South Africa

President of the United States of America, Barack Obama speaking with Archbishop Desmond Tutu during his visit to the Archbishop Desmond Tutu HIV Foundation (DTHF). Credit: DTHF

The President of the United States of America, Barack Obama stressed the feasibility to achieve an AIDS-free generation during his visit to the Archbishop Desmond Tutu HIV Foundation (DTHF) Youth Centre based in Cape Town, South Africa. President Obama toured the Foundation on 30 June as part of an official three-country visit to Africa—Senegal, Tanzania and South Africa.

“We have a possibility of achieving an AIDS-free generation and making sure that everyone in our human family is able to enjoy their lives, raise families, succeed and maintain their health here in Africa and round the world,” said President Obama.

Founded in early 1990s the DTHF provides HIV and Tuberculosis prevention, treatment, research and training as well as management services to communities of the Western Cape, particularly residents of townships who are at high risk of infection.

Its youth centre—opened in 2011 with help from several private sector and international partners including the United States President’s Emergency Plan for AIDS Relief (PEPFAR)—offers health services, life skills, and educational support to more than 2 000 registered young people.

“Thank you to the American people for the contribution that PEPFAR has made in our struggle against TB, HIV and malaria, not just here but in other parts of Africa,” said Archbishop Tutu. “Here in Africa we speak of ‘Ubuntu’—we say a person is a person through another person.”

In recent years, South Africa, which has the world’s largest HIV epidemic, made remarkable progress in its response to AIDS.  In 2011, South Africa recorded a 41% reduction in new HIV infections since 2001. The scale-up of HIV treatment programmes in the country enabled more than 2 million people living with HIV to access life-saving treatment and care services in 2012. And between 2009-2012, new HIV infections among children declined by 63% in the country.

“South Africa has faced a heavy burden from HIV but the great news is that the country is now leading the way in caring for its citizens—paving the way for a brighter future for South African people,” said President Obama.

A general view of the panel during the Symposium held at the University of KwaZulu Natal School of Medicine in Durban, South Africa. Credit: UNAIDS/A.Debiky

When doctors from the University of Mississippi medical centre announced on 2 March 2013 that a baby had been ‘functionally cured’ of HIV, the world hailed the news as a historical medical breakthrough.

The baby—famously known as the ‘Mississippi baby’—was born with HIV and treated with aggressive antiretroviral drugs 30 hours after birth. Now, more than two years old, doctors confirm that the baby has not taken any medication since the age of 18 months and tests show no sign of re-active HIV (detectable viral load).

From the time that this extraordinary news was announced scientists and researchers have been busy trying to understand how the ‘Mississippi baby’ case could advance future research in preventing mother-to-child transmission of HIV.

More than 20 scientists, researchers, public health practitioners, donors, government authorities, representatives of non-government organisations and civil society came together for a two-day symposium on 3-4 June under the theme Scientific advances from ‘Mississippi baby’: Implications for public health programmes on mother-to-child transmission of HIV.

“This meeting is about giving people hope,” said UNAIDS Executive Director, Michel Sidibé. “The Mississippi miracle has to become a Durban miracle, a Bamako miracle, a miracle for all children irrespective of where they are born.”

Organised by UNAIDS and the Centre for the AIDS Programme of Research in South Africa (CAPRISA), the symposium focused on 1) whether programmes to stop new HIV infections among children need to be reformulated to promote early identification and treatment of babies at risk of HIV infection and 2) challenges associated with stopping new HIV infections among children and paediatric antiretroviral treatment.

Despite the 24% drop in new HIV infections in children since 2009, some 330 000 children around the globe were born with HIV in 2011. Most children born with HIV (more than 90%) are in sub-Saharan Africa.

Many African countries have made remarkable progress in preventing mother-to-child transmission of HIV by increasing access and integrating HIV prevention, treatment and cares services to mothers and their new-borns. AIDS-related deaths among children in the 22* priority countries of the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive also reduced from 243 000 in 2009 to 203 000 in 2011

However, progress in expanding access of antiretroviral therapy to children has been minimal. The percentage of children living with HIV  eligible for treatment and who were receiving it in 2011 largely falls below 50% in at least 15 of the 22 priority countries—8% in Chad, 19% in Ethiopia and 29% in Malawi.

