South Africa

Emihle Dlamini (not her real name) lost both her parents to AIDS-related illnesses when she was young, so she was raised by her grandmother. For years, Ms Dlamini didn’t know that she was born with HIV. She was given medicine, but was told it was for tuberculosis. South Africa had approximately 260 000 children living with HIV in 2018. Around one third lived in the KwaZulu-Natal province that Ms Dlamini lives in.

One day, Ms Dlamini attended a lesson at school run by the Community Care Project, where she learned about HIV and was offered an HIV test. The result came as a shock, “I was in total disbelief. I knew that I was not sexually active, but my family had never told me that I was HIV-positive,” she said.

Ms Dlamini experienced feelings of anger, confusion and sadness. “Why did my family not tell me? On many occasions, I stopped taking my “tuberculosis” treatment because I wondered why I was taking it for so many years,” she said.

Many people do not disclose their HIV status out of fear of the stigma and discrimination that, despite improvement, remains a real barrier to people seeking access to health services. Particularly affected are young women seeking protection from sexually transmitted infections, as well as HIV diagnosis and treatment. Every day in South Africa, 200 adolescent girls and young women aged 15–24 years are newly infected with HIV.

The Community Care Project has shown the importance of equal and free access to primary and secondary education as a gateway to other social and health services. Almost 163 000 children (0–14 years) living with HIV in South Africa were receiving antiretroviral therapy in 2018, but many are still missing out: an estimated 66 000 children did not even know their HIV-positive status.

The project is accustomed to breaking the silence surrounding HIV as well as managing and reducing its effects. Founded in 1999, it is a faith-based organization from KwaZulu-Natal that helps communities and families manage HIV and respond to stigma and discrimination. Since 2007, it has partnered with secondary schools to run awareness programmes and provide services that help schools and pupils understand and demystify HIV. It also provides care for orphans and other vulnerable children and their families.

The Community Care Project provided Ms Dlamini and her grandmother with counselling by an auxiliary social worker, to help them come to terms with the HIV diagnosis and to ensure that Ms Dlamini follows a sustained treatment programme. Ms Dlamini says she is now coping much better with her situation emotionally and mentally. She has a better understanding of HIV and sexual and reproductive health and is adhering to her medication. She feels that she can have a bright future.

“The Community Care Project taught me positive life skills. I learned how to cope with my HIV status, deal with stigma and help others to do the same,” she says. “One day I would like to be a motivational speaker and empower my peers at school with HIV information and how to live without judgement.”

Communities played a central role in the commemoration of World AIDS Day in South Africa, which was held in the rural community of Orkney, in the North West Province.

At the invitation of the Government of South Africa, the UNAIDS Executive Director, Winnie Byanyima, commemorated her first World AIDS Day as UNAIDS Executive Director in the local community. Ms Byanyima paid tribute to the role of communities in the AIDs response, including communities of people living with HIV and communities of women, girls and others at higher risk of, or affected by, HIV.

Ms Byanyima told the audience of several thousand people that it was an honour to mark World AIDS Day in South Africa—a country that was late to respond to HIV but that had made huge strides over the past decade and now had more than 5 million people on treatment. She noted, however, that there was still a long way to go, especially to protect women and girls.

“Enough is enough. All women and girls must have the right to choose if they have sex and with whom, and how they protect themselves. We need to bring power, equality and agency to all young women and girls,” she said.

Ms Byanyima said we must never accept that people living with HIV are still dying of AIDS. “It is not a question of science. It is a question of inequality, powerlessness and exclusion. The system is still failing for those who are marginalized,” she said.

South Africa’s Deputy President and Chair of the South Africa National AIDS Council, David Mabuza, told the World AIDS Day event audience that South Africa’s AIDS response had succeeded thanks to the work of communities and the contributions of activists and development partners.

“We could not achieve this without partnerships and support from our global partners,” he said. “That is why we must appreciate the contribution of the global campaign by UNAIDS that has galvanized political leadership, civil society and the private sector into coherent action. Community action remains an important pillar in making change happen, and in shaping the policy agenda and outcomes.”

He noted that there was still much work to be done, including intensifying HIV prevention and tackling contributing factors, including providing comprehensive sexuality education and ending gender-based violence.

Mr Mabuza also said he was pleased to be joined by Ms Byanyima. “She is an activist of note and a distinguished advocate for human rights and development,” he said.” We have no doubt that her vast experience in political leadership and human development will take us forward in the struggle to end the AIDS epidemic.”

