South Africa

When she was four years old, Selokela Molamodi’s teacher asked the class what they wanted to be when they grew up. While her classmates volunteered more conventional professions, such as nurses, doctors and lawyers, Ms Molamodi’s answer, given with a fiery determination, was, “I want to be Minister of Education.”

Her love for education, and her characteristic fieriness, has stood 19-year-old Ms Molamodi in good stead. Last year she graduated top of her class, having been head girl in both primary school and high school. Armed with an unshakeable self-confidence and her core principles of transparency, honesty and humility, Ms Molamodi has avoided the fate of many young South African women—HIV infection, unintended pregnancy and an abandoned high school education.

She says she has had to deal with the same harsh realities as other young women—financial difficulties, crime, violence, peer pressure, the temptation of “blessers” [older men] and drug and alcohol abuse. Staying in school kept her focused, she explained.

“There are still a lot of misconceptions about HIV among young people. Sex is not talked about openly. Young people are given knowledge about sexual and reproductive health, but they are not given knowledge on how to make a decision about sex,” she says.

In South Africa, 1500 young women and adolescent girls between the ages of 15 and 24 are infected with HIV every week. They accounted for 29% of all new HIV infections in the country in 2017. Research has shown that older men, generally five to eight years older, are mostly responsible for passing on HIV to younger women; once women reach their mid-twenties, they pass on the virus to men their own age.

“There is a perception among young women that we should have a high number of sexual partners when we are young because that is what it means to be free. Then, when we reach our mid-twenties we will leave that life behind and settle down. But girls don’t understand that they don’t have control over these sexual relationships, that their consent doesn’t count,” she says.

To start a dialogue about these and many other issues facing young women, Ms Molamodi started You for You while she was in her final year of school.

“I call it a movement, not an organization,” says Ms Molamodi. “It is about accepting and loving yourself for you. While we can exist as a community and a collective, we must first love ourselves as individuals,” she says.

Ms Molamodi, along with two friends who started the movement with her, have one-on-one mentoring sessions with other young women on issues such as self-esteem, body positivity, sexual and reproductive health and drug and alcohol abuse. She has also organized two events that focused on empowering young women as leaders “so we can rise as young women and stand up against discrimination, together.”

She looks at DREAMS—the initiative led by the United States President’s Emergency Plan for AIDS Relief—as the matriarch of a family of young women like her. In South Africa, DREAMS works closely with She Conquers, a government-led national campaign aimed at empowering young women and adolescent girls to take responsibility for their health.

“DREAMS/She Conquers has provided us with a space to have natural conversations about things that affect us as young women with other young women. It gives us a voice and brings enlightenment to us. For instance, most of the girls I know have tested for HIV, but none of them ever got to talk about it, until DREAMS/She Conquers came to our school,” she says.

“These are the kinds of initiatives that increase the effectiveness of what UNAIDS is trying to achieve,” says Ms Molamodi. “Yes, give girls access to discrimination-free HIV prevention and treatment services and family planning, but also ask for our feedback. Give us education and information and teach us that actions have consequences which are responsible for our progress or regress.”

She says she would like to see conversations about HIV prevention and sexual and reproductive health being brought together more often with those about careers, empowerment and entrepreneurship.

As for her ambition for You for You, “I want to help grow a continent of young women who are confident enough to speak out; who are able to stand up for each other and empower each other. If I have someone say, “I did not give up” then I know I had a purpose; that I was someone’s reason not to give up.”

On World AIDS Day, South Africa launched a multidisease national wellness campaign to accelerate screening and testing for HIV, tuberculosis, sexually transmitted infections and noncommunicable diseases, including hypertension and diabetes. The campaign, known as Cheka Impilo, is a direct response to the call by the President of South Africa, Cyril Ramaphosa, during his first State of the Nation address in February 2018 to initiate an additional 2 million people on HIV treatment by 2020, find 88 000 missing tuberculosis cases annually and screen 7 million people for noncommunicable diseases in the first year.

South Africa has made considerable progress in its AIDS response in the past decade and reported that there were more than 4.5 million people on life-saving antiretroviral therapy by the end of June 2018—20% of all people on treatment worldwide. UNAIDS estimates show that as a result the number of AIDS-related deaths in South Africa has dropped significantly, from 200 000 in 2010 to 110 000 in 2017. However, there were 270 000 new HIV infections in 2017, including approximately 77 000 among adolescent girls and young women aged 15–24 years.