“Paediatric treatment and care lags behind; there seems to be a disconnect between investments in programmes to stop new HIV infections in children and for children in need of treatment. Even when the infants are identified they are not successfully linked to care,” said Dr Chewe Luo, UNICEF Senior Advisor on AIDS. 

The ‘Mississippi baby’ case was discussed at great length highlighting the need for early infant diagnosis and initiation of treatment. “The relevance of the ‘Mississippi baby’ to the general population remains unclear and more research, including for safe and appropriate neonatal drugs needs to be done before we push for widespread change in policy,” said Dr Hanna Gay, Associate Professor at University of Mississippi, who treated the ‘Mississippi baby’. “But one thing we can be certain of is that early diagnosis and treatment saves lives.”

At the end of the two-day discussions, participants made several recommendations, including the need for early infant diagnosis, better research and improved medicines for children as well as more efficient funding mechanisms to strengthen mother and child AIDS programmes.

“What we do know is that early diagnosis of HIV and early treatment of infants and children does lead to better outcomes – regardless of the issue of a cure. We should be concerned that we are not diagnosing and treating children early enough. In South Africa only 65% of children who are in need to treatment are on treatment,” said Dr Aaron Motsoaledi, Minister of Health of South Africa.

During a meeting with UNAIDS Executive Director, Michel Sidibé, the Premier of KwaZulu Natal, Dr Zweli Mkhize highlighted that progress made in the province has begun to turn around the AIDS epidemic in the South African Province which has been most affected by HIV.

KwaZulu Natal has made remarkable progress in expanding access to antiretroviral treatment as well as in reducing new HIV infections. From 2011 to the beginning of 2013 more than 300 000 men have undergone medical male circumcision decreasing their risk of HIV infection. Although it remains high, the overall HIV prevalence among 15-24 years old dropped from 31% in 2009 to 25.5% in 2011.

Mr Sidibé applauded the Premier for his personal vision and leadership in the implementation of decentralised HIV prevention, treatment and care programmes that have yielded visible results. He noted that, if current efforts are expanded, KwaZulu Natal can be on-track to reach the targets set out in the 2011 United Nations General Assembly Political Declaration on HIV/AIDS.

Despite these gains, KwaZulu Natal remains South Africa’s most affected province with an antenatal HIV prevalence of more than 40% in two of its districts and more than 1.6 million people living with HIV in 2011.

According to Mr Sidibé, if South Africa is to achieve real progress, the national AIDS response should continue with its current approach of integrating political and traditional leadership, scientific researchers and active engagement of communities.

UNAIDS Executive Director Michel Sidibé and Dr Sibongiseni Dhlomo, Member of the Executive Committee for Health in KwaZulu Natal met on 3 June on the side-lines of the UNAIDS/CAPRISA Symposium: Scientific advances from the ‘Mississippi baby’: Implications for public health programmes on mother to child transmission of HIV taking place in Durban, South Africa.

Mr Sidibé applauded the bold leadership that transformed the province from being the HIV epicentre in South Africa to an innovator in turning the epidemic around.

In recent years, KwaZulu Natal, through strong political commitment and effective HIV programmes, managed to ensure that more than 600 000 people in need of antiretroviral treatment had access in 2012, compared to just over 36 000 in 2005. The rate of mother-to-child transmission of HIV at six weeks declined to 2.1% in 2012 compared to 22% in 2005. The life expectancy in KwaZulu Natal has increased from 56.4 years in 2009 to 60 years in 2011, which is highly attributed to a decrease in AIDS-related deaths.

Dr Dhlomo said he was humbled by the recognition and support his province has been gaining for the successful outcomes in the AIDS response. He acknowledged that the government would need to invest more on HIV prevention services including behaviour and social change programmes. In 2012, the province spent 73% of HIV funds on treatment and care services and only 5% on preventing sexual transmission of HIV.

