/ 22 July 2016

​The challenges of HIV are mutating and we must adapt to counteract them

A simple test may assist in lowering a young woman's risk of getting HIV.
A simple test may assist in lowering a young woman's risk of getting HIV.

At the International Aids conference in Durban this week, South Africa had much to celebrate. In stark contrast with the 2000 conference, which was also held in Durban and clouded by then-president Thabo Mbeki’s HIV dissidence, the country had positive results to show.

At the time of the 2000 conference, South Africa didn’t provide free treatment to HIV-infected people. Today, the country has thelargest antiretroviral (ARV) programme in the world. South Africans’ life expectancy increased from 52.2 in 2004 to 62.9 in 2014, according to Statistics South Africa and Medical Research Council data, and this is largely the result of its investment in making treatment accessible.

In December last year, South Africa became the second country in the world, after the United States, to approve the use of the two-in-one ARV pill, Truvada, as an HIV-prevention measure for people who are not infected with the virus. It can reduce someone’s chances of contracting HIV by about 90% if taken daily.

But South Africa is not yet nearly where it needs to be. HIV infections among teenage girls and young women between 15 and 24 are increasing at an alarming rate. UNAids data shows that nearly 2 000 young women are infected with HIV each week in this country. At the Durban conference, experts warned that, if we don’t decrease the rate at which those infections occur, we run the risk of reversing many of the gains we have made.

South Africa will also need significantly more money to expand its treatment programme. In September, the country will start to provide everyone with HIV with ARVs. That has drastic implications for the nation’s HIV budget: it will mean that eventually we will have to double the number of people on treatment, from today’s 3.4-million to each of the country’s 6.8-mil- lion HIV-infected people. As things stand, only people with HIV whose immune systems have reached a certain point of weakness receive free treatment.

The health department’s HIV and tuberculosis investment case shows that the country’s annual HIV budget may have to increase from its current R20- billion to more than R35-billion in 2020.

Expanding treatment will rely heavily on the use of community health workers, because South Africa does not have sufficient nurses and doctors to administer treatment. But our community health system is fragmented, and we don’t even have a national community health worker policy.

Our health minister has publicly acknowledged the impact of Mbeki’s HIV dissidence on the loss of lives but activists are once more concerned about the political commitment to fight HIV. Earlier this year, ANC leaders questioned the motives of donors funding the Treatment Action Campaign and Section 27, which are often critical of the government, asking why they would be funding organisations perceived to be advocating “regime change”.

It’s not only the ANC they’re concerned about. This week, the Democratic Alliance’s Western Cape premier, Helen Zille, was openly ignorant and prejudiced in her view about the way in which many South Africans become infected. 

On Twitter, she and her followers criticised South African-born Hollywood star Charlize Theron’s statement, in her opening address at the conference, that HIV is not spread only by sex but also through racism, poverty and homophobia. Zille didn’t agree. She thinks it’s merely a case of “translating scientific knowledge into behaviour change”. Poverty apparently plays no role in limiting women’s ability to choose with whom they have sex, or how they have sex.

And South Africa has more than one leader who thinks like that. If we don’t address prejudice and inequality in our society, HIV will continue to spread.