The then Acting President, Deputy President David Mabuza, who is also Chairperson of the South African National AIDS Council (SANAC), urged his fellow countrymen to end gender-based violence and get tested for HIV and seek treatment if HIV-positive. “We will not walk alone. We have always had partners like UNAIDS, the Global Fund and PEPFAR walking with us, side by side, shoulders to the grindstone. We know what unity and struggle is. We are not giving in and we are not turning back,” Mr Mabuza said.

Michel Sidibé, UNAIDS Executive Director, attended the commemoration of the 30th anniversary of World AIDS Day in South Africa to show his support for the launch of the campaign. “Oppression and power imbalances must be reversed. Women and girls must be empowered and harmful masculinities must be consigned to the history books. Our girls and young women deserve a chance to live in a world with dignity and respect and free from violence and HIV,” said Mr Sidibé.

Aaron Motsoaledi, Minister of Health of South Africa, thanked Mr Sidibé for inspiring South Africa almost a decade ago to turn its AIDS response into a success story, characterized by a journey from despair to hope, and from denial to acceptance and to ownership.

Steve Letsike, Deputy Chairperson of SANAC and Chairperson of the SANAC Civil Society Forum, said, “Enough is enough. Patriarchy, sexism, misogyny, homophobia, transphobia and stigma and discrimination must end. We can do better for our people because they matter.”

360HIV harnesses the power of immersive technology to reach young people

GENEVA, 19 November 2018—Ahead of World AIDS Day, which takes place on 1 December, UNAIDS is releasing a series of virtual reality (VR) films focused on HIV testing.

Using the latest technology, the films help to demystify HIV testing. With goggles that viewers can wear for a full VR experience, the aim is to reach young people who may want to know their HIV status but are afraid or worried about taking an HIV test.

In the films, a group of talented young people re-enact several scenarios of a young woman’s journey to find out her HIV status. Going from her home to a local health clinic, the films allow viewers to explore different settings through a 360-degree experience.  

Makhulu Media, a South African production company produced the VR films, with guidance from UNAIDS and the support of Google, the Desmond Tutu HIV Foundation and the Children's Radio Foundation, which were filmed entirely in the township of Nyanga, near Cape Town, South Africa.

“HIV is preventable and treatable but too few young people know their status,” said UNAIDS Executive Director Michel Sidibé. “We hope that this highly engaging tool will help to dispel fears and show the simple steps that people can take to find out their HIV status.”

At the beginning of the project, Makhulu Media organized workshops with young people to discuss their knowledge of HIV, to share their interactions with health-care providers and to describe their experiences while visiting clinics. The next step involved filming non-actors re-enacting scenes between patients and health-care workers. The short films address the fear of a positive test result and HIV-related stigma.

“We wanted to see if immersive virtual reality films could encourage people to take an HIV test and improve relationships between nurses and young people by helping them to step into each other’s shoes,” said Makhulu Media producer Rowan Pybus.

“The data coming back from the study we have commissioned are very positive,” case study researcher and Makhulu Media co-producer Sydelle Willow Smith said. “The youth and health-care workers involved in the film believe that having the films played to people in waiting rooms in clinics would be very useful.”

The films are being rolled out in clinics, schools and communities in South Africa. Despite progress in reducing AIDS-related deaths and in people accessing treatment, new HIV infections in 2017 in South Africa reached 270 000. This is down from a high of 530 000 in 1998, but the country has 7.2 million people living with HIV—the highest in the world. Google Program Manager Sarah Steele believes that the potential for VT to produce positive social impact is enormous.  

“360HIV is a powerful example of how virtual reality can help change the attitudes and beliefs that underlie some of the world’s most urgent social and environmental challenges,” she said.  

A quarter of the 37 million people living with HIV in the world do not know their status. The theme of this year’s World AIDS Day campaign is Live Life Positively—Know Your HIV Status and UNAIDS has prepared a range of communications materials that are now available to download from the UNAIDS website at https://knowyourstatus.unaids.org. All the films and trailers can be found here.

Makhulu Media

Founded in 2004, Makhulu is an award-winning film, photography and creative media agency based in Cape Town, South Africa. Passionate about storytelling, environmental issues, community and the arts, they are among the first to have adopted virtual reality filmmaking in the region. Having pioneered a solar-powered mobile cinema, Sunshine Cinema, to screen educational films, Makhulu subsequently branched out into VR.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The Paris Declaration to end the AIDS epidemic in cities has gained political momentum among city leaders to commit to ending AIDS and to address disparities in access to health and social services. To date, about 300 cities and municipalities around the world have signed the declaration.

