South Africa

Young people are critical to achieving the targets of the 2016 United Nations Political Declaration on Ending AIDS. While young people living with HIV are playing an active role in the AIDS response by providing information, care and peer support, their networks need more support and resources.

To advance efforts to engage young people living with HIV in decision-making on issues that affect their lives, 40 young people from 19 countries representing networks of young people living with HIV met in Cape Town, South Africa, on 19 and 20 June. The Intergenerational Summit for Positive Youth Leadership was held with support from UNAIDS, the Adolescent Treatment Coalition and partners.

The objectives of the meeting included analysing the capacities of networks of young people living with HIV, identifying barriers and opportunities for participation and facilitating a dialogue on how young people living with HIV, and their networks, can be strengthened.

Attending the meeting was Yana Panfilova, a young leader from Teenergizer!, the Ukranian and Eurasian Union of Adolescents and Youth Organizations. She said, “Interruptions and lack of motivation for antiretroviral therapy, discrimination and self-stigma, lack of quality prevention education and barriers to access HIV testing are key challenges faced by adolescents living with HIV in eastern Europe and central Asia.”

Chinmay Modi, a board member representing youth and adolescents in the National Coalition of People Living with HIV in India, said, “Stigma and discrimination remains a key barrier to engaging adolescents and young people living with HIV in the AIDS response.”

While young people are advocating for greater political commitment and action to address the challenges, they are also responding to them through their networks. Moises Maciel, a representative of the National Network of Adolescents and Youth Living with HIV/AIDS in Brazil, said, “The main mission of our social movement is to group, welcome and support adolescents and young people living with HIV. We advocate and take action to strengthen public policies against the stigma and impact of HIV.”

Carlo Andre Oliveras, Coordinator of the Adolescent HIV Treatment Coalition, said, “We see that the majority of work is done by adolescents and young people on a volunteer basis without any financial support and mentorship. This meeting is a start to assess where we are in our movement. Today, the world is facing many challenges; we should not lose sight of the opportunity to make things better.”

“My take-away message from this meeting is that every network can improve their work if we have a more horizontal coordination, if we share our accomplishments and failures, our success and difficulties. I am leaving this meeting feeling empowered, and as soon as I am back in Brazil I’ll use this power to change things for real,” said Mr Maciel. 

Since its establishment in 2003, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has saved millions of lives. In 2016, around 11.5 million people living with HIV had access to antiretroviral treatment through PEPFAR-funded programmes, including 1.1 million children. Nearly 2 million babies born to women living with HIV were born HIV-free, and 6.2 million orphans and other vulnerable children received care and support.

In addition, PEPFAR funding supported more than 11.7 million voluntary medical male circumcision procedures to help prevent HIV acquisition and one million adolescent girls and young women were reached through the DREAMS initiative in 10 countries in sub-Saharan Africa.

And PEPFAR is on track to continue to deliver yet more results. Through a series of consultations over the past three months, PEPFAR has completed planning for its 2017 funding cycle to support more than 30 countries through Country Operational Plans.

The final regional review meeting in the process—which involved around 250 partners, including senior government officials in implementing countries, civil society representatives and multilateral organizations—concluded on 29 April in Johannesburg, South Africa. UNAIDS Executive Director Michel Sidibé addressed the opening plenary meeting, underscoring the vital role of PEPFAR in accelerating country efforts to control their epidemics and advance towards the goal of ending AIDS by 2030.

PEPFAR’s investments in countries supports UNAIDS’ efforts to Fast-Track the response to HIV. The Fast-Track approach focuses on accelerating scale-up of HIV prevention, treatment, care and support for the populations and locations most affected by the epidemic. The development and review of PEPFAR’s Country Operational Plans is a model for transparency, inclusion and country ownership, with senior government officials and people living with and affected by HIV involved in the process.

UNAIDS is a key partner, working closely with countries to leverage PEPFAR investments and accelerate progress towards prevention and treatment targets. Bringing together the diverse technical resources of the United Nations system, UNAIDS helps countries to strengthen data systems, focus national strategic plans, overcome bottlenecks to scale-up, and put in place an enabling policy and social environment for access to services, including by eliminating stigma and discrimination.  

Ahead of the mid-term review of the 90–90–90 treatment targets in 2017, Marc Angel, Chair of Foreign Affairs and Development Committee of the Luxembourg Parliament and UNAIDS Champion for the 90-90-90 targets, undertook a multicountry fact-finding visit to Botswana, South Africa and Lesotho from 17 to 21 April. The visit provided Mr Angel with the opportunity to conduct high-level political advocacy to continue and accelerate momentum towards achieving 90–90–90 by 2020.

