SA has one of the most comprehensive HIV programmes

Currently, in South Africa, we have more than 7.7 million people living with HIV, a prevalence of 20.4%. Even with efforts and initiatives the government and private healthcare sector put in place, we still experience above 70 000 aids-related deaths annually.

The country is estimated to be investing more than $1.34 billion (about R21.7 billion) annually to run its HIV programmes. As a country, however, we have made big strides in getting people to test for HIV using different government and nongovernmental organisation-funded initiatives – 87% are aware of their status, according to Statistics SA. Also by being one of the countries at the forefront of providing pre-exposure prophylaxis, we have seen a reduction in the rates of new infections.

Groups identified as high risk:

Sex workers: Certain factors increase HIV risk, including poverty, the number of dependents they have and lack of alternative career opportunities. Injecting drug use is also common among sex workers, exacerbating their vulnerability to HIV infection.

Men who have sex with men: Despite a constitution that protects the rights of gay, lesbian, bisexual, transgender, intersex, asexual and queer communities, many men who have sex with men face social stigma and homophobic violence. There is also a lack of knowledge about the issues they face, which makes it difficult for them to disclose their sexuality to healthcare workers and get the healthcare they need.

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Transgender women: Stigma is another major barrier to transgender individuals receiving care.

People who inject drugs: People who inject drugs are also associated with other high-risk behaviours such as sex work and unsafe sexual practices.

Children and orphans: New infections have declined among SA children due to the success of the prevention of mother-to-child transmission programmes. Children are also affected by the loss of family members. Orphans are particularly vulnerable because of economic and social insecurities; they are often at risk of being forced into sex, have sex in exchange for support and typically become sexually active earlier than other children.

Women and adolescent girls: Poverty, the low status of women and gender-based violence have been cited as reasons for the disparity in HIV prevalence between genders. Intergenerational relationships between older men and younger women are understood to be driving a cycle of infections.

HIV Testing and Counselling

More people are being tested for HIV, with the target of getting 90% of South Africans living with HIV to know their status and get treatment. The private sector plays an important role, while better relationships need to be built with the government to move towards 100%.

More women than men present themselves for voluntary testing. This is partly because mother-to-child prevention programmes enable women to access HIV testing services during routine antenatal appointments. Studies show men are often reluctant to test and this is one of the challenges. Maybe self-testing would be an attractive option. Those who know their status are more likely to have a higher level of education, be employed, have accurate HIV knowledge and have a higher perception of risk.

HIV prevention programmes

South Africa aims to reduce the annual number of new infections to under 100 000 by 2022. It has also committed to achieving zero new infections due to mother-to-child transmission.

• Prevention of mother-to-child transmission: SA has made great progress in reducing mother-to-child transmission due largely to improvements in the choice of antiretroviral medicines and the accessibility to the programme.

• Condom use and distribution: Male and female condoms must continue to be distributed widely. Education initiatives need to also focus on making sure people use condoms correctly.
• Voluntary medical male circumcision: Studies have shown this can reduce the risk of female-to-male HIV transmission by up to 60%. The department of health is working closely with the private sector to make sure the service is offered to as many young men as possible.
• Pre-exposure prophylaxis: In December 2015, SA became the first country in sub-Saharan Africa to fully approve pre-exposure prophylaxis, the use of antiretroviral drugs to protect HIV-negative people from infection.
• Education and awareness: Only 59% of young people in SA have comprehensive knowledge of ways to prevent HIV. Only 5% of schools provide comprehensive sex education. There is power in knowledge. Providing comprehensive sex education will also lead to a reduced incidence of sexually transmitted infections in young people, a significant decrease in physical violence or sexual assault perpetrated by young men and a lower proportion of young men engaging in transactional sex with a casual partner. Barriers to providing such knowledge include high drop-out rates, a shortage of teacher training and resistance in schools because of the perceived sensitive nature of the subject matter.

Antiretrovirals (ARVs)

In 2018, UNaids reported 4.4 million South Africans were receiving treatment. This equates to 61% of the people living with HIV. In 2016, SA implemented Test and Treat, whereby everyone with a positive diagnosis was eligible to start treatment. This means the number of people eligible for treatment has increased from 3.39 million in mid-2015 to 7.1 million in 2016.