Sponsored by USAID through the United States President's Emergency Plan for AIDS Relief, a joint UNAIDS and International Association of Providers of AIDS Care Fast-Track cities project was designed to provide essential and strategic technical support to priority high-burden cities to accelerate the AIDS response and deliver on the commitment of the Paris Declaration. Ten cities, represented by local governments, civil society organizations and development and other partners, gathered in Johannesburg, South Africa, on 2 November to reflect on experiences and lessons learned during the first year of implementation of the project.

In all 10 cities, political leadership of the HIV response has been mobilized and city health departments are actively engaged in leading the response to HIV. In addition, the projects are receiving high-level support from local and national governments, as well as national AIDS councils. In Yaoundé, Cameroon, the project has provided an opportunity to convene partners on a regular basis, under the leadership of the seven city mayors, to improve coordination of activities, address potential overlap and review progress.

The project is contributing to innovation in cities. In Jakarta, Indonesia, concept testing of mobile solutions has identified an effective and relevant approach to reaching young people and a mobile application is being developed to reach young gay men and other men who have sex with men with key messages related to HIV testing, prevention and support.

“Cities present their own unique advantages to building a multisectoral approach to HIV and can benefit from social transformation opportunities associated with a strong AIDS response. Equity, inclusiveness, resilience and sustainability are not only key to a successful health-care strategy, they are also the building blocks to a thriving city,” said Catherine Sozi, Director of the UNAIDS Regional Support Team for Eastern and Southern Africa.

Civil society is actively engaged in the 10 cities. In Kinshasa, Democratic Republic of the Congo, civil society has been active in the implementation of the project, in advocacy meetings with political leaders, national authorities and other partners, on issues related to stigma, discrimination and human rights. The Kigali, Rwanda, team highlighted the support by the project to the strategic outreach activities to provide HIV services to key populations, including distribution of more than 10 000 condoms in three different locations.

“Through the condom kiosk project with the city government, we were able to successfully reach key populations in Kigali,” said Uwase Nadège, Programme Manager of the Kigali Hope Association. “People who access these services trust others from the community, and we see this as a way to meaningfully engage with the government to Fast-Track the response.”

In Durban and Johannesburg, South Africa, the project is receiving high-level political support from local as well as national governments. In Johannesburg, the project will support the establishment of a city AIDS council, with the key goal of coordinating the HIV response in the city.

Durban, Jakarta, Johannesburg, Kigali, Kinshasa, Lusaka, Maputo, Mozambique, Nairobi, Kenya, Windhoek, Namibia, and Yaoundé are the first 10 cities participating in the project.

Ahead of its 43rd meeting in December, the UNAIDS Programme Coordinating Board (PCB) conducted a four-day visit to South Africa between 15 and 18 October. During the visit, the delegates met with a wide range of national and development partners working on the AIDS response and conducted a number of site visits in order to experience the support of the Joint Programme to the national AIDS response in a high-burden country.

South Africa has the largest HIV epidemic in the world, with 7.2 million people living with HIV. In the past 10 years, it has made significant progress in its AIDS response, with 4.4 million people living with HIV on treatment. The country also invests heavily, with approximately 75% of the response funded by the government—just over US$ 2 billion in 2017. However, new HIV infections are high, at 270 000 in 2017.

The PCB delegation, led by the UNAIDS Deputy Executive Director, Gunilla Carlsson, and Danny Graymore, from the United Kingdom of Great Britain and Northern Ireland, the Chair of the PCB, comprised seven representatives of Member States, one civil society representative and a number of participants from the Joint Programme.

“The strength of the UNAIDS Programme Coordinating Board is its unique multistakeholder representation, which includes civil society and United Nations cosponsoring organizations, in addition to Member States,” said Mr Graymore. “The United Kingdom has put a particular focus on prevention for 2019. Coming to South Africa, we wanted to see how to get better results on HIV prevention in the context of a conducive environment and a significant investment in the national response.”

During a meeting with the South African National AIDS Council’s (SANAC) civil society forum, Valeria Rachinska, a PCB delegate from civil society, encouraged members of civil society in South Africa to use their voice in the UNAIDS PCB through the two African region representatives.

“The UNAIDS Programme Coordinating Board is unique in that civil society are members and our voice is heard. We can influence the global agenda in this way. I encourage you to get in touch with your African representatives and make your voices heard,” she said in response to concerns about the financing and sustainability of civil society organizations in South Africa.

During the visit, PCB delegates met with other representatives of SANAC, national and local government, civil society and the private sector and visited community-based initiatives in the KwaZulu-Natal and Gauteng Provinces.

