda said of 500 000 people with HIV-Aids in the city, 450 000 were on anti-retroviral treatment.
The Witness article – Shock at new KZN HIV stats (Open access)
SABC News – Alarming drop in HIV testing, COVID-19 pushed increase in infections
Spotlight – Sobering moments at opening of SA AIDS Conference
See more from MedicalBrief archives:
African countries commit to end child Aids deaths by 2030
Six HIV vaccine research projects under way globally
Pepfar changes strategy, empowers Africa in HIV battle