In the days prior to the World AIDS Day commemoration, Ms Byanyima met with political and civil society leaders, women activists and others to hear their concerns and understand the challenges and opportunities facing South Africa.

She also visited a clinic in Soshanguve, outside Pretoria, to see in action the project Ritshidze (“saving our lives”), which aims to improve the quality of HIV and tuberculosis service delivery in South Africa by empowering people living with HIV to monitor the health services they receive and to advocate for changes needed. The project is funded by the United States of America with support from UNAIDS.

"We can spend billions building beautiful clinics to distribute millions of pills,” Ms Byanyima said. “But only if we empower communities at the grass roots to hold service providers accountable and call out injustices will we make a real difference for people."

Aziwe is 19 years old and lives with her mother, Phatiswa, in an informal settlement called Umlazi, near Durban, South Africa. Both women are living with HIV and both are full of energy, love, hope and optimism for the future.

Aziwe didn’t find out she was HIV positive until she was about 14 years old. She had already been on treatment for five years but her mother had decided not to tell her that she was HIV positive, even while making sure that her daughter stayed healthy by taking her medication every day.

When the doctor asked her if she wanted to know why she had to take medicines so regularly, Aziwe did not hesitate. As she had grown older, so had her curiosity. When the doctor told her that she was living with HIV she broke down. Her mother too.  

Now, five years later, Aziwe is a happy, confident teenager who is highly articulate as she tells the family story to the UNAIDS Executive Director a.i. Gunilla Carlsson ahead of the launch of UNAIDS global report on the state of the AIDS epidemic.

Phatiswa lived in the Eastern Cape in 1999 but, like many women, left to find work as a domestic worker in Durban. She’s good at her job and has been working for the same family for 19 years.

The children stayed behind in the Eastern Cape at first. But Aziwe was a sickly child and came to live with her mother a few years later. In 2009, she became very ill and was rushed to hospital where she would remain for 2 weeks. It was there that she was tested for HIV and found to be positive. Phatiswa also tested positive for the virus.

Today, the women take their treatment and encourage others at community support groups to keep taking their medicines so that they stay well. Aziwe also challenges the stigma and discrimination that still surround HIV and has spoken about living with HIV at a church group. She says there is still too much ignorance about the virus and it sometimes upsets her. But she and Phatiswa support each other.

“I have days where I just want to cry but she speaks to me as a mother. I have good family and friends who are always there for me.”        

Aziwe explains that she values life so much more because she has lost loved ones to AIDS.

“I want to live because there are so many things that I want to achieve in life—for my mother and for myself.”

Like many young people, she wants to travel and later to work as a talk-show host on television. In the future, she wants to have a family of her own.

“I’m just a normal teenager living with HIV,” she explains.

South Africa is making strong progress in scaling up HIV testing and increasing viral suppression in patients receiving antiretroviral therapy (ART), but is not yet reaching its targets for treatment coverage and HIV prevention, according to an updated Thembisa model released at the 9th South Africa AIDS Conference in June.

The results of the annual updated Thembisa model (version 4.2) was released by researchers at the Centre for Infectious Diseases Epidemiology and Research, University of Cape Town. Work on the Tembisa HIV estimates is  funded by UNAIDS through a grant from the United States Centres for Disease Control (CDC), and used data from multiple sources including recent surveys by the Human Sciences Research Council and the Medical Research Council of South Africa.

South Africa is committed to reaching the UNAIDS 90–90–90 Fast-Track targets by 2020. The aim of this strategy is to ensure that 90% of people living with HIV are tested and know their status, that 90% of people living with HIV are receiving treatment, and 90% of people on treatment have a suppressed viral load. The latest Thembisa estimates indicate that South Africa reached 90–68–88 by mid-2018. This means that total viral load suppression among all people living with HIV was 55%, which is 18 percentage points below the target of 73%.

The Thembisa model also estimates that men had a lower uptake of HIV testing and treatment compared to women. As a result, in 2018, 47% of HIV-positive men were virally suppressed compared to 58% of HIV-positive women. This was also reflected in annual AIDS-related deaths which halved from 2010 to 2018, but with men increasingly over-represented.