“I am delighted to visit South Africa with such a broad and knowledgeable Programme Coordinating Board delegation. It is clear that the support of the Joint Programme is appreciated and important. We need to focus more on HIV prevention and ensure that we reach people being left behind by the AIDS response and find ways to deliver effective prevention services for young women and adolescent girls,” said Ms Carlsson.

Results from population-based HIV impact surveys provide insight into where investments are needed

AMSTERDAM/GENEVA, 22 July 2018—Cameroon, Côte d’Ivoire, and South Africa have released new survey data on progress towards the 2020 targets. The Cameroon and Côte d’Ivoire population-based HIV impact assessment (PHIA) surveys and the South African survey all studied knowledge of HIV status, new HIV infections, condom use, voluntary medical male circumcision, antiretroviral therapy coverage, viral suppression and other indicators. 

In South Africa, which has the largest HIV epidemic in the world with more than 7 million people living with HIV and the largest treatment programme in the world with 4.4 million people on antiretroviral therapy, the new data combined with similar data from an earlier survey indicate that there has been a 40% reduction in the rate of new adult HIV infections between 2010 and 2017.

“These surveys are incredibly important and play a vital role in helping countries to review and refine their HIV programming to make sure that the right services are reaching people affected by HIV,” said Michel Sidibé Executive Director of UNAIDS.

The survey data confirm UNAIDS estimates which indicate that South Africa has also improved treatment coverage and is very close to reaching the 90-90-90* treatment targets. It found that 85% of people living with HIV knew their HIV status, 71% of people who knew their status were accessing antiretroviral treatment and 86% of people who were accessing treatment had supressed viral loads.

Viral load suppression among all people living with HIV in Cameroon and Côte d’Ivoire however was less than 50% reflecting low treatment coverage. The two countries are far from reaching the 90-90-90 targets at 47%, 91% and 80% and 37%, 88% and 76% respectively.

The largest difference between the southern African country and the two western and central African countries is observed in knowledge of HIV status, indicating that HIV testing services need to be significantly scaled up in west and central Africa.

The PHIA surveys provide key information for identifying characteristics of the populations that are not receiving services. In Cameroon, viral load suppression varied by province from 28% to 63%. In South Africa less than 50% of children and young men (ages 15-34 years) living with HIV had suppressed viral load (compared to 67% among the women aged 15-49). These data will provide critical information to allow programme managers to direct their responses to the populations and locations most in need of services.

The PHIA surveys, were led by Columbia University in collaboration with country governments and supported by the United States President’s Emergency Plan for AIDS Relief. The South African survey was conducted by the Human Sciences Research Council

* 90% of people living with HIV know their HIV status, 90% of people who know their status are receiving antiretroviral treatment, and 90% of people on treatment have suppressed viral loads.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The UNAIDS Executive Director, Michel Sidibé, has completed a five-day visit to three countries in southern Africa. The mission included high-level political discussions, the launch of the Lesotho HIV health and situation room and a frank and open dialogue with women activists about how to address sexual harassment and abuse.

Beginning in Lesotho, Mr Sidibé attended the launch of the HIV health and situation room with the Deputy Prime Minister, Monyane Moleleki. Special guest Naomi Campbell was invited by UNAIDS to join the two-day country visit to learn more about the HIV response.

The Lesotho HIV and health situation room shows real-time service delivery data, producing a comprehensive picture and understanding of Lesotho’s HIV epidemic. It enables quick feedback on results at the national and community levels and identifies bottlenecks in access to health-care services.

“The launch of the Lesotho HIV and health situation room gives us access to data to shape impactful and efficient health programmes. These are the kind of innovations that will bring services to those who need them most and ensure that no one is left behind by the AIDS response,” said Michel Sidibé, the UNAIDS Executive Director.

On the eve of the launch, Mr Sidibé and Ms Campbell visited the Queen II Hospital in Maseru, Lesotho, and met with young women living with HIV and others affected by the epidemic.

“I commend the Government of Lesotho and its partners for the progress made in the AIDS response. But the work is far from done. The reality is that we are not reaching adolescent girls and young women. I leave Lesotho today empowered, inspired, encouraged and determined to do all I can to highlight this critical issue,” said Ms Campbell.

In South Africa, Mr Sidibé addressed the Pan African Parliament and underlined the importance of integrated health approaches that were people-centred. He urged parliamentarians to commit more domestic funding for health services to increase the sustainability of the AIDS response and to put in place more preventative measures to improve people’s health. In addition, he called for laws to protect women and vulnerable groups. 

Mr Sidibé left the parliamentary session to meet civil society activists concerned by UNAIDS' response to allegations of sexual harassment and abuse in the organization.

At a follow-up meeting the next day, Mr Sidibé and women activists met to discuss their concerns.

