South Africa

Increasing the resilience of health system infrastructure across Africa was at the centre of discussions at the second China–Africa Health Development Forum, which took place in Cape Town, South Africa, from 4 to 6 October. Discussions resulted in the Cape Town Declaration, which will serve as a blueprint for health as an intrinsic part of development in Africa.

Sub-Saharan Africa accounts for 14% of the world’s population and 24% of the global burden of disease. Thousands of deaths could be prevented by timely access to medicines, including 70% of AIDS-related deaths. During the meeting, the participants agreed that local production of medicines and medical supplies in Africa is limited and health systems need significant strengthening. The UNAIDS Executive Director, Michel Sidibé, reminded participants that in order to end the AIDS epidemic by 2030, Africa needs to explore innovative ways of producing antiretroviral medicines, not only to ensure that more people access HIV treatment, but so that people move from first-line to second-line treatment regimes, which are currently prohibitively expensive.

While there are many challenges, the participants heard that Africa is transforming and presents many possibilities for partnership and investment. The continent is experiencing a rapidly growing economy, with a gross domestic product of US$ 2.4 trillion in 2013, which is expected to climb to US$ 3.3 trillion by 2020. Health-care spending rose from US$ 28.4 billion in 2000 to US$ 117 billion in 2012. The value of Africa’s pharmaceutical industry is increasing steadily and many countries are demonstrating strong political leadership in the AIDS response.

The five focus areas of the Cape Town Declaration are: to develop innovative information and communication technology for health; to build regional surveillance systems; to improve the core capacities of international health regulations; to enhance the use and regulation of traditional medicines; and to focus on public–private partnerships.

The outcomes of the forum will shape the agenda for the upcoming high-level China–Africa Cooperation Summit, which will be held in December 2015, also in Cape Town. 

A new book that tells the inspiring stories of 12 mothers living with HIV and their children born free of the virus has been launched at a community event near Polokwane in Limpopo province, South Africa, on the occasion of National Women’s Day (August 9). The book, Faces of an AIDS Free Generation in eastern and southern Africa, aims to promote the further uptake of mother-to-child transmission (PMTCT) services to help prevent the transmission of HIV to children during pregnancy and early motherhood.

In recent years, there has been a rapid scale-up of PMTCT services in the region that has produced significant results. By the end of 2014, an estimated 88% of pregnant women living with HIV in eastern and southern Africa were accessing services to stop them transmitting the virus to their children. This has resulted in a 60% decline in the number of HIV infections among children between 2009 and 2014, from 230 000 to 93 000.

Despite this progress, there is still work to be done to achieve the targets of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. High levels of gender inequality, including gender-based violence and stigma, continue to make it difficult for many women to access sexual and reproductive health care services.

The book highlights the urgent need to further expand PMTCT services to make pregnancy and breastfeeding safer for women living with HIV, as more than 90% of new HIV infections among children occur when women are inadequately supported during pregnancy and early motherhood.

It also stresses the need for the rapid scale-up of paediatric testing and treatment to prevent AIDS-related deaths among children. Without knowing the HIV status of a child it is impossible for them to receive life-saving treatment. Just 38% of children living with HIV in eastern and southern Africa had access to antiretroviral medicines in 2014. Without treatment, half of all children born with HIV will die by the age of two and the majority will die by the age of five.  

Faces of an AIDS Free Generation in eastern and southern Africa is published with the support of the Swedish International Development Cooperation (Sida) and the Norwegian Agency for Development Cooperation (Norad).

In recent years, considerable progress has been made in eastern and southern Africa to reduce the number of new HIV infections, which decreased by 21% between 2010 and 2014. The region has also made a significant contribution to achieving the global target of having 15 million people on life-saving antiretroviral medicines by the end of 2015, which was met nine months ahead of schedule in March this year. Despite these advances, however, the region still accounts for over half of all new HIV infections worldwide.