Women accounted for 62% of new HIV infections in adults from 2017 to 2018. The lead developer of the Thembisa model, Leigh Johnson, said two factors were hampering progress on reducing HIV incidence: low ART coverage and the need to improve linkage and retention in care, and evidence of reduced condom use. He noted that adolescent girls and young women (15–24 years) account for 31% of all sexually-acquired HIV and require special attention.

The Thembisa results highlighted concern about slow progress in reducing HIV incidence. The model estimates that in the last year there were more than 240 000 new HIV infections in South Africa, which was a reduction of less than 40% from 2010. The UNAIDS target is to reduce annual new infections by 75% between 2010 and 2020. To achieve this, South Africa would need to reduce new infections to fewer than 100 000 by mid-2020, which poses a significant challenge.

The Thembisa results show that  that KwaZulu-Natal, the province with the most severe HIV epidemic, succeeded in reducing its annual new HIV infections by 49% from 2010 to 2018. Thembisa also estimates that annual new infections among children declined 55% from 29 000 in 2010 to 13 000 in 2018.

More detailed results and model details are available on the Thembisa website: https://thembisa.org/downloads

South Africa has reaffirmed its commitment to accelerate the pace of its response to HIV in order to reach the 2020 Fast-Track targets and end the AIDS epidemic as a public health threat by 2030.

During the opening plenary of the 9th South Africa AIDS conference in Durban, UNAIDS Deputy Executive Director, Shannon Hader, reminded participants that 1in 5 people living with HIV globally lives in South Africa. The country has the largest treatment programme in the world with 4.5 million people on treatment by June 2018. However, around 3 million people living with HIV are yet to access treatment. Ms Hader also reminded the audience that the country is not on track to reach its prevention targets.

“Pace really matters. The world will only succeed in ending AIDS when South Africa succeeds,” she said. Ms. Hader noted that ending the AIDS epidemic was a strategic priority for South Africa and an essential element of the Sustainable Development Goals. “Success in HIV is success in health, and we won’t have health for all if we don’t address HIV.”

Ms Hader reiterated that UNAIDS and the UN system remain committed to support South Africa’s response to HIV and TB. “We are with you,” she said.

Delivering the opening address to the conference, South Africa’s Minister of Health, Zweli Mkhize said the success of the AIDS response to date was a tribute to the work of researchers and the courage of activists who dedicated their lives to finding solutions. “This event reminds us to harness the huge potential of people living with HIV to guide the delivery of services,” he said.

When closing the conference, South Africa’s Deputy President, David Mabuza, thanked UNAIDS and the UN system for their continued support and noted that South Africa is determined to expand HIV treatment to at least 6.1 million people by 2020. He cited Thembisa modelling by the University of Cape Town and funded by UNAIDS that suggests 12.9% of the South African population is living with HIV. 

While South Africa’s HIV response is being hailed as a success, it is “clear that we are not doing well in preventing new infections,” said Mr Mabuza. “It is estimated that there are around 250 000 new infections annually, and our target is to get below 100 000 new infections by December 2020. This gap is big and it must be closed.” Mr Mabuza noted that stigma and discrimination remained a challenge to ending AIDS and he expressed determination to overcome them. “We must be compassionate and ensure that available services are provided with respect and dignity to all,“ he said.

At a pre-conference event, the UN Resident Coordinator Nardos Bekele-Thomas joined the Minister of Health, the Premier of KwaZulu-Natal, the Deputy Ministers of Justice and Social development, and several political, community and civil society leaders, to launch a new human rights and gender plan to address barriers to access HIV and TB services. The plan was handed over to Mr Mabuza, who is also Chair of the South Africa National AIDS Council during the closing session of the South African AIDS conference. Mr Mabuza welcomed the launch of the plan and said the Government was committed to ensuring every public servant provides care with compassion and at the highest possible level of quality. “This is not only a right thing to do, but a fundamental human right,” he said.

Ms Bekele-Thomas noted that South Africa has ratified several international human rights instruments and has a progressive Constitution with a bill of rights, but she said these alone were insufficient to promote and protect the rights of vulnerable and key populations. “Human rights must be respected, protected and fulfilled through the adoption of relevant strategies and implementation plans, by refraining from limiting the enjoyment of human rights, by preventing others from interfering in the enjoyment of human rights, and by promoting human rights awareness,” she said. She also commended the Global Fund for supporting the development of the plan.