Mr Sidibé agreed with activists to issue a statement following the meeting. The statement begins:

‘During my recent visit to South Africa, I listened carefully to you, I heard you. The HIV epidemic is inextricably linked to sexual and gender-based violence and the two can never be separated. We need the passion of advocates to move issues forward.`

During his visit to South Africa, Mr Sidibé held separate meetings with the President, Cyril Ramaphosa, the Deputy President and South African National AIDS Council Chair, David Mabuza, and the Minister of Health, Aaron Motsoaledi. They discussed plans to increase the number of people on treatment by 2 million by 2020 and the need to empower local and provincial authorities to bring treatment and prevention services closer to vulnerable communities.

The last leg of Mr Sidibé’s visit saw him arrive in Lusaka, Zambia, to confer the 2018 UNAIDS Leadership Award upon Kenneth Kaunda for his efforts in strengthening the AIDS response.  

People living with HIV and other chronic illnesses are getting faster, simpler access to essential medicines thanks to new medicine dispensing machines being piloted in Johannesburg, South Africa.

The non-profit organization Right to Care is testing three pharmacy dispensing units at a shopping mall and two hospitals. Most of the people using the new machines are accessing repeat prescriptions for HIV medicines.

The machines connect users to pharmacy assistants by video for remote consultations in any of the 11 official languages of South Africa. The entire process, from consultation to the release of the medicines from the machine, takes only a few minutes.  

The machines are integrated with public health facilities responsible for patients with chronic conditions, in order to ensure that patients receive and adhere to effective treatments. The users of the machines get a printed receipt with the date of their next visit and receive a reminder by SMS. The system alerts pharmacists if patients are late to collect their medicines.

The device could be a game-changer for expanding access to HIV treatment. The South Africa UNAIDS Country Director, Mbulawa Mugabe, said, “One of our biggest challenges today in most countries in Africa is that health facilities are packed. We need to find ways in which we can relieve the congestion in the interest of patients themselves and also for the health systems.”

People living with HIV can often wait several hours to have their prescription filled at a local clinic. The process also takes up valuable time for skilled pharmacists. Now those tasks are being handled by junior pharmacists, who work with a robotic system to dispense pills in a matter of minutes.

The pharmacy dispensing units were engineered by Right to Care’s subsidiary Right e-Pharmacy in collaboration with the German company Mach4 and supported by German and American development agencies GIZ and USAID. The current trials are being conducted in collaboration with the Gauteng Department of Health and Right to Care hopes to expand the trial to two other African countries in the near future.

South Africa has the highest rate of HIV prevalence in the world and provides free treatment to 4.2 million people. The President of South Africa, Cyril Ramaphosa, recently set a target of expanding HIV treatment to an additional 2 million people by 2020. With millions of South Africans accessing medicines from clinics and hospitals, innovations such as these dispensing machines promise to help South Africa achieve its ambitious targets.

South Africa tests potential game-changer in HIV treatment

Zaheer Cassim reports for VOA from Alexandra township in Johannesburg.

Jimmie Earl Perry, the first UNAIDS National Goodwill Ambassador for South Africa, has died.

A seasoned singer and performer in theatre productions around the world, Mr Perry was notable for his work in using the creative arts to educate audiences. At the Africa Centre of HIV/AIDS Management at Stellenbosch University, South Africa, he staged HIV educational theatre productions that were performed to more than 3 million people in communities and workplaces nationally and internationally.

At the time of his appointment as UNAIDS National Goodwill Ambassador, Mr Perry said, “If we are to turn this epidemic around, South Africans have to really understand what the virus is, how it is spread, that it is not a death sentence thanks to medical treatment and to put an end to the fear and stigma of living with HIV.”

Michel Sidibé, UNAIDS Executive Director, said Mr Perry’s appointment in 2009 came at a critical time for the AIDS response in South Africa, with far-reaching policy changes announced by the President of South Africa, Jacob Zuma, on World AIDS Day of that year. “I decided to appoint Jimmie Earl Perry as National Goodwill Ambassador because of his capacity to inspire and his willingness to lead and empower others. He had a strong belief in the potential of people to rise above their circumstances and he encouraged the best in everybody he met.”

Mr Sidibé said Mr Perry’s passing was a great loss for the AIDS community. “Jimmie Earl Perry encouraged and inspired my global advocacy and efforts to end the AIDS epidemic as a public health threat by 2030. UNAIDS benefited a great deal from our association with Mr Perry, and we are grateful for his service and dedication. I am humbled and privileged to have counted him as my friend and brother,” he said.