Young participants at the UNAIDS workshop. Credit: UNAIDS

Young people in South Africa are facing the challenge of creating a movement to overcome the impact that the AIDS epidemic is having on their lives.

Issues such as intergenerational and transactional sex, substance abuse and high rates of teenage pregnancy are just some of the many factors that put young people at even higher risk of HIV infection than people in other age groups.

Recently, UNAIDS brought to Johannesburg, South Africa, young people from around the country to discuss ways to effectively empower youth to take the lead in the response to AIDS. The base for the discussion was the application of the CrowdOutAIDS Strategy—the UNAIDS Secretariat’s youth-led policy recommendations—in the context of South Africa.

“The UNAIDS CrowdOutAIDS Strategy puts the focus on youth. In the strategy, young people are part of the process in terms of involvement and engagement,” said Bruce Dube, Managing Director of Youth Village, an online portal for youth. “Every young person has a contribution to make, not just at a high level. Young people have the power to effect change in their own communities,” he added.

The elimination of existing high levels of stigma and discrimination, increase availability of youth-friendly HIV services and facilities, and the creation of opportunities to develop youth–driven solutions were identified as the key elements for the young South African activists to act upon.  

“It was clear from the discussions at the workshop that young people are eager to create spaces where they can gather and create dialogue not only about the challenges, but importantly, what solutions lie in their hands,” said UNAIDS Country Coordinator, Dr Catherine Sozi.

Participants in the workshop explored ways to strengthen community mobilization and political advocacy led by young people to scale up the demand and supply of HIV services for all young people regardless of HIV status, sexual orientation or gender identity. The young activists also strengthened their skills for effective leadership at national and provincial levels. They also had an opportunity to brainstorm ways to gain access to HIV-related information, especially through digital technologies, and forge strategic networks among themselves and their respective youth organizations. The workshop will lead to the development of an action plan, using the CorwdOutAIDS Strategy to guide future activities.

“HIV activism is not part of the youth lifestyle—we need to change that and incorporate it into all facets of our lives,” stressed Mr Dube. 

UNAIDS Executive Director Michel Sidibé joined health leaders from Africa and other international organizations to support a new push to accelerate progress against tuberculosis and HIV. The initiative was unveiled at a press briefing in Johannesburg, South Africa on 20 March and will be formerly launched on 21 March in Mbabane, Swaziland.

The initiative includes a package of new investments worth more than US $120 million which will be used to expedite progress against TB and HIV in the next 1000 days. The initiatvie will work with South African Development Community (SADC) countries to achieve the international targets of cutting deaths from TB and HIV-associated TB by half by 2015.

Mr Sidibé and other health leaders will sign the Swaziland Statement in Mbabane at tomorrow’s formal launch of the initiative.

Study confirms the urgent need for rapid and wide-scale roll out of antiretroviral therapy to communities which have been most affected by the epidemic.

The full results of a study on the effects of antiretroviral therapy in preventing new HIV infections have been published this week in the journal Science. The study, led by Professor Frank Tanser from the Africa Centre, spanned a seven year period (2004-2011), and followed nearly 17 000 people, the largest ever study completed at a population-level in a rural sub-Saharan African setting.

It was conducted in the sub-district of Hlabisa in the rural Province of KwaZulu-Natal, South Africa. The rolling hills of KwaZulu Natal are perhaps one of the most beautiful places on earth but it is also an area which has been particularly affected by the AIDS epidemic. KwaZulu Natal has one of the highest HIV prevalence rates in the world––one in four people over the age of 15 are living with HIV.

The province of KwaZulu Natal has been widely acknowledged as leading a strong provincial response to HIV. In Hlabisa for example, by mid-2012 the Hlabisa HIV Treatment and Care Programme had rolled-out antiretroviral treatment to more than 20 000 people across the area.

