South Africa has the largest HIV epidemic in the world with a prevalence of 18.8 percent of the country’s population aged from 15 to 49. Consequently, South Africa has some of the most comprehensive treatment and support systems for this issue. In addition to dedicated civil society organizations, the government has a guiding framework for reducing HIV in South Africa. One of such initiatives is the National Strategic Plan (NSP) for HIV, TB (tuberculosis) and STIs (sexually transmitted infections) 2017-2022 that aims to overcome barriers and set goals that could ultimately help influence global HIV infection management. In this article, five solutions for reducing HIV in South Africa that this country is implementing are presented.

Five Solutions for Reducing HIV in South Africa

1. Address inclusivity. Reducing the HIV epidemic in South Africa requires caring for the most vulnerable populations in society: sex workers, men who have sex with men, transgender women and people who inject drugs. Discrimination, intolerance and neglect culminate in intense stigma consequently keeping these cohorts out of the research and clinics where valuable testing and treatment are available. In addition, up until recently, nationally available programs like the National Sex Worker HIV Plan and the South African National AIDS Council’s LGBTQ HIV Framework were unavailable. The creation of specialized programs to address the unique needs of a chronically abused population is a valuable first step towards reducing HIV in South Africa.
2. Support women. Women and girls comprise more than half of the 36.7 million people living with HIV around the world. This statistic is even worse in South Africa where HIV prevalence is nearly four times greater for women and girls than that of men of the same age. These staggering high numbers are the result of poverty, systemic gender-based violence and intergenerational marriage. In addition to the programs identified above, nationally deployed resources like the She Conquers campaign provide multiple societal interventions like reducing teenage pregnancy and gender-based violence as well as providing educational support and business opportunities.
3. Prioritize prophylactics. A little over three years ago, South Africa became the first country in Africa south of the Sahara to completely approve pre-exposure prophylaxis (PrEP), which stands for the use of antiretroviral drugs to protect HIV-negative people from infection. This initiative is a primary tenet in the NSP‘s first goal to acceleration HIV prevention, especially for the most vulnerable population. The goal is to increase PrEP treatments to nearly 100,000 participants in the coming years. In addition, campaigns to distribute condoms, educate the population and even encourage male circumcision are operating to reduce initial transmission by providing means to encourage safe sex thus keeping the entire population safer from infection.
4. Deliver ART. South Africa has the largest antiretroviral treatment (ART) program in the world and UNAIDS estimates that 61 percent of South Africans living with HIV are receiving treatment in 2017. This figure has more than doubled since 2010. This success is largely due to the latest “test and treat” strategy that makes anyone who has tested HIV positive immediately eligible for ART treatment. Moreover, this strategy incentivizes the population to get tested which is a major barrier to reducing HIV in South Africa. Additional work is needed to encourage South Africans, specifically men, to get tested, as men tend to get tested and start treatment much later and at a more progressed stage of infection thus reducing effectiveness and placing the population, especially women, at risk. It is important to note that South Africa has made tremendous strides in reducing mother-to-child transmission (MTCT) largely because of the ubiquity and delivery of ART therapies. As a result, MTCT rates have been reduced by more than half between 2011 and 2016, achieving the national target for 2015 of a transmission rate below 2 percent.
5. Treat Tuberculosis (TB). Tuberculosis is the leading cause of death in South Africa. HIV severely suppresses the immune system leaving victims vulnerable to all infections, however, TB is particularly difficult and without treatment, fatal. It is estimated that two-thirds of HIV-positive South Africans have TB. In response, South Africa’s NSP incorporated TB reduction strategies and sets forth priorities for reducing TB mortality.

These five solutions for reducing HIV in South Africa have been a successful start for the country as they tackle the world’s largest HIV epidemic. The government has developed a comprehensive, multi-dimensional plan that shows a lot of promise, however, following through remains questionable. National organizations like the Treatment Action Campaign question the government’s ability to remain engaged and accountable.

Addressing HIV requires relentless attention and civil society participation, especially since UNAIDS’ ambitious 90-90-90 (90 percent of all people know their HIV status, 90 percent HIV-positive patients will receive ART therapy and 90 percent of ART therapy patients will have viral suppression) goal to suppress and eliminate HIV and AIDS, all by 2020, is right around the corner.

– Sarah Fodero

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