The fact-finding visits to southern Africa confirmed the importance of intensifying efforts to increase the proportion of people living with HIV who know their HIV status. In addition, the visits highlighted the central importance of community health workers, both to achieve the 90–90–90 targets and to ensure national preparedness to identify and address emerging health challenges.

What are the 90–90–90 targets?

• By 2020, 90% of all people living with HIV will know their HIV status.
• By 2020, 90% of people who know their HIV-positive status are accessing treatment.
• By 2020, 90% of all people on treatment have suppressed viral loads .

Modelling suggests that achieving these targets by 2020 will enable the world to end the AIDS epidemic as a public health threat by 2030, which in turn will generate profound health and economic benefits

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In each country he visited, Mr Angel met with leaders from government and civil society to witness how 90–90–90 is being adopted in high-burden countries. He also visited numerous health facilities and community-based projects to experience first-hand how 90–90–90 is being implemented on the ground. All three countries have adopted and implemented the World Health Organization guidelines for universal HIV testing and treatment for all people living with HIV and have strong political commitment to reaching 90–90–90. The three ministers of health from each country agreed that community health workers must be the central mode of delivery for 90–90–90.

China and Africa have come together to find new ways of improving access to health care. More than 30 Ministers of Health from across Africa joined the Vice-Premier of China Liu Yandong, and the Chinese Minister of National Health and Family Planning Commission Li Bin at the China-Africa Ministerial Conference on Health Cooperation. The event was held in Pretoria, South Africa on April 24 under the theme China-Africa Health Cooperation, From Commitments to Actions.

The Vice Premier of China talked about the long standing partnership between China and Africa in the field of health care and of China’s commitment to help build the health sector in developing countries and boost efforts for a broader future for China-Africa cooperation in health.

In his address, the UNAIDS Executive Director, Michel Sidibé, outlined three critical initiatives that need to be put in place. He said that, together with the African Union, partners should create a workforce of 2 million community health workers for Africa, learning from the Barefoot Doctors of China organization, which trains people on basic medicine to work in rural areas of China. Trilateral cooperation between China, Africa and UNAIDS should focus on disease surveillance for accelerating action to achieve Sustainable Development Goals 3. He added that UNAIDS will continue to support the scale-up of the local production of medicines and health commodities.

Following his speech, participants signed a five-point plan for China–Africa cooperation on health which focuses on improving access to health-care services through Chinese medical teams working in Africa and by strengthening public health preparedness and capacity-building, particularly through the African Centre for Disease Control. The plan also includes a special focus on key populations, women and young people and urges an increase in training opportunities for African and Chinese people. Increasing China–Africa cooperation, specifically around accelerated action for technology and local production, is also part of the plan.

During meetings with the Chinese Minister of Health, and the Uganda Minister of Health, Jane Aceng, Mr Sidibé emphasized how the China–Africa partnership can go beyond AIDS, to create sustainable solutions for social and economic development in Africa.

South Africa has made great strides in its AIDS response—it has the largest HIV treatment programme in the world, with more than 3.3 million people on antiretroviral therapy, funded almost entirely from domestic sources; AIDS-related deaths have declined by more than 55% since 2005; and around 95% of all pregnant women living with HIV in South Africa now have access to medicines to reduce the risk of transmitting HIV to their child.

South Africa is continually striving to do more to stop new HIV infections and prevent AIDS-related deaths and on 31 March launched its third five-year South African National Strategic Plan on HIV, Sexually Transmitted Infections and Tuberculosis (2017–2022). The plan was launched at a special event in Bloemfontein, the judicial capital of South Africa, by Deputy President Cyril Ramaphosa. The Executive Director of UNAIDS, Michel Sidibé, was present at the event to show his support for the new plan. 

In the plan are a set of bold and ambitious targets which include reducing new HIV infections from 270 000 to less than 100 000 per year, reducing new tuberculosis (TB) infections from 450 000 to less than 315 000 per year and reaching the 90–90–90 targets—whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads—by 2020.

To achieve the targets the government and partners will use a combination of high-impact programmes in the locations and among the populations most affected by HIV. The plan also outlines a special focus on HIV prevention among adolescent girls and young women, who have the highest rates of new HIV infections in South Africa—100 000 young women became newly infected in South Africa in 2015.