The theme of the AIDS conference was “Unprecedented Innovations and Technologies” and it engaged community members, scholars and policy experts in detailed discussion of implementation science and game changing approaches, ranging from PrEP and U=U (Undetectable equals Un-transmittable) to new data on contraception and sub-national data on prevalence and progress on the 90-90-90 targets.

During a visit to South Africa, UNAIDS Executive Director, Michel Sidibé, has warned that the global AIDS response is at an inflection point, at which gains to date could easily be reversed unless urgent efforts are made to reach targets for 2020 and achieve ambitious goals for the decade beyond.

In a meeting with South Africa’s Minister of Health, Aaron Motsoaledi, Mr Sidibé congratulated the country on its progress made to date and encouraged the government to accelerate action to reach ambitious targets that will put the HIV response on a sustainable path to ending the AIDS epidemic by 2030. Mr Sidibé said it was time to fully leverage the power of communities to close the remaining gaps to the UNAIDS 90–90–90 treatment targets. 

In a meeting with the First Lady of South Africa, Tshepo Motsepe, Mr Sidibé encouraged her to use her voice and outreach capacity to empower people who lacked visibility and access to services, particularly emphasizing the importance of adolescent girls to have access top the human papillomavirus vaccine to prevent cervical cancer. 

Ms Motsepe indicated her willingness to engage on national and international issues for the sake of social development. “Health is not simply the absence of disease,” she said. “Some call me the First Lady, some call me the President’s spouse, but whatever you call me I am a social worker for South Africa.”

Mr Sidibé also met with former South Africa President Kgalema Motlanthe and urged him to keep people alert to the serious risks of losing momentum in the AIDS response and especially the need to engage more men in HIV testing and sustained treatment. 

Mr Motlanthe, who is a member of the Champions for an AIDS-free Generation in Africa, expressed his appreciation for the efforts of Mr Sidibé over the course of his career, including as UNAIDS Executive Director. He noted that Mr Sidibé has repeatedly identified and advocated for crucial steps to advance the AIDS response.

“Your timing has always been spot-on,” he said.  

While in Johannesburg, Mr Sidibé addressed the directors of UNAIDS country offices across eastern and southern Africa. He reminded them of the primary purpose of UNAIDS—to serve the needs of people living with HIV and those at risk of infection. As a health organization, he stressed that UNAIDS plays a unique role in advocating for the rights of vulnerable people, engaging strongly with civil society and insisting that nobody should face discrimination for how they live or who they love. 

“UNAIDS is not an organization driven by logistics or materials,” he said. “It is an organization that puts people at the centre.”

“The AIDS response, especially in eastern and southern Africa, offers lessons and approaches to ensure sustainability through political leadership, resource mobilization and community engagement,” he continued.

“With people behind you, you can really make the world better.”

Rise clubs are helping adolescent girls and young women start conversations about HIV and sexual and reproductive health and rights.

Khayelitsha is one of South Africa’s largest townships, situated in the Cape Flats in Cape Town, South Africa.

As is the case in many other communities in South Africa, women and girls in the semi-informal settlement deal with gender inequality on a daily basis, which puts them at higher risk of HIV infection.

Gender inequality is a barrier for adolescent girls and young women to access HIV and sexual and reproductive health services and comprehensive sexuality education. It also places girls at higher risk of gender-based violence.

“There is a lot of crime. The community is not on the girls’ side. The community believes that women must submit to men. Sometimes it is hard for us to speak out,” said a young woman who is a member of the Rise club in Khayelitsha.

“We belittle ourselves to fit in the box that the community puts us in. Girls get raped, kidnapped … there is a lot of violence. “You can do this, you can’t do that”, you are told what to do,” she says.

For most girls, it is difficult to talk to parents, teachers or family members about sex, sexuality and sexual and reproductive health and rights. Young women and adolescent girls face stigma and discrimination, such as being shamed for being sexually active, from nurses in health-care settings when they seek sexual and reproductive health services. While many countries in eastern and southern Africa have signed the Ministerial Commitment on Comprehensive Sexuality Education and Sexual and Reproductive Health Services for Adolescents and Young People in Eastern and Southern Africa and have some sort of policy on comprehensive sexuality education, implementation is still uneven. 

Young women are at higher risk of HIV and other sexually transmitted infections than their male peers or older women.

In eastern and southern Africa, a quarter of the 800 000 new HIV infections in 2017 were among adolescent girls and young women between the ages of 15 and 24 years. Of the 2.17 million adolescents and young people aged 15–24 years in eastern and southern Africa living with HIV, 1.5 million are adolescent girls and young women.

