South Africa

More than 50 000 people in eastern and southern Africa received HIV testing and counselling services as part of national campaigns held between 17 and 30 November. On 1 December, World AIDS Day, countries unveiled the number of people tested during the campaigns, which took place in Botswana, Ethiopia, Lesotho, Namibia, South Africa and United Republic of Tanzania.

While the campaigns sought to reach the general population, some countries focused on reaching populations at higher risk of HIV infection, including young people, women and migrants.

Ethiopia held a one-day campaign in Gambella, which has the highest HIV prevalence in the country, at 6.5%, according to the 2011 Ethiopian Demographic Survey. Botswana provided HTC services at 10 testing sites in Maun District, with a special focus on couples and young people. Lesotho undertook a two-week nationwide campaign focusing on young people, migrants, men and traditional healers. Namibia held the testing in Katutura—a township of the capital Windhoek—to reach underserved communities in informal settlements.

Communities, non-profit organizations and national partners supported the campaigns by mobilizing communities, procuring test kits or distributing HIV information materials and commodities. The campaigns also ensured that people who tested positive for HIV were referred and linked to HIV treatment and care services.

The number of people tested during the campaigns reaffirms the strong commitment of countries to accelerate community action and galvanize the active involvement of young people and networks of people living with HIV to end the AIDS epidemic by 2030.

Around 100 representatives of populations at higher risk of HIV infection from 18 countries in eastern and southern Africa are convening in Johannesburg, South Africa, from 17 to 19 November to discuss ways to improve access to HIV services.

Under the theme Close the Gap—Leave No One Behind, sex workers, gay men and other men who have sex with men, transgender people and people who inject drugs will engage in the first regional consultation for key populations in the region. During the meeting, the participants will share experiences and take stock of the remaining challenges.

During the 30 years of the AIDS epidemic, it has become evident that better and faster health outcomes are achieved through smart investment and community-centred systems that leave no one behind, noted UNAIDS Deputy Executive Director Luiz Loures.

People at higher risk of HIV infection contribute to substantial proportions of new HIV infections in some countries in the region. According to the latest Modes of Transmission study conducted between 2008 and 2010, sex workers and their clients, gay men and other men who have sex with men and people who inject drugs accounted for an estimated 33% of the total number of new HIV infections in Kenya, 26% in South Africa and 18% in Mozambique.

Daughtie Ogutu, Africa Coordinator for the African Sex Workers Alliance and a sex worker from Kenya, noted that countries can control the HIV epidemic only when all of its citizens, including people vulnerable to HIV infection, are guaranteed access to comprehensive HIV prevention, treatment and care services.

In the three days of the meeting, communities and development partners will focus their discussion around access to HIV prevention and treatment services, HIV-related stigma and discrimination and strategic information for people at higher risk of HIV infection. 

Oral pre-exposure HIV prophylaxis (PrEP) has been shown to be up to 90% effective in preventing HIV infection among people who take it consistently. However, the United States of America is the only country in which PrEP is licensed and recommended for use within HIV prevention programmes. 

In order to find ways to bridge the gaps between evidence and policy-making processes, UNAIDS, AVAC and WHO organized a meeting during the 2014 HIV Research for Prevention (HIV R4P) conference, which is taking place from 28 to 31 October in Cape Town, South Africa. HIV R4P is the world’s first scientific meeting dedicated exclusively to biomedical HIV prevention research.

Participants

The meeting brought together representatives of ministries of health and national AIDS councils from Kenya, Mozambique, South Africa, Uganda and Zimbabwe, PrEP researchers and participants from research and demonstration sites where PrEP is currently being delivered, funders and drug manufacturers, and HIV activists.

Key messages

• PrEP is being used in several demonstration projects across eastern and southern Africa, covering a wide range of populations, including serodiscordant couples in Kenya and Uganda, sex workers in Zimbabwe and men who have sex with men in Kenya and South Africa.
• In order to be used more widely, PrEP must be part of a comprehensive prevention strategy with associated milestones and success indicators that have been defined with policy-makers. The Kenyan Prevention Roadmap already includes the possibility of PrEP.
• Costs and cost-effectiveness models remain key, as are the selection of populations for which PrEP should be offered and the choice of an appropriate delivery model. The Sisters clinics, which provide a dedicated service for sex workers in Zimbabwe, are acceptable to many sex workers and fit within a government strategy.
• The early stopping of the PROUD PrEP study demonstrates that within the sexual health services of the United Kingdom of Great Britain and Northern Ireland there is a strong demand for PrEP and that it is feasible to identify people at greatest risk.
• Demand is now beginning to grow in African communities and needs to be stimulated among those who would most benefit and would be most likely to use PrEP.
• Policy-makers in health and other government departments need more information on PrEP presented in a way that they can use, as well as opportunities to discuss their specific concerns, for example on PrEP safety studies or measures to improve adherence.
• More needs to be understood about the costing of PrEP. This demands greater understanding of who would use PrEP, how they would use it and where they would access it.

During a fact-finding mission to South Africa with the Elton John AIDS Foundation, UNAIDS International Goodwill Ambassador Victoria Beckham expressed her commitment to raising awareness around women and girls’ vulnerability to HIV.

Ms Beckham met with Sheila Tlou, Director of the UNAIDS Regional Support Team for Eastern and Southern Africa, and was briefed by Ms Tlou about the HIV epidemic in the region and UNAIDS’ support to national AIDS responses. The conversation focused on the various factors driving HIV infection among women, including violence, child marriage, intergenerational sex, human rights violations and traditional practices in eastern and southern Africa. 