South Africa is also stepping up its efforts to treat TB. Most AIDS-related deaths in South Africa are due to TB, and in recent years South Africa has experienced a new epidemic of multidrug resistant and extensively-drug resistant TB. As part of plans to dramatically improve adherence and drug resistance issues, the Minister of Health, Aaron Motsoaledi, recently launched a new nine-month drug regimen to treat multidrug resistant TB. 

The AIDS response in Africa has come a long way and the continent is seeing results in many areas, including the dramatic reduction in the number of babies being born with HIV and an equally dramatic increase in access to HIV treatment. Nevertheless, inequalities in access to health, especially for key populations and adolescent girls and young women, remain a major barrier to ending AIDS as a public health threat in Africa by 2030.

These issues were the focus of a high-level dialogue between the Champions for an AIDS-Free Generation in Africa, a distinguished group of former presidents and influential African leaders, UNAIDS Executive Director Michel Sidibé and civil society representatives in Pretoria, South Africa, on 30 March.

The Royal Commonwealth Society, which promotes the values of the Commonwealth of Nations, has found that 41 of its 53 member states criminalize consensual same-sex relationships in some way. Across these member states, many of which are in Africa, lesbian, gay, bisexual, transgender and intersex people face high levels of discrimination, harassment and violence in their everyday lives. 

Adolescent girls face a higher risk of HIV infection, with those in the age group 15–19 being the only age group for which AIDS-related deaths are increasing in sub-Saharan Africa. In 2015, an estimated 64% of all adolescents aged 15–19 years living with HIV in the region in 2015 were girls.

Participants in the dialogue made it clear that removing barriers that are holding back progress in the AIDS response, such as punitive laws, prosecutions, policies and practices that block access to HIV services, is critical to reaching the people being left behind.

The round-table dialogue was convened by the Champions, the Royal Commonwealth Society, Access Chapter 2, the Kaleidoscope Trust and the African Think Tank on HIV, Health and Social Justice. It is one of the advocacy mechanisms and platforms that these partners will use to respond to these complex issues.

There is strong demand for pre-exposure prophylaxis (PrEP) from many people at high risk of HIV infection, but in many areas it is not yet available. Where PrEP is not available through well-structured programmes, people may seek to obtain it through unofficial channels. Self-prescribing PrEP in this way would result in inadequate follow-up with no linkage to health service support and an increased risk of using substandard products, drug resistance and reduced impact.

South Africa has taken on these challenges and was the first country in Africa to approve the use of antiretroviral medicines for prevention. The country has accessed a generic supply of PrEP, thereby reducing the price of the medicines, and its delivery is integrated with other services.

The South African PrEP model is based on both rights and needs, and is initially intended for sex workers, who have the highest HIV prevalence in South Africa and face high levels of stigma and discrimination. User-friendly services have been designed in partnership with sex workers; however, the decision to use PrEP remains an individual choice, free from coercion.

Adding PrEP to combination prevention services is affordable, despite the costs associated with its roll-out, since those costs are expected to be offset by the savings made from avoiding new HIV infections and the associated benefits of increased contact with sexual health services by people at high risk of HIV infection.

“People ask me “How can you afford to implement new interventions?” and I always reply, “How can we afford not to?” Once you answer this question, you will find the way to work it out,” says Aaron Motsoaledi, South Africa’s Minister of Health.

Mandie Pakkies is shivering outside in her thin black coat on a chilly Durban winter’s night at a truck stop in the suburb of Marianhill on one of the main trucking routes out of Africa’s busiest port. The steady stream of trucks passing by on the highway do not disturb her. She’s actually eager for some of them to pull in for diesel and even a chat. Her job is to encourage truck drivers to take care of their health, and when they park up for the night she invites them into a clinic constructed out of shipping containers at the far end of the truck stop.

“These drivers have such pressing health needs! It’s encouraging to see them come to have their blood pressure taken or want to know their HIV status,” Ms Pakkies said. “I am even teaching them the basics like “drink water”, or “walk 20 minutes to get exercise before you go to sleep in the parking lot.””

The clinic opens in the evenings to coincide with the overnight stop that many truckers make before loading up at the port first thing in the morning. Ms Pakkies, the peer educator, and Thuthuka Xulu, a professional nurse, work side by side welcoming truck drivers and the sex workers from the surrounding streets, who come into the parking lot with the drivers. “We not only provide basic health services, but we test for HIV, tuberculosis and sexually transmitted infections, and of course we distribute a lot of condoms,” said Mr Xulu.

With 2000 trucks passing weekly at the Marianhill site and about 500 trucks parking overnight, the team has plenty to do. Truck drivers come from all over South Africa and neighbouring countries. Owing to their erratic schedules and mobility, truckers face many challenges in accessing basic health services. To respond to these needs and those of the sex workers who work around the truck stop, Truckers Wellness established a network of clinics along the major trucking routes around South Africa. 