The 16 667 participants enrolled in the Professor Tanser’s study did not have HIV at the start of the trial and were regularly tested on average every two years. By the end of the study period 1 413 people had become infected with HIV. The people who tested HIV positive were offered antiretroviral therapy when they became eligible for treatment under national South African guidelines. Initially, adults with a CD4 count of <200 were offered treatment, this was extended to people with CD4 counts of <350, pregnant women and TB patients by April 2010.

What the study found was that the risk of acquiring HIV declined significantly if a person was living in an area where antiretroviral coverage was highest. For example in the areas where treatment coverage was between 30%-40% of all people living with HIV (which corresponds to about 60% of people eligible for treatment under current guidelines) people were nearly 40% less likely to become infected with HIV than in communities where coverage was much lower, at less than 10%. These results are yet further confirmation of the enormous impact antiretroviral therapy could have on morbidity, mortality and new HIV infections if access to treatment was scaled up to full impact levels in populations most affected by HIV.

"This study is extremely significant. It is another piece in the puzzle that shows how treatment keeps people healthy and productive, and at the same time significantly reduces the likelihood to transmit the virus,” said Bernhard Schwartlander, Director of Evidence, Innovation and Policy at UNAIDS. “This large scale population based study, the first in a hyper epidemic region in Africa, delivers powerful evidence that treatment is prevention and is an essential part of our combination prevention tool kit.” 

Concerns relating to the uptake of testing and treatment, retention, adherence, the development of drug resistance and other factors such as the capacity of health systems to deliver antiretroviral therapy have been long-debated, particularly since the findings of the HPTN052 trial were announced in 2011. The HPTN052 trial gave rise to great optimism amongst the HIV community––it showed that if a person living with HIV adheres to an effective antiretroviral regimen the risk of transmitting the virus to their uninfected sexual partner could be reduced by 96%. However larger, population based studies were yet to confirm how these findings apply to community settings.

While it is not unexpected that such a large scale and longer term population level study would pack the percentage punch of the HPTN052 trial, what it lacked in percentage points it made up for in the sheer scale and depth of the trial. What it has done is to bring us one step closer to finding out the true potential of antiretroviral therapy and the enormous impact it could have on preventing new HIV infections in real settings where HIV is part of daily life.

It has given further confirmation of the urgent need for rapid and wide-scale roll out of antiretroviral therapy  to communities which have been most affected by the epidemic. And it has given yet another strong reason for countries to keep their commitments and meet the targets set out in the 2011 United Nations General Assembly Political Declaration on HIV/AIDS––to scale up access to treatment to reach 15 million people by 2015––and to halve the numbers of sexually transmitted HIV infections by 2015.

Dr Olive Shisana, Chief Executive Officer, HSRC and Professor Sheila Tlou, Director, UNAIDS Regional Support Team for Eastern and Southern Africa signing the memorandum of understanding. 30 January 2013.

UNAIDS and the Human Sciences Research Council (HSRC) have signed a memorandum of understanding to strengthen research, policies, and programmes on HIV prevention globally, with a special emphasis on Africa.

“This partnership is a unique opportunity for UNAIDS to consolidate strategic information on the AIDS epidemic and realise our common vision of zero new HIV infections, zero AIDS-related death and zero discrimination,” said Professor Sheila Tlou, Director, UNAIDS Regional Support Team for Eastern and Southern Africa.

Objectives of the collaboration include developing evidence-based HIV prevention strategies and building capacity at the national level to develop more efficient HIV policies and programmes as well as to improve programme monitoring, evaluation and reporting.

“We are pleased that the HSRC’s credibility in HIV research is recognized and that we are able to make a contribution to this global effort,” said Dr Olive Shisana, Chief Executive Officer, HSRC. “It is indeed a great honour and opportunity for the HSRC and we look forward to this collaboration.”

Based in South Africa, HSRC is a statutory research agency focusing on social sciences. It aims to serve as a knowledge hub that bridges the gap between research, policy and action through partnership with several key constituencies including government, universities, NGOs, and donor and development organizations.