New HIV infections among young women and girls aged between 15 and 24 are especially high, with 3700 new HIV infections per week among young women and adolescent girls across eastern and southern Africa. New HIV infections occur five to seven years earlier in young women and adolescent girls compared with young men and boys of the same age. This means that sexual partners of young women and adolescent girls—who are often much older—are themselves a priority population for HIV prevention and treatment programmes.

Another challenge for the region is reaching key populations at higher risk of HIV infection, such as men who have sex with men, people who use drugs and sex workers. These groups are often marginalized due to legal barriers to accessing services or because of stigma and discrimination. In addition, a lack of strategic information or insufficient resources leads to many high impact HIV prevention programmes not being implemented to the necessary standard or scale.            

At a recent meeting in Johannesburg, South Africa, experts from UNAIDS, the United Nations Population Fund (UNFPA) and the World Bank came together to discuss these challenges. Participants agreed that the way forward included customizing UNAIDS global Fast-Track targets to the regional level and re-positioning HIV prevention strategies based on existing evidence.

UNAIDS Fast-Track targets for 2020 include 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status on antiretroviral treatment and 90% of people on treatment with suppressed viral loads, keeping them healthy and reducing the risk of HIV transmission. Other targets include reducing the number of new HIV infections to fewer than 500 000 and reaching zero discrimination.

Those taking part in the Johannesburg meeting also concluded that upcoming forums such as ICASA 2015 (International Conference on AIDS and STIs in Africa) and the 21^st International AIDS Conference 2016 in Durban, South Africa, will be crucial in persuading the international community to invest sufficient resources in HIV prevention programmes.

On Nelson Mandela International Day, 18 July, UNAIDS brought together a small group of artists for a joint visit to South Africa to raise awareness about HIV among young people.

The grandsons of Nelson Mandela, Ndaba and Kweku Mandela, joined the group, which included North American actress and singer Zendaya and Norwegian musical duo Nico & Vinz.

The group met with young people living with HIV to learn about the challenges they face on a daily basis to access HIV and other health-related services. They also visited several HIV programmes and witnessed how a community-led health programme is providing HIV services in Mthatha, Eastern Cape, near the birthplace of former President Mandela.

HIV is the number one contributor to adolescent mortality in Africa. Discrimination, poverty, inequalities and harsh laws often prevent adolescents from seeking and receiving HIV testing, health care and support. Too many adolescents do not get tested for HIV or receive counselling, especially adolescents at a higher risk of HIV infection and the most marginalized adolescents—adolescent girls, adolescent males who have sex with males, adolescents who inject drugs and sexually exploited adolescents.

The visit gave the group an insight of the importance of removing barriers to access HIV testing and the participants had the opportunity to engage with the ProTESTHIV initiative, which promotes HIV testing.

The need for a holistic approach to HIV prevention among young women and girls was the focus of the 15th Ordinary Assembly of the Organization of African First Ladies, (OAFLA). The meeting was held on the side lines of the 25th African Union Summit, held on 15 June in Johannesburg, South Africa. 

The African First Ladies stressed that addressing the needs of young women and adolescent girls must be a priority at all levels of society—from the highest political leadership to schools, families and community leaders. They called for an integrated approach to HIV prevention, treatment and care that addresses all socio-economic and structural drivers which place young women and adolescent girls at a higher risk of HIV infection, including poverty, gender inequality and harmful cultural practices.

Lordina Mahama, First Lady of Ghana and newly-elected President of OAFLA, encouraged all African First Ladies to ensure that the UNAIDS and UNICEF All In! campaign, which focuses on ending adolescent AIDS, is rolled out in their countries.

African Heads of State and Government reaffirmed their commitment to provide bold leadership for the AIDS response in Africa during the AIDS Watch Africa (AWA) meeting held on 14 June on the side lines of the 25th African Union Summit in Johannesburg, South Africa.