Of the 277 000 new HIV infections in South Africa in 2017, 77 000 were among adolescent girls and young women between the ages of 15 and 24 years, more than double that of their male counterparts (32 000).

Knowledge of HIV prevention ranges from a high of 64.5% in Rwanda to low of 20.37% in Comoros, with South Africa mid-range at 45.8%.

In some countries in the region, adolescent girls and young women are permitted by law to marry at a young age. Early marriages are associated with loss of bodily autonomy, lack of education owing to school drop-out, lack of economic independence and gender-based violence.

Transactional sex contributes to the gender disparity in HIV infection among young people in sub-Sahara Africa.

Evidence shows that transactional sex among adolescent girls and young women is associated with a number of sources of HIV risk, including abuse and violence, alcohol use, having multiple partners, lack of condom use and age-disparate sex.

Rise clubs

Rise is a club for adolescent girls and young women that seeks to build social cohesion, self-efficacy and resilience through allowing adolescent girls and young women (aged 15‒24 years) a space to support each other and undertake projects in the community that help prevent HIV, mitigate its impact and enable safer choices.

Rise helps meet the needs of adolescent girls and young women in terms of building self-confidence and encouraging them to speak out against social ills and helps them to make decisions about their lives.

The clubs were started in 2014 for young people in 15 high-burden districts in South Africa by the Soul City Institute for Social Justice.

“African parents do not talk to us about sex and we are embarrassed to talk to them. I couldn’t speak to my sister so I joined Rise and now I can sit with my girls. Some are older than me and they can give me advice.” —Cinga 

“My parents taught me that the only way to be knowledgeable is to ask questions. When I joined Rise, we’d ask questions for girls who can’t ask for themselves, making life easier for the girls.” —Okuhle

“I could not speak to anyone at home. And then I became the most talkative person. Rise has helped me deal with low self-esteem.” —Lisa

Adolescent girls and young women in eastern and southern Africa need laws, policies and programmes that meet their needs. These include tailored and focused programmes for sexual and reproductive health services and comprehensive sexuality education and on the prevention of unintended pregnancies, gender-based violence and HIV infection.

They must be informed by the principles of gender equality and human rights and should address other socioeconomic issues, such poverty and unemployment.

Having such policies and programmes will not only result in positive health outcomes but will give adolescent girls and young women the opportunity to live their lives with freedom and dignity.

Mandisa Dukashe was nervous before she took an HIV test in 2002. As a nursing student in South Africa, where more than 4 million people were living with HIV at the time, she knew it was possible that she would test positive for the virus. “I was very stressed,” she says. “I kept postponing the test.”

Ms Dukashe had learned about HIV during her university studies, so the staff at the clinic assumed that she was well informed and didn’t need pretest counselling. “They told me I am a nursing student and should know what it entails.”

The test result was positive. Ms Dukashe joined 510 000 other South Africans who became newly infected with HIV in 2002—20% of all new infections worldwide.

When Ms Dukashe was diagnosed with HIV, South Africa had only recently started to roll out treatment and it was five years before she got access to it. It was harder to come by then, with limited medicine formulations that were only prescribed for people falling ill with an AIDS-related illness.

In 2002, South Africa had more than 4 million people living with HIV but fewer than 15 000 people receiving treatment through public facilities. That year the country also recorded more than 190 000 AIDS-related deaths.

The picture today is much improved.

Ms Dukashe and her family featured on the cover of the 2018 UNAIDS World AIDS Day report, Knowledge is power, as living proof that sustained HIV treatment can suppress a person’s viral load and prevent the transmission of HIV to a partner and children. “This can be done by anyone,” she says.

In 2017, there were more than 4.3 million people on HIV treatment and 110 000 AIDS-related deaths in South Africa. Yet there are still miles to go to end the AIDS epidemic by 2030. South Africa continues to rapidly scale up HIV treatment and is determined to reduce annual AIDS-related deaths to 80 000 or fewer by 2020.

Ms Dukashe says it didn’t take long to reconcile herself to her HIV-positive status. She was determined to embrace her status, look after herself and spread the word. She wanted to warn other young people to avoid HIV infection, take a test and seek support if they tested HIV-positive. “After the counselling, I felt so bold and confident and I was ready within a week to go out and tell the world with an intention of raising awareness, in particular among young women and adolescent girls.”

