The mood in South Africa is upbeat, but not just about the forthcoming Fifa World Cup. It is also about the way the country is responding to Aids. The government and civil society groups are talking and working together. Academics and activists are engaging in evidence-informed discussions with officials to make the right choices about HIV programmes. The government has shown its seriousness by investing more than $1billion (R7.3billion) in the Aids response this year.
People can feel the difference. The international community can feel the difference. There is fresh enthusiasm to act and to save lives. Truly, South Africa is showing leadership and taking responsibility.
I believe that South Africa can break the trajectory of the Aids epidemic — in Africa and globally. It is also its duty. It owes it to its citizens that no child is born with HIV, that mothers do not die for lack of access to healthcare during childbirth, that girls and women fully contribute in society with their heads held high, without fearing violence, and that all people living with HIV have access to treatment when they need it.
A starting point is testing and counselling for HIV. HIV testing by itself is not going to stop HIV transmission or treat people living with HIV. But it is a necessary first step. It can break the logjam in starting difficult conversations around HIV treatment and prevention. Such conversations are necessary to achieve universal access to HIV prevention, treatment, care and support. This is why the country’s new campaign to test nearly 15-million people for HIV by 2011 is courageous and must succeed. And the international community should do all it can to support this effort.
The benefits are very clear for treatment access. Early detection of HIV helps individuals make the right choices for looking after their health. The health system can prepare itself to provide ongoing care and, eventually, treatment for all people living with HIV. Welfare and other development issues can be planned and managed to mitigate impact. But the real advantage is for families and communities. They can begin talking about HIV — between couples, parents and children, elders and peers, and between friends. Communities find different entry points for beginning a conversation around difficult issues. A national HIV testing and counselling effort can be South Africa’s entry point to discuss issues of sexuality, violence against women, intergenerational sex, negotiating safer sex and stopping babies from becoming infected with HIV. It can be the start of the prevention revolution — getting to zero new infections.
Testing and counselling millions of people for HIV may pose a logistical challenge. But it has been done before. During a six-month campaign in Tanzania, more than three million people were tested and counselled for HIV. In Malawi in 2008 nearly 200 000 people were tested in the course of just one week. Kenya and Uganda have conducted national door-to-door HIV testing campaigns. In Botswana there is near-universal testing and counselling for pregnant women. Lesotho, too, has for long championed the “Know your status” campaign. South Africa is building on these campaigns for an ambitious and achievable goal.
Far too few South Africans know their HIV status. The new campaign aims to make it easy to find out. Cellphones will help people to find an HIV testing centre. Text messages can provide instant reminders. And game applications can assist in assessing an individual’s risk for HIV.
The country’s rich tradition of social mobilisation is going to be tapped into at learning institutions such as schools, colleges and youth clubs. Places of worship — including churches, mosques and temples — as well as workplaces and entertainment spots will all be mobilised. Each point of contact is an opportunity to begin a conversation and move to action. By taking an HIV test, each South African can say: “I am responsible.” By creating the right environment for access to testing and counselling and reducing stigma and discrimination, communities and health and social systems can say: “We are responsible.”
Knowing one’s HIV status must be the beginning of a long process of engagement of the health and social sectors with individuals and families. This means we have to strengthen both these sectors.
Citizens must be able to build anew their relationships and their confidence in the health system to protect and look after them. Communities must be able to bring back their age-old role of caring for their people — not just by providing commodities, but also by providing the moral leadership that protects human rights, especially those of women and children.
Michel Sidibé is the executive director of the Joint United Nations Programme on HIV/Aids (UNAids)