Ms Beckham noted that her visits to mothers2mothers project sites and the Ramokgopa Clinic, as well as her close interaction with women and girls in Soweto, helped broaden her understanding of the different challenges affecting communities in South Africa.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

UNAIDS Executive Director Michel Sidibé met with the President of South Africa, Jacob Zuma, on 4 September at the President’s official residence in Pretoria, South Africa. During the meeting, Mr Sidibé congratulated the President on his re-election and praised the government’s leadership in the country’s HIV response.

Mr Sidibé called on President Zuma to support countries affected by western Africa’s current Ebola virus outbreak. The lack of a locally produced serum to respond to Ebola illustrates the need for African research and drug production for this and other diseases affecting the continent, including HIV.

President Zuma and Mr Sidibé agreed that the local production of antiretroviral medicines is critical, as of the 35 million people living with HIV worldwide, 24.9 million live in Africa. South Africa can lead the way and play a critical role in ensuring that all countries have access to cheaper generic drugs.

Mr Sidibé also made a plea to President Zuma to address HIV prevention among populations at higher risk of HIV infection in South Africa, including sex workers and young people, particularly young women and girls.

The First Lady of South Africa, Thobeka Madiba-Zuma, pledged to improve the health of young women and girls in South Africa during a meeting with UNAIDS Executive Director Michel Sidibé on 4 September at the President’s official residence.

Mr Sidibé acknowledged the First Lady’s role in lobbying for a price reduction for the human papillomavirus vaccine and ensuring better access to the vaccine in developing countries. The First Lady works extensively on health issues related to breast and cervical cancer and  HIV, including prevention initiatives for young women and girls.

During his four-day visit to the country, Mr Sidibé also met with the South African Minister of Health, Aaron Motsoaledi, to discuss Africa’s response to the Ebola virus outbreak and the lessons African leaders can learn from the AIDS response. Mr Sidibé said that strengthening health systems and bridging the gap between health systems and the community are critical to addressing the outbreak effectively.

In a round-table dialogue with Mr Sidibé, members of the South African National AIDS Council’s Civil Society Forum reiterated the need to form a stronger and strategic partnership with the Government of South Africa and the critical role that civil society plays in creating demand for the services that the government provides to respond to HIV and tuberculosis. 

UNAIDS and the University of Witwatersrand Reproductive Health and HIV Institute (Wits RHI) have signed a memorandum of understanding (MoU) in order to combine efforts towards ending the AIDS epidemic in eastern and southern Africa. The MoU was signed on 3 September at a ceremony in Johannesburg, South Africa, by UNAIDS Executive Director Michel Sidibé and the Executive Director of Wits RHI, Helen Rees.

UNAIDS and Wits RHI will work with governments and partners to develop and implement a regional strategy on ending the AIDS epidemic, analyse programmatic gaps and increase access to antiretroviral therapy as a preventative measure for people at higher risk of exposure to HIV. They will also work more closely on integrating HIV and tuberculosis services and on developing a regional index on social justice to strengthen advocacy work around human rights and the protection of people living with HIV, populations at higher risk and women and children.  

UNAIDS and Wits RHI will further collaborate on enhancing HIV awareness and prevention education, reducing legal barriers, strengthening social protection for young people and ending gender-based violence.

Now a 19-year-old university student in South Africa, Noxolo Myeketsi started receiving a social welfare grant in 2005. Part of a state-run programme to assist poor households, the cash transfers allowed her to stay in school and her grandmother to buy food and pay their bills.

The grant changed Noxolo’s life for the better. Other girls turned to having sex, often with older men, in exchange for basic needs, and potentially exposed themselves to sexually transmitted infections and HIV.

“I believe that without the grant assistance, I would not have been able to make healthy decisions in my life. Maybe I would have ended up being a sugar daddy’s girl, like others from my area, or ended up contracting HIV,” Noxolo said.

Social protection schemes, including financial incentives, can make a difference in a number of ways. The World Bank reports that, globally, there is strong evidence that cash transfers improve the education, health and lifelong income of beneficiaries. 

“Cash transfer programmes work for HIV prevention and a host of other human development outcomes as well, and they are scalable,” said David Wilson, Director of the World Bank’s Global HIV/AIDS Program.

Studies conducted in South Africa show that small cash grants provided to poor households allow teenage girls to make safer sexual choices and can significantly reduce the number of new HIV infections. When psychosocial care and support are added to the cash, the results for girls are even better.

At the UNAIDS Programme Coordinating Board (PCB) meeting held in Geneva in July a thematic session was organized on addressing the social economic drivers of HIV through social protection, at which Noxolo spoke about the positive impact grants can have.

Following up on the PCB meeting, UNAIDS and the World Bank pledged to assist governments in the process of scaling up social protection programmes, including cash transfers, for HIV prevention in eastern and southern Africa, covering Botswana, Kenya, Lesotho, Malawi, South Africa, Swaziland, United Republic of Tanzania and Zambia.

“It is befitting that South Africa is the centre of the initiative because the country accounts for 23% of sub-Saharan Africa’s new HIV infections, 18% of the global HIV burden and has one of the world largest social protection programmes,” said Benjamin Ali, UNAIDS Country Director for South Africa.

Countries and partners will be urged to collaborate in a comprehensive review of social protection systems. Proposals to make such systems HIV sensitive include modifying age bands and other inclusion criteria to ensure that the groups most affected and at risk of HIV infection are covered, providing some cash directly to girls and young women and linking cash incentives to their adherence to HIV prevention and treatment programmes.