The need to invest in health, particularly for the sustainable financing of Africa’s massive HIV treatment programme, came under the spotlight. Participants stressed that, in order to end the AIDS epidemic as a public health threat by 2030 in Africa, it is critical to expand treatment coverage and ensure that the millions of people in Africa currently receiving antiretroviral treatment continue to have uninterrupted access for the rest of their lives. Furthermore, investing in local production of antiretroviral medicines, increasing domestic spending and continuing to implement the African Union Roadmap on shared responsibility and global solidarity for AIDS, Tuberculosis and malaria response in Africa were highlighted as key elements to achieve the 90-90-90 targets.

UNAIDS Executive Director, Michel Sidibé, urged African leaders, the AU Commission, representatives of regional economic communities, development partners and civil society present to ensure that the significant investment that has already been made is not lost.  

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) at the University of KwaZulu-Natal has been designated as a National Research Foundation Centre of Excellence for HIV prevention by the South African Department of Science and Technology. The announcement was made on 14 April at the opening of the annual CAPRISA Scientific Advisory Board meeting, held in Durban, South Africa.

CAPRISA, a UNAIDS Collaborating Centre for HIV Research and Policy, has been recognized for its pioneering work in cutting-edge research as well as for its training programme for doctoral and medical students.

Speaking at the opening of the meeting, Luiz Loures, Deputy Executive Director of UNAIDS, emphasised the critical role CAPRISA plays in global efforts to end the AIDS epidemic by 2030.

The need to find new ways to prevent new HIV infections among young women and girls between the ages of 15 and 24 in South Africa emerged as a clear priority during the meeting, since they remain at a much higher risk of HIV infection than boys and young men of the same age group. The participants agreed that scientists have a key role to play in understanding and addressing the gender gap, in partnership with government and civil society. 

Established and emerging scientists from around South Africa presented innovations in HIV and tuberculosis-related science at the meeting that will provide a direction for current and future scientific research led by CAPRISA.

At a press conference, CAPRISA also announced that Nobel Laureate Françoise Barré-Sinoussi, was appointed to its Scientific Advisory Board for a three-year term. Along with fellow board members, she will guide and advise CAPRISA on research ideas and plans.

The Champions for an AIDS-Free Generation in Africa—a distinguished group of former Presidents and influential African leaders—hosted a dinner in Johannesburg, South Africa, on 13 April to celebrate the role played by partnerships in ending the AIDS epidemic.

The evening included speeches to welcome five new Champions, a powerful contribution from a mother living with HIV and a special musical performance from Loyiso Bala, UNAIDS National Goodwill Ambassador for South Africa. Private sector representatives also pledged their support to move forward with the Champions. 

Champions who attended the dinner included Festus Mogae, former President of Botswana and Chairperson of the Champions, Kenneth Kaunda, former President of Zambia, Alpha Oumar Konaré, former President of Mali, and Kgalema Motlanthe, former President of South Africa.

The dinner came at the end of the first of three days of meetings and talks between the Champions and their partners to mark a strengthened commitment to ensuring that all children are born free from HIV and that both children and mothers living with HIV have access to life-saving treatment. During the day, the Champions also announced that they are extending the scope of their work to cover adolescents and HIV.

Partners attending the three day-meeting include UNAIDS, the South African Development Community (SADC), the SADC Parliamentary Forum, the Economic Community of West African States and the South African Broadcasting Corporation) Foundation. 

An HIV testing and counselling campaign in Botswana, South Africa and United Republic of Tanzania has set a new Guinness World Record by testing 4367 people over an 8-hour period.

Teams worked across 20 testing sites in Maun District, Botswana, Dar es Salaam, United Republic of Tanzania, and Gauteng and KwaZulu-Natal provinces in South Africa. The campaign, which was intended to increase the number of people aware of their HIV status and, if necessary, refer people to HIV treatment and care services, broke the previous Guinness World Record, which was held by Argentina.

In 2013, there were around 1.1 million new HIV infections in eastern and southern Africa. Although HIV prevalence among young women aged 15–24 in eastern and southern Africa was about 40% lower in 2013 than a decade ago, HIV prevalence remains high among this age group—an estimated 3.7% in 2013—about twice that of young men.