South Africa’s President Jacob Zuma at the New Partnership for Africa’s Development meeting held on the side-lines of 20th African Union Summit in Addis Ababa, Ethiopia on 26 January 2013. Credit:UNAIDS/J.Ose

South Africa’s President Jacob Zuma called on African leaders to effectively deal with HIV and as such eliminate one of the main causes of maternal deaths on the continent.

Addressing the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA), President Zuma was one of more than 15 Heads of State and policy makers who participated in the High-Level Meeting. The African leaders reviewed past successes and future opportunities for reducing maternal and child mortality in Africa.

“HIV still contributes to about 40% of maternal and child deaths in South Africa. This means that unless we deal decisively with HIV we will not be able to reduce maternal and child mortality to any significant extent,” said President Zuma.

He declared that the extent of the HIV epidemic and decreasing donor funding makes it imperative for Africa to develop its local capacities to produce antiretrovirals for HIV treatment as well as male and female condoms.

“We need to ensure that we can sustain the gains that we have made as reported in the 2012 Global AIDS Report prepared by the UNAIDS, and that we are able to expand access to commodities like condoms and medicines and antiretrovirals,” underscored President Zuma.

Speaking alongside President Zuma, the outgoing Chair of the African Union and President of Benin, Dr Thomas Boni Yayi said thanks to incredible leadership, African countries have turned the story of AIDS from tragedy to hope.

Dr Boni Yayi said “breakthroughs in prevention and treatment have been rolled out, contributing to achievements in several countries.” But he said, “Despite these gains, AIDS is far from over and complacency and competing priorities meant that “we must remain vigilant and committed today, more than ever”.

Benin’s President also pointed to the initiative Roadmap on Shared Responsibility and Global Solidarity, adopted by the African Union in July 2012 as a response to the challenge. “Our Roadmap on Shared Responsibility and Global Solidarity is a new course for our Continent’s response to AIDS, TB and malaria,” said Dr Boni Yayi. “It optimizes the returns from AIDS investments, boosts capacity on the African continent to manufacture essential quality-assured medicines, strengthens mutual accountability and enhances governance.”  

According to the World Health Organization’s report, “Trends in Maternal Mortality”, Africa has reduced maternal mortality by 41% and mortality of children under the age of five by 33% between 1990 and 2010.

The Chairperson of the African Union Commission, Dr Nkosazana Dlamini-Zuma emphasized that as Africa celebrates its progress, it must also reassess the persistent challenges to find comprehensive solutions. “We need to adopt an integrated approach to reducing maternal, new-born and child mortality within the overall continuum of care,” she said. “The impact of our combined efforts shall be much greater than the sum of our individual efforts.” 

In May 2009, the Conference of Africa Union Ministers of Health launched CARMMA under the theme of “Universal Access to Quality Services: Improve Maternal, Neonatal and Child Health”; with the slogan “Africa cares; no woman should die giving life.” 37 countries have implemented the initiative at a national level, galvanising high level political commitment, country ownership, and social mobilization for maternal, new-born and child health issues in Africa.

The meeting took place on the side-lines of the 20^th African Union Summit held in Addis Ababa, Ethiopia where the United Nations Secretary-General Ban Ki-moon addressed the opening.

Ending AIDS in Africa

Mr Ban commended the incredible leadership that enabled Africa to make tremendous progress in reducing new HIV infections and AIDS-related deaths. He said the progress was due to “good policies, strong leadership and global partnerships as well as scientific advances,” and he added, “The UN will continue to support you as we work for an AIDS-free generation, especially by ending HIV in new-borns.”

UNAIDS Executive Director Michel Sidibé meets with President of Benin, Dr Thomas Boni Yayi, and Vice President, Africa, World bank, Makhtar Diop, at the 20th African Union Summit in Addis, 27 January 2013. Credit: UNAIDS/J.Ose

Africa has made remarkable progress in the AIDS response. According to the UNAIDS World AIDS Day 2012 Report, new HIV infections dropped by 50% in 13 countries across Africa. The number of children newly infected with HIV, in sub-Saharan Africa fell by 24% between 2009 and 2011.