But things were not always easy for her. Ms Dukashe was married when she was diagnosed. “Some people say that HIV can bring you closer, but that wasn’t to be.” They eventually divorced and it took time before Ms Dukashe found love again. “At first, I didn’t want to reveal my HIV status because I knew that it could be an issue, so I focused on my nursing studies. Eventually I fell in love with a guy and I feared he would reject me, but I had to tell him—I cannot live a lie. It took me three months to disclose my status, but to my surprise his response was much better than I hoped. He remains HIV-negative and he is the best husband and father of my children that I could ever ask for. When you have got that kind of support you can live healthily and even forget about HIV.”

Despite the love and support of her husband and family, the weight of living with HIV came flooding back to Ms Dukashe when she and her husband started planning to have children. “When the time came for us to talk about preventing HIV transmission to our children, we needed to think carefully, plan and consult medical experts. That brought it all back for me and I got depressed for a while.”

But help was available, she says. “I got counselling and worked through those feelings and it was all worth it. I now have two wonderful children who were born without HIV. It was my responsibility and also my husband’s responsibility. We got great support and advice.

“Being able to give birth to HIV-negative children was a blessing because I believe if I did not test, my kids could have been born with HIV.”

Ending new HIV infections among children is a high priority for South Africa, with a target of virtual elimination by 2020. Yet despite many years of concentrated effort, 13 000 children acquired HIV from their mothers in 2017.  “It pains me that I could not breast-feed my babies,” says Ms Dukashe. “Because I wanted so hard to prevent them from getting HIV I fed them with formula milk, which made me sad.”

Thanks to improved treatment options, women living with HIV are now encouraged to take HIV treatment for their own health and to avoid their children becoming infected during pregnancy, birth or breastfeeding. All breastfeeding women in South Africa living with HIV and on HIV treatment are encouraged to exclusively breastfeed until their baby is at least six months old.

Ms Dukashe is now working as a project manager for point-of-care HIV testing and quality assurance. She is also a motivational speaker, creating demand for HIV testing and treatment, including among women of child-bearing age and their partners.

“I want to encourage everybody in our situation: there is life after HIV, there is love. People should not think twice about going for an HIV test. It was the best decision I ever made, since I learned what to do to keep myself healthy and prevent transmission to my spouse and children. Thinking twice is not going to change the result.”

“As a healthcare professional, it is important for me to show that I am living positively with HIV and managing it successfully. My experience should encourage others to protect themselves and get tested regularly. If you test positive for HIV, start treatment and get counselling and support so you can keep yourself healthy and protect others. HIV is, unfortunately, a reality for millions of people, but treatment works and we are stronger than HIV.”

Finally, Ms Dukashe has a message for young women: “HIV is invisible. Always use a condom and be wary of older men. Age-disparate relationships are a risk. If you rely on an older partner and try to please them, you won’t be able to insist on using a condom,” she said. “I speak from experience, as someone who faced the same pressures.”

Colour my HIV is an HIV prevention and empowerment campaign led by and focused on young people in South Africa. It was launched on World AIDS Day 2018 in Johannesburg, South Africa.

The aim of the campaign is to create an information platform to debunk myths and misconceptions about HIV in order to reduce HIV-related stigma and discrimination, increase knowledge of HIV by presenting new findings by experts and researchers, promote human rights, advocate for political commitment and accountability by policy-makers and other partners and highlight issues around HIV prevention among young people.

UNAIDS sat down with Sibulele Sibaca, the founder of the campaign, to ask her a few questions.

Question: Describe Colour my HIV in five words

Vibrant. Youthful. Life-changing. Futuristic.

Hopeful in all that we do. We hope that by 2030 we will end AIDS. With Colour my HIV we’re hopeful that young people themselves will change the course of HIV.

Question: What do you want to achieve with Colour my HIV?

Firstly, I want get to a point in South Africa where being HIV-positive is like having any other chronic disease—diabetes, high blood pressure—in that it’s a manageable illness.

Secondly, to change the narrative where people think that when you contract HIV it is a death sentence. It’s no longer that at all. South Africa has one of the most well-implemented HIV treatment programmes in the world. I remember when a very close person in my life contracted HIV, the doctor said, “You should be so glad you got HIV in South Africa. This is the country to be in when you have HIV. In other countries people are still crying for HIV treatment and you have it here; all you have to do is adhere to it.”