The Marianhill Trucking Wellness Centre is one of 22 such clinics in the country within a larger network of trucker outreach projects across the region. This programme, launched in 1999, is funded by the freight industry and truck owners and linked to Department of Health services. In the last five years they have tested more than 10 000 people for HIV, averaging around 30 tests per week.

“We are seeing more people get tested and seek our services,” added Mr Xulu, seated behind a cramped desk covered with folders, a box of surgical gloves and HIV testing kits.

The next step for his centre is to be able to adopt the World Health Organization’s guidelines, so that patients can start antiretroviral therapy immediately if they test positive. Grinning he said, “That will really enlarge the scope of our centre.”

The Deputy President of South Africa, Cyril Ramaphosa, launched an ambitious national campaign to prevent HIV among young women and adolescent girls on 24 June in Pietermaritzburg, South Africa. The campaign will respond to the unacceptably high rate of new HIV infections among young women and adolescent girls in the country.

Almost 2000 new HIV infections occur among young women and adolescent girls (aged 15–24) in South Africa each week, a rate two and a half times that among males of the same age. The name of the campaign – to be determined through a competition among young women and adolescent girls themselves – will be announced at a later date. The campaign, developed with technical support from UNAIDS, UNFPA and other cosponsors, seeks to reduce the interlinked problems of HIV, school dropout, teenage pregnancy and gender-based violence and to maximize health, education and economic opportunities for young women and adolescent girls.

The three-year campaign will focus initially on the subdistricts with the highest incidence of HIV and will increase access to sexual and reproductive health information and services through adolescent- and youth-friendly clinics, the Integrated School Health Programme, community and peer outreach and support and parenting programmes for parents of teenagers and for teenage and young parents.

Special emphasis will be given to keeping young women in secondary and tertiary education. Young women have had a strong voice in developing the campaign, which will remain youth-led. The campaign has been funded through the United States President’s Emergency Plan for AIDS Relief DREAMS initiative, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the German development agency KfW and the national government. 

Antiretroviral therapy to be offered to all people living with HIV as soon as possible after HIV-positive diagnosis

GENEVA, 13 May 2016—The Government of South Africa has announced a major policy shift that will move the world faster towards the global 90–90–90 treatment target. On 10 May 2016, the South African Minister of Health, Aaron Motsoaledi, announced in his Health Budget Vote Speech to the Parliament of South Africa that the country will implement a new evidence-based policy of offering HIV treatment to all people living with HIV by September 2016. This ground-breaking announcement brings South Africa, which already has the world’s largest HIV treatment programme, in line with the latest World Health Organization guidelines on HIV treatment. South Africa is among the first countries in Africa to formally adopt this policy.

South Africa already encourages everyone who is HIV-negative or who does not know their HIV status to be tested for HIV at least once a year. However, instead of having to undergo an additional test of the immune system (the CD4 cell count) to determine eligibility for treatment, people who are diagnosed HIV-positive will be offered HIV treatment as soon as possible after diagnosis.

“South Africa takes another bold step towards ending its AIDS epidemic by 2030, once again demonstrating that scientific evidence, paired with political will, saves lives,” said UNAIDS Executive Director Michel Sidibé.

This major advance comes only months after the government announced that it will provide pre-exposure prophylaxis (PrEP) to sex workers in 10 sex worker programmes from June this year. South Africa is also considering whether to expand the offer of PrEP to prevent HIV in vulnerable young women, based on the lessons learned from demonstration projects.

These combined efforts demonstrate the South African Government’s commitment to maximizing the benefits of antiretroviral medicines for both the prevention and treatment of HIV. This approach has proved to be highly effective in reducing new HIV infections and AIDS-related deaths in high-prevalence settings, such as South Africa.

Provision of HIV treatment for all is estimated to cost an additional US$ 66 million per year and will be paid for by South Africa from domestic resources in this year’s budget.

While much success has been achieved by the country’s HIV treatment programme, with approximately 3.5 million people on HIV treatment today, the number of new HIV infections is unacceptably high, with an estimated 340 000 new HIV infections in 2014.

“The United Nations has a vision to transform the world through the 2030 Agenda for Sustainable Development,” said Mr Motsoaledi. “Ending the AIDS epidemic as a public health threat by 2030 is among the Sustainable Development Goals. The South African Department of Health is committed to this goal and achieving a long and healthy life for all South Africans.”

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.