While acknowledging Africa’s gains towards the Millennium Development Goals (MDGs), Mr Ban raised his concerns over the remaining challenges. “I am still concerned about the hundreds of millions of Africans living in poverty,” said Mr Ban. “We must accelerate our efforts as we near the 2015 deadline.”

He called on African leaders to participate in the Special Event on the Millennium Development Goals at the United Nations General Assembly in September 2013, where world leaders convene to deliberate on MDG targets and the Post 2015 development agenda.

Delivering on Africa’s commitments

The opening of the AU Summit was preceded by the NEPAD Heads of State and Government Orientation Committee (HSGOC) Meeting. Addressing the meeting, NEPAD’s Chief Executive Officer Dr Ibrahim Mayaki stressed the need for continued advocacy for mutual accountability and the fulfilment of past commitments by development partners in Africa. “We are engaging the African Union Commission and UNAIDS on an Accountability report to combat HIV and AIDS, Tuberculosis and Malaria under the G8-Africa framework for 2013,” said Dr Mayaki.

UNAIDS Executive Director, Michel Sidibé, shares a moment with Florence Ngoqo, left, and Thabang Lebese’s 101-year-old maternal grandmother, right.
Credit: UNAIDS/M.Safodien

Thabang Lebese was a little boy who grew up in Orlando East, Soweto. From an early age he could kick a ball—dazzling his family with his talent on the pitch. It didn’t take long before he was given the opportunity to join one of the major football clubs in South Africa and by the age 15 he was playing for the Kaizer Chiefs’ junior team.

Thabang played 279 Premier Soccer League (PSL) games in his 13-year long career. He was one of a handful of players to have played for the big teams: Chiefs, Orlando Pirates and Moroko Swallows. He was a much-loved and celebrated player and people today still remember him for his trademark victory dance after scoring a goal.

Then, in early February 2012, Thabang was admitted to Helen Joseph Hospital complaining of a ‘stiff neck and terrible headache’. Days later—on 12 February 2012—he died. Two weeks after his death his family publicly disclosed that Thabang had died of an AIDS-related illness.

“By doing so we wanted to stop the gossip and the whispering. We wanted people to know so that there could be no speculation about why Thabang had died,” said Thabang’s aunt and family spokesperson, Naomi Lebese.

His family said that Thabang lived in silence and suffered alone, with only a few friends knowing the truth but didn’t know how to help him. He wanted to disclose his status but had left it too late.

“Thabang was too afraid to come out publicly and disclose his HIV status,” said Mabalane Mfundisi, director of Show Me Your Number, the HIV prevention programme of the South African Football Players Union. “I think soccer stars have a harder time disclosing their status than ordinary people precisely because the fall from grace is so much harder. The pressure on a football player to be perfect, to perform, is immense—after so much public scrutiny, it is hard to admit being a mere mortal.”

“We need everyone to know that if you are diagnosed with HIV, you are not alone and there is a lot of support available to you including life-saving HIV treatment,” said UNAIDS Executive Director Michel Sidibé.

Thabang’s story shows that despite an ambitious AIDS programme, HIV-related stigma is still pervasive in South African communities.

UNAIDS, Show Me Your Number, the South African National AIDS Council (SANAC) and Thabang’s family have teamed up to produce a public service announcement sharing Thabang’s story to highlight issues around HIV stigma, silence and secrecy. The announcement coincided with the start Africa Cup of Nations 2013 which is being hosted in South Africa between 19 January and 10 February.

“It is very important to break the conspiracy of silence that exists around HIV,” said Mr Sidibé. “This is what the Lebese family have done and by doing so, they will save lives,” he added.

“We believe that we can use Thabang’s story to help other people in the same situation”, said Thabang’s mother, Florence Ngoqo. “We hope that people who see the message and will reach out to their loved ones for help and speak out about their status. People need to speak out and communities need to stop living in denial.”