Thirdly, the stigma around testing for HIV is that if I test positive I am going to die, so people must know that they will not die when they are HIV-positive. It’s one of the reasons I have called the campaign Colour my HIV. We must own it. We must celebrate how far we’ve come with HIV as a country. Let’s not discriminate or stigmatize, instead we must go out and get tested for HIV.

Question: Why the focus on young people?

Primarily, we were thinking of adolescent girls and young women between the ages of 15 and 24 years, because they are the most at risk of HIV infection in South Africa. In this age group, nine girls contract HIV every hour in South Africa. My question is, how and why? Where are they? What are the circumstances that lead to the moment they contract HIV? Are they hungry? This group can be influenced. The messages planted in their heads are critical, as they are still growing. So, Colour my HIV looks to be that voice of reason, to teach and educate them about why they should get tested, to prevent themselves from contracting HIV.

However, it is difficult to focus on girls in isolation. We can’t solely speak to girls, we have to engage boys as well. Men and boys hardly visit the clinic, test or take medication. They have to be included in the narrative, which is why Colour my HIV focuses on young people in general.

Question: Where do you see Colour my HIV in five years?

In the short term, we are looking to start touring South Africa from April until the next World AIDS Day, going into communities and really just spreading HIV awareness. As HIV is not only an issue on World AIDS Day, we are looking to engage communities on how they can embrace HIV and live in colour.

We actually need to end AIDS by 2030. We have 11 years to go. So, the question is what are we doing now? Hopefully this year we are going to take Colour my HIV countrywide. In the next three years, I want to see it journey from the Cape to Cairo. When they talk about ending AIDS by 2030, I want Colour my HIV to be part of the narrative.

A Tanzanian delegation touring South Africa has stressed the role of political leadership in the AIDS response and noted the importance of matching policies and legislation to the responses to HIV and tuberculosis (TB).

Led by Oscar Rwegasira Mukasa, the Chair of the HIV and Narcotics Parliamentary Committee of the United Republic of Tanzania, the delegation included Tanzanian Members of Parliament and representatives of the Tanzania Commission for AIDS (TACAIDS). Mr Mukasa said political leaders have an important role to play in uniting efforts in the AIDS response and harnessing domestic resources “so that we can stand on our own feet,” during the 13 to 15 February visit.

The United Republic of Tanzania will take over the Chair of the Southern African Development Community (SADC) in August and the parliamentarians indicated they would use that opportunity to engage SADC ministers of health in developing policies on HIV and TB in the region. We need to align policies and legislation with technical programming for HIV and tuberculosis to ensure that we are in synch with the 90‒90‒90 strategy,” Mr Mukasa said.

This was echoed in a meeting with Aaron Motsoaledi, Minister of Health of South Africa, who emphasized the regional nature of the epidemics of AIDS, TB and malaria and called on the United Republic of Tanzania to use its forthcoming leadership role in SADC to advance coordinated policies and actions. Mr Motsoaledi, who is Chair of the Stop TB Partnership board, reminded the delegates of the inextricable linkage between HIV and TB and noted that TB is the biggest cause of death in South Africa and of people living with HIV.

The delegates explored a range of issues, including the multisectoral response in South Africa, legislation, sustainability and service delivery arrangements, including public, private and community service delivery. The study tour included field visits to a community health centre and a medicine-dispensing ATM.

In a meeting hosted by the South African National AIDS Council (SANAC), its Chief Executive Officer, Sandile Buthelezi, told the delegation that HIV is still very much a health emergency. Noting the high burden of drug-resistant TB, he said that South Africa was adopting new treatment options. “South Africa has strong political leadership, yet still more needs to be done to reach our targets,” he said. Mr Buthelezi stressed the importance of engaging civil society and working with government institutions and the private sector to coordinate efforts and ensure that the needs of people at higher risk of HIV infection and people living with HIV are reflected in HIV programmes.

Mbulawa Mugabe, the UNAIDS Country Director in South Africa, noted the considerable success in the region, but said there was a risk of complacency. “People are on HIV treatment for the rest of their lives and we need political commitment to invest domestic resources to sustain prevention and treatment efforts in the long term,” he said.

Leonard Maboko, the Executive Director of TACAIDS, noted that the parliamentarians would use the results of their study trip to strengthen their national response, explore innovative service delivery models and advance a multisectoral approach. “Too often we talk among ourselves: we need to consult others on these issues,” he said.